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