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