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FAQ: For Members

The answers to all Medicaid frequently asked questions (FAQs) can be found here. You can scroll through or click on the topic that may apply to you or your family.

Remember that program questions and answers are specific to each program area and all answers do not apply to all programs.

 

FAQ: Applying for Medicaid

Do I Qualify?

Each Medicaid program has different criteria for determining if a person or family qualifies for coverage. Eligibility could be based on income, assets, family size, medical need, or a combination of these factors.

How to Apply?

Applications for Medicaid, Supplemental Nutrition Assistance (SNAP, formerly known as 'Food Stamps'), and Temporary Assistance for Needy Families (TANF, cash assistance) are processed by the Division of Family Resources. You can begin to apply for benefits online or by calling 1-800-403-0864. You may also apply in person at a local DFR office or at a Community Enrollment Center.

Where is my local DFR office?

DFR offices are located in all 92 counties.  You can go to the DFR website and click on the county where you live to find your local office.

Where is the online application?

Click on "Apply for Benefits Online" to complete your application.

What information do I need to know/take with me to apply for Medicaid?

For all the people in your household you will need to know:

  • Names and dates of birth
  • Social Security Number
  • Income from jobs or training
  • Benefits you get now (or got in the past) such as Social Security, Supplemental Security Income (SSI), veteran's benefits, child support
  • Amount of money in your checking account, savings accounts or other resources you own
  • Monthly rent, mortgage payment and utility bills
  • Payments for adult or child care
  • Health coverage and/or medical benefits you currently have

FAQ: Applying for a Waiver

When should I apply?

It is helpful to apply as soon as you identify a need for waiver services. If you have been denied Medicaid eligibility in the past, you should re-apply if your situation has changed and you think you may qualify.

Where Do I Apply?

Where you apply depends upon the type of Medicaid waiver services needed.  The Division of Aging. through local Area Agencies on Aging (AAA) administers the Aged and Disabled (A&D) waiver and the Traumatic Brain Injury (TBI) waiver.  To apply for one of these waivers, go to your local AAA office or call 1-800-986-3505.

The Bureau of Developmental Disabilities Services (BDDS) administers the Community Integration and Habilitation (CIH) waiver and the Family Supports waiver (FSW) for people with developmental and intellectual disabilities.  To apply for one of these waivers, go to your local BDDS office or call 1-800-545-7763 for more information.

Is there a waiting list for services?

Yes. The Division of Aging and BDDS both have wait lists for the Medicaid waivers they administer.

What do I need to do to stay on the waiting list?

You will need to keep your contact information current, including any changes to your phone number or address.  For Aging waivers, go to your local AAA office or call 1-800-986-3505.  For BDDS waivers, go to your local BDDS office or call 1-800-545-7763.

What services are available while I am waiting?

Individuals on the Aging waiting list may be eligible for other supports and services. Go to your local AAA office or call 1-800-986-3505 for information.

Families on the BDDS waiver waiting list are eligible to receive a small amount of Care Giver Support Services (i.e. respite) each year. Your local BDDS office can provide information and a listing of providers for this service.

If you should have an EMERGENCY (serious illness or incapacitation of a primary care giver) while your loved one is waiting for a waiver, you may be able to receive Emergency Support Services. This is not a waiver but rather an individualized package of supports created to address the needs of an individual when a primary caregiver is not able and no other supports exist. If you are in need of this type of assistance, contact your local BDDS office and ask about Emergency Support Services.

FAQ: Hearings and Appeals

What is an appeal?

An appeal is asking for a hearing because you do not agree with a decision the Office of Medicaid Policy and Planning (OMPP) has made regarding your eligibility or benefits.  The information listed here is for members who are already on Medicaid.  If you want to appeal a decision regarding your eligibility for Medicaid, you must follow the process for eligibility appeal that is listed on the notice you received from the Division of Family Resources (DFR).  You can learn more about the appeal process here.

Is there a charge to file an appeal?

No. You do not have to pay to file an appeal.

How do I appeal?

If you are enrolled in Hoosier Healthwise or the Healthy Indiana Plan, you must contact your health plan first.  You are required to exhaust their grievance and appeals process prior to filing an appeal or grievance with the state.

Your appeal must be in writing. In your letter, tell us why you think the decision is incorrect. Please make sure your name and other important information, such as the date of the decision, are on the letter. You may also download an appeal form from www.indianamedicaid.com.

Mail your appeal to:

Family and Social Services Administration
Attn: Hearings and Appeals Section
402 West Washington Street, Room E034
Indianapolis, IN 46204

Eligibility: If you want to appeal a decision made about your eligibility for Medicaid, you must follow the process for eligibility appeal that is listed on the notice you received from the Division of Family Resources.  You can learn more about that process here.

How long do I have to appeal?

You must file an appeal:

  • Within 33 calendar days of the date on the notification; or
  • Before the date a decision goes into effect, whichever is later.

Can I continue to get benefits when my appeal is pending?

New services cannot be started, but you may keep your current benefits until an appeal is final, if you file an appeal:

  • within 10 calendar days of the date of the Notice or
  • before the date a decision goes into effect, whichever is later

Am I responsible for payment if my appeal is not overturned?

Any disputed benefits you receive while your appeal is being decided may have to be paid back if the appeal process determines that the original decision is correct.

What is a hearing?

A hearing is a meeting between you (and any representative) and the State. An Administrative Law Judge (ALJ) will hear both sides and make a decision according to the law. The ALJ is impartial in the appeal. The ALJ will notify both you and the State of their final decision in writing.

How will I know if I get a hearing?

You will be notified in writing of the date, time, and place for the hearing.

Can I have someone else help me in the hearing?

You or someone else, such as a lawyer, friend, or relative, can tell why you disagree with this decision. If you wish to have legal representation and you cannot afford it, you may call Indiana Legal Services.

FAQ: Hoosier Healthwise

How can I change my Primary Medical Provider (PMP)?

To change your PMP, please call your health plan at the number listed below:

  • Anthem: 1-866-408-6131
  • MDwise: 1-800-356-1204
  • Managed Health Services: 1-877-647-4848

What is a health plan?

A health plan is a group of health care providers, including primary care doctors, specialists, home healthcare providers, pharmacies, therapists, and more. Each doctor is enrolled in one or more of these health plans. When you choose your doctor, you will also choose a health plan. It is important for you to know which Hoosier Healthwise health plan you and your doctor are in because for most health care services, you must only use health care providers that are in your health plan.

How can I change my health plan?

You can change your health plan at certain times during the year:

  • Any time during your first 90 days with a new health plan;
  • Annually during your open enrollment period;
  • Anytime you file a grievance with your health plan and the State finds that you have a good reason to change health plans. Another name for good reason to change health plans is "just cause." You must first contact your health plan so they can attempt to resolve your concern. If you are still unhappy after contacting your health plan, you can call the Hoosier Healthwise Helpline at 1-800-889-9949, and they will review your request.

How do I file a complaint?

Call your health plan if you have a complaint or grievance. If you do not know which health plan you are enrolled in, please call the Hoosier Healthwise Helpline at 1-800-889-9949. The telephone numbers for all health plans are listed below:

  • Anthem: 1-866-408-6131
  • MDwise: 1-800-356-1204
  • Managed Health Services: 1-877-647-4848

Can I choose a doctor for my baby before the birth?

Yes, you should choose a doctor before your baby is born. You will need to choose a doctor in your current health plan. If you do not choose a doctor before the baby is born, one may be assigned to you.

Do I have to get my doctor to approve all of my health care services?

There are some types of services that you can go to on your own without seeing your personal doctor first. These include basic eye care (eye surgeries require a doctor's approval), dental services, foot care, chiropractic services, and family planning. However, some services need a referral from your doctor, such as going to the hospital or a specialist.

What if I need medical attention and my doctor's office is closed?

Make sure you get the number where you can reach your doctor after hours. A qualified medical professional is available to you 24 hours a day to give you medical advice and tell you what you should do in each situation. Never go to the emergency room unless you have a true emergency. True emergencies are when a delay in treatment would result in lasting injury or death. Some examples are chest pain, broken bones, bleeding that cannot be stopped, or drug overdoses. You can also call your health plan 24 hours a day.

How can I request a new card?

If you need to request a new card, please visit your local DFR office or call 1-800-403-0864.

How can I change my address?

It is very important that you keep your address updated with the Division of Family Resources (DFR). You can report a change online.  You can also visit your local DFR office to report a change, or call 1-800-403-0864.

What do I do if I need to miss or have missed a doctor appointment?

If you need to miss a scheduled appointment with a provider, you need to call the doctor's office as far in advance as possible. Most offices consider 24-48 hours notice as acceptable. If you remember that you have missed an appointment after the appointment, you should call your doctor's office to apologize, explain why the appointment was missed, and reschedule.

Who can I call if I receive a bill from my doctor?

If you receive a bill from your doctor, you should call your health plan.

  • Anthem: 1-866-408-6131
  • MDwise: 1-800-356-1204
  • Managed Health Services: 1-877-647-4848

If you receive a bill from your dentist, you should call the number listed below.

  • 1-800-457-4584

Who do I call if I have questions about premium payments for the Children's Health Insurance Program (CHIP)?

If you are a new CHIP member, you will be mailed a premium invoice shortly after you are determined eligible. CHIP members who have questions about premium payments can call 1-866-404-7113. Premium payment checks or money orders should be mailed to:

Hoosier Healthwise
P.O. Box 3127
Indianapolis, IN 46206-3127

Is it true that I can go to ANY doctor as long as that doctor accepts Hoosier Healthwise or Medicaid?

No. When you join Hoosier Healthwise, you must choose a plan within 14 days, or one will be assigned to you. You must see this doctor for all your care. He or she will refer you to another doctor if you need specialty care. Call the Hoosier Healthwise Helpline at 1-800-889-9949 to pick your plan, and then call your health plan organization to select your doctor.

  • Anthem: 1-866-408-6131
  • MDwise: 1-800-356-1204
  • MHS: 1-877-647-4848

 

FAQ: Care Select

What is Care Select?

The Care Select program is a disease management program.  Disease management is a system of coordinated health care interventions and communications for members with chronic health conditions. This new program will help members with chronic conditions, such as asthma or diabetes, better manage their disease.

What conditions are covered in the Care Select program?

Members with the following conditions will be eligible for the disease management program:

  • Asthma
  • Diabetes
  • Heart Failure
  • Congestive Heart Failure
  • Hypertensive Heart Disease
  • Hypertensive Kidney Disease
  • Rheumatic Heart Illness
  • Severe Mental Illness
  • Serious Emotional Disturbance (SED) for Wards and Fosters
  • Depression

How will disease management assist me?

Disease management offers members with chronic health conditions assistance with understanding and taking care of their health.  The disease management program will offer educational information, access to nurses and other health care professionals, and assistance with finding providers.

Can I apply for Care Select?

You do not specifically apply for Care Select. You apply for Medicaid, and if you are eligible for the program, you will be enrolled in Care Select.  If you qualify for Care Select, but do not wish to be on Care Select, you may opt out of the program and choose to be on Traditional Medicaid instead.

How is my health plan determined?

You are able to select a Primary Medical Provider (PMP) and health plan of your choice.

Are there PMPs in Care Select?

Yes.  In Care Select you will select a Primary Medical Provider(PMP) and a Care Management Organization (CMO).

How can I change my PMP?

To change your PMP, please call your health plan. The telephone numbers for the health plans are:

  • ADVANTAGE: 1-800-784-3981
  • MDwise: 1-800-356-1204 or 1-317-630-2831 in Indianapolis

How long does it take to change my Primary Medical Provider (PMP)?

Changes within the health plan usually take 3-5 days. Changes between health plans generally take 30-45 days in order to become effective.

Is it true that I can go to any doctor as long as that doctor accepts Care Select or Medicaid?

No. Care Select members must select a PMP that accepts Care Select.  You can see any other doctor that accepts Medicaid for your other health needs.  If you don't already have a PMP, call the Helpline for assistance at 1-866-963-7383. This is a free call.

What if I need medical attention and my doctor's office is closed?

Make sure you get the number where you can reach your doctor after hours for health care services. A qualified medical professional is available to you 24 hours a day to give you medical advice and tell you what you should do in each situation. Often your doctor's office will provide a 24 hour contact number to use when their office is closed. Never go to the emergency room unless you have a true emergency. True emergencies are when a delay in treatment would result in lasting injury or death. Some examples are chest pain, broken bones, and bleeding that cannot be stopped.

What do I do if I need to miss or have missed a doctor appointment?

If you need to miss a scheduled appointment with a provider, you need to call the doctor's office as far in advance as possible. Most offices consider 24-48 hours notice as acceptable. If you remember that you have missed an appointment after the appointment, you should call your doctor's office to apologize, explain why the appointment was missed, and reschedule.

How can I request a new Medicaid card?

If you need to request a new card, please call 1-800-403-0864 or visit your local DFR office.

How can I change my address?

It is very important that you keep your address updated with the Division of Family Resources (DFR). You can report a change online.  You can also call 1-800-403-0864 or visit your local DFR office to report a change.

I need an Authorized Representative Form.  Where can I find it?

You can find that form on this site.  The Authorized Representative Form for Care Select is in the Forms Library found under the Resource Center.

How do I file a complaint?

If you have a complaint or grievance regarding your PMP or health plan, you should call your health plan provider directly. Telephone numbers for the health plans are:

  • ADVANTAGE: 1-800-784-3981
  • MDwise: 1-800-356-1204 or 317-630-2831 in Indianapolis

If you do now know which health plan you belong to, contact the enrollment broker helpline at 1-866-963-7383. This is a free call.

Are Home and Community Based Services (HCBS) waiver participants eligible for Care Select?

HCBS waiver participants are not eligible for the Care Select program, even if you have one of the included chronic health conditions.  HCBS waiver recipients are eligible for case management under the waiver, which is similar to disease management.

What if I do not want to participate in disease management?  Will I still have coverage?

You will be able to opt out of the disease management program if you prefer.  Medicaid coverage and benefits are the same for members in the disease management program and members who are not in the disease management program.  Members in the Care Select disease management program have access to additional educational resources.

Can a member choose to not be in Care Select?

Yes, you can choose not to participate or "opt out" of Care Select at any time.  If you choose to opt out of Care Select, you must contact the enrollment broker, MAXIMUS, at 1-866-963-7383.  The change will be effective in five business days.

Will I be able to see my current PMP if I move from Care Select?

If you move from Care Select, you will be in Traditional Medicaid.  You will be able to see any Indiana Medicaid provider.  It is good to keep going to a doctor that is familiar with you and your health conditions.

FAQ: M.E.D. Works

I am a Medicaid member and have a disability. If I go to work and get on the M.E.D. Works program, will my benefits change?

No. The Medicaid benefits for Medicaid Disability are the same as for M.E.D. Works. M.E.D. Works is Medicaid.

Who is eligible for M.E.D. Works?

M.E.D. Works is available to you if you are disabled, according to Indiana Medicaid standards, and working. Financial eligibility is based on a formula for determining countable income. Your countable income must not exceed 350% of the Federal Poverty Level (FPL)

How can I find out if I qualify for M.E.D. Works?

Contact your local Division of Family Resources (DFR) office. If you are not already on Medicaid, you must apply for Medicaid and meet the medical eligibility requirements.

I only have a part-time job; would I be able to qualify for M.E.D. Works?

Maybe. No minimum work effort is defined for this program. As long as your employment is verifiable through pay check stubs, W-2s or self employment records, you will be considered employed, and therefore eligible, for M.E.D. Works, provided that you meet the other eligibility standards.

How much are premiums?

Premiums are a sliding scale fee based on your monthly gross income. Premiums range from $48-$187 a month for a single person and $65-$254 for a married person. You may not have any premium at all, and premiums are often much less than the spend-down requirements for Medicaid.

How often do I pay premiums?

Premiums are paid on a monthly basis. You will receive a premium payment book when you are enrolled in M.E.D. Works.

Where do I send my premium payments?

You will receive a premium book with a coupon stub that will provide you with the address to send your payment. You may also call the M.E.D. Works Payment Line at 1-866-273-5897 for the mailing address and information about your payments.

I have private health insurance through my job; should I cancel it if I am on M.E.D. Works?

No. If you pay to participate in private health insurance, continue to do so. Your M.E.D. Works premiums will be adjusted by the amount that you pay each month for your private health insurance. Medicaid will pick up payment on your medical expenses where your private insurance leaves off.

What happens if I lose my job?

You may keep your M.E.D. Works coverage for 12 months following the involuntary termination of your employment if you notify the Division of Family Resources within 60 days and continue to meet the criteria to maintain a connection in the workforce.

I have more questions. Who do I call now?

If you have more questions, you should call 1-800-403-0864 or visit your local DFR office.

 

FAQ: Presumptive Eligibility

How can I apply for Presumptive Eligibility (PE)?

You can apply for PE at certain clinics or doctor's offices. You can use the Provider Search for a list of locations near your, or call 1-800-889-9949. While there, you will be asked to take a pregnancy test or show proof of pregnancy from another doctor or clinic.

If you are pregnant, the doctor or clinic will ask you some questions and will fill out all the PE forms for you. If you qualify for PE, your coverage will begin that day.

What should I bring with me to the designated clinic or doctor's office?

You will need the following information on your first visit:

  • Name
  • Address
  • Phone Number
  • Social Security Number
  • Number of People in Your Family
  • Dollar Amount of Monthly Family Income

How can I find a designated clinic or doctor in my area?

Please call us at 1.800.889.9949. You may also use the provider search to find a list of locations near you.

Note: when searching for a provider, you have the option to search only the providers in your area who are approved PE providers. This will help you to determine where you should go for services.

Can I visit the clinic or doctor even if I'm not certain that I'm pregnant?

Yes. Any woman who thinks she is pregnant and whose income allows her to participate should visit a designated clinic or doctor to find out if she is pregnant and to apply for PE. However, if you are not pregnant, you will not be eligible for PE and will have to pay for the cost of the pregnancy test.

What services will I get with PE?

PE care includes doctor visits, tests, lab work, and other care for your pregnancy. It also includes dental care and prescription drugs.

What health care is not covered?

PE will not pay for hospital stays, labor and delivery, and services unrelated to your pregnancy. If you become eligible for Medicaid, these services will be included. Because of this, it is very important to complete the follow-up interview for your Medicaid eligibility application.

How long will PE coverage last?

You will qualify for PE until your Medicaid eligibility is determined. However, if you do not complete your Medicaid application and interview, your PE could end very quickly. It is very important that you respond to all requests regarding your coverage. If you do not respond, you will not be enrolled in Medicaid, which means you will have to pay for all prenatal and labor and delivery costs. These costs can be very expensive.

Will my first visit to the designated provider be paid for?

If you qualify for PE, all medical services received on that day from the designated clinic or provider will be paid by PE. If you do not qualify for PE, you will have to pay for the services.

Will I have to pay for some of the services in PE?

With PE coverage, you will not have to pay any portion of the cost of covered prenatal services. PE will not pay for hospital stays, labor and delivery, and services unrelated to your pregnancy. If you become eligible for Medicaid then these services will be included. Because of this, it is very important to complete the follow-up interview for your Medicaid eligibility application.

Will my baby have health care coverage if I am covered by Medicaid for the baby's delivery?

If you have Medicaid coverage, your baby will also be covered from the day of birth.

If you do not have Medicaid coverage for labor and delivery, including those who had PE but did not qualify for Medicaid coverage, you will have to apply for Medicaid coverage for your newborn baby. The Medicaid application process can take some time. It is best to make sure that you respond to all requests for information and begin Medicaid coverage before the baby is born.

If I qualify for PE, will I have to choose a health plan and a doctor?

Yes. You must choose your health plan and your doctor while you are at the designated clinic or doctor's office applying for PE. You will make your choice by calling the enrollment broker. The clinic or doctor's office will help you with this process while you are in their office.

Whom should I contact if I have more questions about PE?

Please call us at 1.800.889.9949.  Additional information is also available online at the Presumptive Eligibility Program webpage.

 

FAQ: Spend-down

How do I know if I have a spend-down?

Spend-down is determined when you apply for Medicaid eligibility by the Division of Family Resources.

Will I be notified of dollars I have spent?

Each month, if you have a spend-down, you will receive a summary of the medical bills that were processed during the month. The summary will include you and your spouse or parent, if applicable. Each member, including both spouses of a married couple on spend-down, will receive his or her own summary notice.

You will receive this notice, called the Medicaid Spend-down Summary Notice, every month.

Do I have to pay my spend-down at the time I receive Medicaid services?

You do not have to pay for spend-down at the time of service as long as you are seeing a Medicaid provider. The Medicaid provider will bill Medicaid for the service, regardless of if your spend-down has been met yet or not. Your provider will bill you for the service after Medicaid has been notified that the service was provided.

An exception to this is a point-of-sale provider, like a pharmacy, who is told right away any amount the individual owes for spend-down. You are responsible for co-pays, which are different from spend-down. Co-pays are typically due when getting a prescription filled. Your co-pays do count toward your spend-down total.

If you must see a provider who does not see Medicaid patients, you will be responsible for those charges out of your own pocket. But if that happens, it is important to report those services to your local DFR office so those dollars can be credited to your spend-down for the month.

FAQ: General Medicaid

How often can I get my glasses replaced?

If you are 21 years or older, you can have your glasses replaced every 5 years. Medicaid will replace lost, stolen and broken glasses that cannot be fixed.

Can I get a ride to my doctor or dentist office?

Yes. You can get a ride to and from your medical and dental appointments. Call the member hotline at 1.800-457-4584 for help with finding transportation in your area.

What's the difference between Medicare and Medicaid?

Many people think that Medicare and Medicaid are the same program that are referred to by different names. This is not true. They are two completely separate insurance programs. Medicaid is a state-run insurance program to help primarily those with low income and low resources. Medicare is a Federal entitlement program targeted to people 65 and older and certain individuals with a disability. The Social Security Administration determines who is eligible for Medicare, enrolls people into the Medicare program, and sends out information about Medicare.

What's the difference between a co-pay and a spend-down?

Spend-down: This is the amount you pay each month before Medicaid will cover the costs of your health care services and supplies.

Co-pay: This is the amount you may have to pay at the time you receive services. You may owe co-pays for rides to and from the doctor's office, at the pharmacy and/or the dentist office as well as some pharmacy supplies and drugs.

Are Braces Covered?

Braces are covered only if your dentist says your child has a cleft lip or palate.

What is Prior Authorization?

Prior Authorization is where your doctor requests that you can receive some special treatments, services, or supplies, such as wheelchairs or hospital beds. Your doctor cannot simply order these items for you; he or she must ask for and show proof that you need them.