Managed Care

The Indiana Family and Social Services Administration (FSSA), through the Office of Medicaid Policy and Planning (OMPP) and other divisions, administers the Indiana Health Coverage Programs (IHCP), including the managed care health plan programs.

The FSSA has the final responsibility for all program policies and coordinates with other state and federal agencies as required.

The FSSA has contractual agreements with the following entities to support and administer the managed care 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
  • Pharmacy Benefits Manager

The IHCP includes the following managed care health plan programs:

Care Select

Care Select is a disease management program, serving the aged, blind, and disabled; individuals receiving adoption assistance; wards of the court; and current and former foster children. Care Select is managed by the care management organizations (CMOs).

To learn more about this program, please visit the Care Select page on this website.

Hoosier Healthwise

Hoosier Healthwise is a mandatory risk-based managed care (RBMC) program, implemented under a federally approved Section 1915(b) waiver, 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 Hoosier Healthwise page on this website.

Healthy Indiana Plan (HIP)

The Healthy Indiana Plan (HIP) program provides a more affordable healthcare choice to thousands of otherwise uninsured individuals throughout Indiana. HIP provides health insurance for uninsured low-income Hoosiers between the ages of 19 and 64 who are not otherwise eligible for Medicaid. Unlike many other government-sponsored programs, parents and childless adults can participate. Participants are required to make monthly contributions toward coverage. This program is managed by the State's contracted HIP insurers.

To learn more about this program, please visit the Healthy Indiana Plan page on this website.

Presumptive Eligibility

The IHCP includes a Presumptive Eligibility for Pregnant Women process through which pregnant women can be determined presumptively eligible and receive prenatal healthcare through a managed care health plan while their full IHCP application is considered and eligibility determined.

This program was designed to provide better birth outcomes by providing earlier prenatal care. To learn more about this process, visit the Presumptive Eligibility page on this website.

Associated Links

To learn more about the managed care programs, please follow these links to other pages on this website:

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