Each state develops a state plan, which is a comprehensive
written commitment by a Medicaid agency to administer or supervise
the administration of a Medicaid program, in accordance with
federal and state requirements. The Indiana requirements are
contained in the Indiana Code (IC) and the Indiana
Administrative Code (IAC). States may elect to administer the
Medicaid program themselves or enter into contractual agreements
with outside entities to administer the program.
The Office of Medicaid Policy and Planning (OMPP) is the office
within the Indiana Family and Social Services Administration (FSSA)
that administers the Indiana Health Coverage Programs (IHCP),
including the health plan programs. The OMPP has the final
responsibility for all program policies and coordinates with other
state and federal agencies as required.
The State of Indiana has contractual agreements with the
following entities to support and administer the health plan
component of the IHCP:
- Fiscal agent
- Surveillance and Utilization Review Contractor
- Enrollment broker
- Managed care entities (MCEs)
- Monitoring contractor
- Care management organizations (CMOs)
- Healthy Indiana Plan (HIP) insurers
The State of Indiana has developed the following health plan
During the summer of 1994, the OMPP, under a federally approved
Section 1915(b) waiver, implemented a mandatory managed
care program known as Hoosier Healthwise - Risk-Based Managed Care
(RBMC), covering low-income families, children, and pregnant women.
The program is managed by the state's contracted managed care
entities (MCEs). To learn more about this program, please visit the
Healthwise page on this website.
As of March 1, 2008, Medicaid Select is no longer an
IHCP program. All Medicaid Select providers were provided
the option to contract as Care Select providers.
Medicaid Select members were transitioned into Care
Select, with the exception of dually eligible members. Dually
eligible members were transitioned into the Medicaid traditional
Hoosier Healthwise PCCM or PrimeStep
As of January 1, 2006, Primary Care Case Management (PCCM) or
PrimeStep is no longer a Hoosier Healthwise program. PCCM providers
and members have transitioned into risk-based managed care
Presumptive Eligibility for Pregnant Women, which began July 1,
2009, provides coverage to women while the women's Hoosier
Healthwise applications are under review by the Division of Family
Resources (DFR). Women found to be presumptively eligible (PE) have
coverage for ambulatory prenatal services while their applications
and the determination process for Hoosier Healthwise and Medicaid
is completed. For more information, see Presumptive Eligibility.
The State of Indiana has a disease management program, Care
Select, to serve the populations of the aged, blind, and
disabled, members receiving adoption assistance, and wards of the
court and foster children. Care Select is managed by the
care management organizations (CMOs).
To learn more, please visit the Care Select page.
Healthy Indiana Plan (HIP)
The Healthy Indiana Plan (HIP) is a program sponsored by the
State of Indiana that provides a more affordable healthcare choice
to thousands of otherwise uninsured individuals throughout Indiana.
HIP provides health insurance for uninsured adult Hoosiers between
the ages of 19 and 64 whose incomes are up to 200% of the federal
poverty level (FPL), and who are not otherwise eligible for
Medicaid. Unlike many other government-sponsored programs, parents
and childless adults can participate. Eligible participants must be
uninsured for at least six months and cannot have access to
employer-sponsored health insurance. Participants are required to
make monthly contributions toward coverage.
To learn more, please visit the Healthy Indiana Plan page.
To learn more about the managed care programs, please follow
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