Hoosier Healthwise

The Hoosier Healthwise program primarily provides coverage for children from low-income families. Enrollment in Hoosier Healthwise is mandatory for aid categories that include children eligible for Children's Health Insurance Program (CHIP). The specific eligibility aid category determines the benefit package.

Hoosier Healthwise offers the following benefit packages:

  • Package A: Standard Plan - Full coverage for qualified children and pregnant women.
  • Package C: Children's Health Insurance Plan - Preventive, primary, and acute care services for qualified children under 19 years old.
  • Presumptive Eligibility for Pregnant Women - Coverage of most pregnancy-related outpatient services for pregnant women determined to be "presumptively eligible" while their Indiana Application for Health Coverage is being processed.

Risked-based Managed Care Delivery System

The Hoosier Healthwise 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 Hoosier Healthwise managed care population:

For more information or questions about the Hoosier Healthwise MCE plans, please contact the MCEs directly. See the IHCP Quick Reference Guide for contact information.

The care of Hoosier Healthwise members enrolled with the MCE is managed by the MCE through its network of primary medical providers (PMPs), specialists, and other providers of care that contract directly with the MCE.

As part of the Hoosier Healthwise enrollment process, members must select an MCE within 14 days of their initial enrollment into Hoosier Healthwise. Members who do not choose their health plan are assigned to an MCE through an automated assignment process. Auto-assignment is a federal requirement.

The following provider specialties are eligible to enroll as PMPs:

  • Family practice (type 31, specialty 316)
  • General practice (type 31, specialty 318)
  • Internal medicine (type 31, specialty 344)
  • Obstetrics/gynecology (type 31, specialty 328)
  • General pediatrics (type 31, specialty 345)

To be reimbursed for services provided to Hoosier Healthwise members, PMPs must be enrolled with the IHCP (see Become a Provider) and contracted with the MCE to which the member belongs. After successfully enrolling in the IHCP, a provider can contract with one or more MCE.

Additional information

Additional information about Hoosier Healthwise is available via the Managed Care page of this website, in the Member Eligibility and Benefit Coverage provider reference module, and at the following links: