Indiana Health Insurance

Indiana Medicaid:

Medicaid eligibility is determined by several factors and can be complicated. There are many categories of eligibility and several different Medicaid programs. Please review all of the eligibility information and if you think you may be eligible, the best thing to do is apply. While different Medicaid programs have different eligibility criteria, in general four main criteria are used to determine eligibility.

Income/Family Size: Both earned (wages from a job) and unearned income (Social Security Disability payments). Income limits are adjusted to account for the number of people in your family.
Age: Eligibility criteria can be based on age. Certain programs are designed for people in specific age groups.
Resources/Assets: Certain things you have are taken into consideration when determining eligibility. Different programs count different resources/assets.
Medical Needs: Specific medical needs may determine your eligibility and they may also determine which program can best serve your needs. Some programs are designed to meet the medical needs of a targeted group.

What program Might be right for me?

The following list of Medicaid programs can give you an idea of which program might be right for you. You can also go to the Eligibility Guide to get detailed information on eligibility criteria.

Hoosier Healthwise:

Indiana’s health care program for children, pregnant women, and low-income families. There are several different program packages under Hoosier Healthwise that are tailored for specific groups of people.

*If you are a pregnant woman, you may be able to get coverage immediately under a program called Presumptive Eligibility. This will allow you to receive important prenatal care while your Medicaid application is being processed.

Care Select:

Indiana’s health care program to serve individuals who may have special health needs or benefit from specialized attention. People served by Care Select may be aged, blind, disabled, wards of the court and foster children, or children receiving adoptive services. Individuals must also have one of the following medical conditions:

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

Healthy Indiana Plan (HIP):

The HIP plan covers individuals who do not live with a dependent child, and parents who earn up to approximately $44,000 annually for a family of four, have been uninsured for six months and do not have access to insurance through their employer. HIP may require you to pay a small monthly fee based on the amount of your income. HIP does not cover vision, dental or maternity services. More information about the HIP program can be found at www.in.gov/fssa/hip/index.htm

Traditional Medicaid:

Traditional Medicaid is a low-income healthcare program that offers medical care such as doctor visits, prescribed drugs, dental and vision care, family planning, mental health care, surgeries and hospitalizations. The Traditional Medicaid program is for individuals who have both Medicaid and Medicare, have a spend down/monthly deductible, or are refugees.

Waiver:

Waiver services are for individuals of any age who have special medical needs. Waiver services allow members to live in a community setting and avoid institutional placement. To be eligible for any waiver program, you must meet both Medicaid guidelines and waiver eligibility guidelines. Indiana offers five waiver programs that target specific groups. The Aged and Disabled Waiver, The Traumatic Brain Injury Waiver, The Developmental Disabilities Waiver, The Autism Waiver, and the Support Services Waiver.

M.E.D. Works:

MED Works is Medicaid for Employees with Disabilities. Many disabled people feel that they may be able to return to work, but are fearful of losing their Medicaid benefits. MED Works is a program designed to allow disabled employees to work without fear of losing their Medicaid. MED Works offers the same coverage levels as regular Medicaid. There may be small monthly premiums based on the amount of money a worker earns. If you are receiving SSDI and no cash benefits and feel that you may be able to return to work, MED Works may be the program that would be best for you.

How do I apply?

The Division of Family Resources (DFR) is the group that determines eligibility for all Indiana Social Services Programs. The DFR will assist you in determining which programs are right for you and your family. You can learn more about the application process by going to Apply for Medicaid.

Important Things to Know

Medicaid is health insurance and it can seem very complicated. This section provides you with the information you need to help ensure that your coverage continues without interruption and your responsibilities as a patient are fulfilled. Some of the issues you will want to understand are:




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