Hoosier Healthwise

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

The following Medicaid enrollees are excluded from mandatory participation in Hoosier Healthwise managed care:

  • Individuals in nursing homes and other institutions, such as intermediate care facilities for individuals with intellectual disability (ICFs/IID, formerly ICF/MR)
  • Undocumented individuals
  • Individuals receiving waiver or hospice services
  • Members with a spend-down

Hoosier Healthwise offers the following benefit packages:

  • Package A: Standard Plan - Full coverage for qualified children, low-income families, and pregnant women.
  • Package B: Pregnancy Coverage Only - Pregnancy-related, postpartum care, family planning, pharmacy, transportation, and urgent care services for some pregnant women. (Effective 1/1/14 new members will not be assigned to Package B: existing members covered under Package B will remain so, until their current eligibility ends or until their eligibility redetermination is made.)
  • Package C: Children's Health Insurance Plan - Preventive, primary, and acute care services for qualified children under 19 years old.
  • Package P: Presumptive Eligibility - Ambulatory prenatal coverage for pregnant women who are determined "presumptively eligible" while their Indiana Application for Health Coverage is 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 the services covered under the program and 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 three 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 who 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 a PMP:

  • 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 the Become a Provider page on this website) 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 Chapter 2 of the IHCP Provider Manual, and at the following links: