Healthy Indiana Plan (HIP)

The Healthy Indiana Plan (HIP) program provides affordable healthcare coverage to low-income nondisabled adults between the ages of 19 and 64. The HIP program offers four distinct plans:

  • HIP Plus - The preferred plan available to most HIP-eligible individuals; provides the best value for members. HIP Plus members are required to pay affordable monthly contributions in a Personal Wellness and Responsibility (POWER) Account and receive a full commercial benefit package that includes coverage for vision and dental services.
  • HIP Basic - Available only to HIP members with incomes at or below 100% of the federal poverty level (FPL), who lose HIP Plus eligibility because they did not make the required POWER Account contributions. HIP Basic members have a more limited benefit plan and most are assessed copayments for most services.
  • HIP State Plan - Available to individuals who qualify as low-income parents and caretakers, low-income 19- and 20-year-olds, and individuals with serious and complex medical conditions who are deemed "medically frail." The HIP State Plan provides access to comprehensive Indiana Medicaid State Plan services and includes cost-sharing responsibilities through POWER Account contributions (HIP State Plan - Plus) or copayments (HIP State Plan - Basic), as determined by a member's eligibility category and income level.
  • HIP Employer Link - (Implementation pending) - HIP Link allows HIP-eligible individuals who have access to qualifying employer-sponsored insurance plans to enroll in their employers' plans and receive assistance with premiums and cost-sharing obligations.

Risked-based Managed Care Delivery System

The HIP program is operated within the risk-based managed care (RBMC) delivery system. In this delivery system, contracted managed care entities (MCEs) are paid a capitated monthly premium for each Indiana Health Coverage Programs (IHCP) member enrolled with the MCEs. The capitated premium covers the cost of services under the program incurred by IHCP members enrolled with the MCE. The MCE assumes financial risk for services rendered to its members.

MCEs are lawful entities authorized to operate a prepaid healthcare delivery plan. These entities arrange, administer, and pay for the delivery of healthcare services to members.

The following four MCEs are contracted with the state of Indiana to serve the HIP population:

The care of HIP members enrolled with the MCE is managed by the MCE through its network of medical providers that contract directly with the MCE. To be reimbursed for services provided to HIP members, providers must be enrolled with the IHCP (see the Become a Provider page on this website). After successfully enrolling in the IHCP, a provider can contract with one or more of the MCEs to serve their enrolling members. Reimbursement for all services, except Medicaid Rehabilitation Option (MRO) services, is provided through the MCEs. This includes dental and pharmacy services.

For more information or questions about the HIP MCEs, please contact the MCEs directly. See the IHCP Quick Reference Guide for contact information.

Additional information

Additional information about the HIP program is available at the following links:

  • IHCP Bulletin BT201503 - FSSA announces the "NEW" Healthy Indiana Plan! Coverage for qualifying Hoosiers will start effective Feb. 1, 2015
  • IHCP Bulletin BT201506 - Pregnancy-related services covered under HIP
  • IHCP Bulletin BT201507 - Healthy Indiana Plan includes enhanced coverage for the medically frail
  • IHCP Bulletin BT201508 - Guidance offered to dental providers under the Healthy Indiana Plan
  • IHCP Bulletin BT201509 - Correction regarding HIP State Plan - Basic copayments for dental services
  • IHCP Bulletin BT201511 - IHCP updates transition plan for Family Planning Eligibility Program members to HIP
  • IHCP Bulletin BT201516 - Changes made to IHCP Pharmacy Benefit Management
  • IHCP Bulletin BT201523 - IHCP clarifies CMHC behavioral health services for HIP members
  • IHCP Bulletin BT201524 - IHCP clarifies application of HIP Basic copayment