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Managed Care

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, 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 organizations (MCOs)
• Monitoring contractor
• Care management organizations (CMOs)
• Healthy Indiana Plan (HIP) insurers

The State of Indiana has developed the health plan programs outlined below:

Hoosier Healthwise

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 organizations (MCOs). To learn more about this program, please visit Hoosier Healthwise.

Medicaid Select

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 program.

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 been transitioned into  risk-based managed care (RBMC).

Presumptive Eligibility

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/Medicaid is completed. For more information, see Presumptive Eligibility.

Care Select

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 percent 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.

Associated Links

To learn more about the managed care programs, please follow these links:

• To find out the provider service location mail destination of your IHCP Managed Care system-generated letters, reports, bulletins and reimbursement, check the Addresses Used from IndianaAIM System.
• To view the managed care regions, see the Managed Care Region Map.
• For the processes regarding managed care member grievance and appeal process and contact information, please view the Member Grievance and Appeal Process.
• For health plan forms, visit the Forms section.
• For IHCP managed care entity mailing addresses and phone numbers, see Health Plan Contacts.

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