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

The FSSA 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
  • Pharmacy Benefits Manager

The State of Indiana has developed the following health plan programs:

Care Select

The state of Indiana has a disease management program, Care Select, to serve the aged, blind, and disabled; members 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

The FSSA, 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 Hoosier Healthwise page on this website.

Healthy Indiana Plan (HIP)

The Healthy Indiana Plan (HIP) is a program sponsored by the state of Indiana to provide 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.

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

Presumptive Eligibility

The IHCP includes two authorized processes by which individuals can be determined presumptively eligible and receive temporary health coverage while their application and determination process for full Hoosier Healthwise coverage is completed by the FFSA - Presumptive Eligibility for Pregnant Women and Hospital Presumptive Eligibility.

To learn more about these processes, 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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