Traditional Medicaid

Providers are reimbursed by the Indiana Health Coverage Programs (IHCP) for services rendered to some IHCP members, including Traditional Medicaid members, on a fee-for-service (FFS) basis.

Coverage for healthcare services rendered to the following eligible groups are delivered under the FFS delivery system:

  • Persons in nursing homes and other institutions, such as intermediate care facilities for the intellectually disabled (ICFs/ID)
  • Emergency services for immigrants whose alien status is unverified or undocumented
  • Persons receiving hospice services
  • Persons with both Medicare and Medicaid (dual eligibility)
  • Persons with breast and cervical cancer
  • Refugees who do not qualify for any other aid category
  • Current and former foster children
  • Wards of the State

When individuals apply for Medicaid, they are automatically enrolled in the appropriate program.

Traditional Medicaid

Traditional Medicaid is a program created to provide healthcare coverage to individuals with low incomes. Like other healthcare programs, eligibility and coverage are based on the member's aid category. Members in the following categories will be covered by Traditional Medicaid:

  • Members eligible for home and community-based services
  • Members who are dually eligible for Medicare and Medicaid
  • Members in nursing homes, intermediate care facilities for the intellectually disabled, and state-operated facilities

Benefit Packages

The benefit packages associated with the FFS delivery system are:

  • Standard Plan - Members enrolled in the Traditional Medicaid Standard Plan are eligible for full coverage.
  • Medicare Savings Program − Federal law requires that state Medicaid programs pay Medicare coinsurance, deductibles, and premiums for certain elderly and disabled people through a program called the Medicare Savings Program. These people are designated as qualified Medicare beneficiaries (QMBs), specified low-income Medicare beneficiaries (SLMBs), qualified individuals (QIs), or qualified disabled working individuals (QDWIs), and must meet the following eligibility criteria to receive assistance with Medicare-related costs:
    • Entitled to Medicare
    • Low income
    • Age 65 years or older, or younger than 65 years old and entitled to Medicare
    • Few personal resources
  • Emergency Services Only (Package E) - Health coverage for certain members is limited to treatment for medical emergency conditions. These members are in the FFS delivery system only. The Omnibus Budget Reconciliation Act (OBRA) of 1986 defines an emergency medical condition as: "A medical condition of sufficient severity (including severe pain) that the absence of medical attention could result in placing the member's health in serious jeopardy, serious impairment of bodily functions, or serious dysfunction of any organ or part."
  • Presumptive Eligibility (PE) - Services to members determined presumptively eligible for temporary coverage via the PE process are reimbursed by FFS except for those in the Adult aid category. Members in the PE Adult aid category have HIP Basic plan coverage, including cost-sharing obligations. Once the PE coverage period ends, if the member is officially determined eligible for IHCP services, the member is enrolled in the appropriate program with the associated benefit plan.

More Information

For more information, see the IHCP Provider Reference Modules.