Orlando Harmon
Indiana's Medicaid program provides health care coverage to individuals who are not enrolled in managed care. Eligibility for Medicaid is determined by several factors, including age, disability, income, and current health insurance coverage. While having private insurance may affect eligibility, individuals with existing insurance can still apply for Indiana Medicaid if they meet the other criteria. The application process involves submitting an Indiana Application for Health Coverage, which can be done online, by mail, phone, or in person.
| Characteristics | Values |
|---|---|
| Eligibility | Determined by several factors, including age, disability, income, and health insurance coverage. |
| Application Process | Submit an Indiana Application for Health Coverage form online, by mail, phone, or in person at a Division of Family Resources office. |
| Time for Processing | Up to 90 days to determine eligibility after submitting the application. |
| Immediate Medical Attention | Pregnant women can receive immediate attention through Presumptive Eligibility while waiting for their application to be processed. |
| Health Coverage | Traditional Medicaid is for individuals not enrolled in managed care, including those eligible for both Medicare and Medicaid. |
| Healthy Indiana Plan | A health insurance program for adults 19-64 who are not disabled, requiring a minimal monthly contribution. |
| Hoosier Healthwise | A health care program covering medical, prescription, mental health, dental, hospitalization, and surgery costs for children up to age 19 and pregnant women. |
| Hoosier Care Connect | A program for individuals aged 65+, blind, or disabled who are not eligible for Medicare, including children who are wards of the state or in foster care. |
| Income and Asset Limits | Vary based on factors such as age, marital status, and health conditions. For example, a single nursing home applicant in 2025 must have an income under $2,901/month and assets under $2,000. |
| Exemptions | Personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one's primary home are exempt from asset consideration. |
| Gifting Allowance | Applicants can gift up to $1,200 annually to family members or tax-exempt nonprofits without affecting their eligibility. |
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What You'll Learn
Eligibility criteria for Indiana Medicaid
Indiana's Medicaid program provides low-income individuals of all ages with health care coverage. While eligibility criteria can be complicated and depend on several factors, there are some general guidelines.
Hoosier Healthwise is a health care program for children up to age 19 and pregnant women. The program covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost.
The Healthy Indiana Plan is a health insurance program for adults ages 19 through 64 who are not disabled. The plan requires a minimal monthly contribution to coverage.
Hoosier Care Connect is a health care program for individuals who are aged 65 years and older, blind, or disabled and who are not eligible for Medicare. This program includes children who are wards of the state, receiving adoption assistance, or in foster care.
Traditional Medicaid is a program that provides health care coverage to individuals who are not enrolled in managed care. This includes individuals eligible for both Medicare and Medicaid.
In addition, seniors in Indiana (65 years of age and older) may be eligible for long-term care Medicaid, which includes nursing home care, adult foster care, and assisted living facilities. There are three categories of Medicaid long-term care programs:
- Institutional/Nursing Home Medicaid: Provides benefits only in nursing homes.
- Medicaid Waivers/Home and Community-Based Services: Provides services intended to delay the need for nursing home admissions, including home care, adult day care, adult foster care, or assisted living. This program is not an entitlement and has limited participant slots.
- SSI Pathway: In Indiana, persons who are eligible for SSI are automatically approved for Regular Medicaid, including long-term services and supports.
It is important to note that having private insurance may affect eligibility, and income limits are also a factor in determining eligibility. If you think you may be eligible for Indiana Medicaid, the best course of action is to apply. Applications can be submitted online, in person, by mail, or by phone.
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Indiana Medicaid application process
The Indiana Medicaid program includes Traditional Medicaid, Hoosier Healthwise, Medicaid Waivers, Healthy Indiana Plan (HIP), MED Works, Care Select, and Presumptive Eligibility programs. The eligibility criteria vary depending on the sub-program and can be complicated. However, here is a general overview of the Indiana Medicaid application process.
Firstly, determine your eligibility by completing the eligibility screening tool on the Indiana Health Coverage Program website. This website provides complete details about each of the Medicaid programs. It is important to note that just because you may not meet the eligibility requirements for one of the Medicaid sub-programs, it does not mean you are ineligible for all available programs.
If you think you may be eligible, the next step is to fill out and submit an application, also known as an Indiana Application for Health Coverage. This can be done online, in person, by mail, or by phone. The application will be processed by the Family and Social Services Administration (FSSA), Division of Family Resources (DFR). Remember that your application must be complete, and all required documentation must be submitted before DFR can begin processing it. This process can take up to 90 days.
During this waiting period, pregnant women may be able to receive medical care through the Presumptive Eligibility program. This is a temporary cover that provides important healthcare during early pregnancy while the Medicaid application is being processed.
If you need further assistance, you can sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and important information. Additionally, you can refer to the Eligibility Guide for detailed information on eligibility criteria and application processes.
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Indiana Healthy Plan
The Indiana Healthy Plan is a consumer-driven approach that requires members to make a minimal monthly contribution to their coverage. The plan covers medical costs for members and can even provide vision, dental, and chiropractic coverage. It also rewards members for taking better care of their health.
The Indiana Healthy Plan offers full health benefits, including hospital care, behavioral healthcare for mental health and substance use, doctor care, prescriptions, and diagnostic care. The first $2,500 of medical expenses for covered services are paid through a special savings account called a Personal Wellness and Responsibility (POWER) Account. The state pays most of this amount, and if you are in HIP Plus or HIP State Plan Plus, you are responsible for paying a portion.
You can apply for Indiana Healthy Plan online, in person, by mail, or by phone. Once you submit your complete application, it can take up to 90 days to determine if you are eligible.
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Hoosier Healthwise
To apply for Indiana Medicaid, including Hoosier Healthwise, one must fill out and submit an application, known as an Indiana Application for Health Coverage. The applications are processed by the Family and Social Services Administration (FSSA), Division of Family Resources (DFR). Individuals can apply in person, online, by mail, or by phone. The processing time for applications can take up to 90 days.
The Healthy Indiana Plan is another health insurance program for adults aged 19 to 64 who are not disabled. This plan requires enrollees to make a minimal monthly contribution to their coverage. Hoosier Care Connect, on the other hand, is a program for individuals aged 65 and older, blind, or disabled who are not eligible for Medicare.
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Medicaid expansion in Indiana
Indiana has expanded its Medicaid program to cover more people, but with some state-specific variations from the Affordable Care Act (ACA). The expansion was implemented during the tenure of then-governor Mike Pence. Indiana's Medicaid expansion is known as the Healthy Indiana Plan (HIP) and has provided health insurance to a large number of Indiana residents.
The ACA's Medicaid expansion aimed to extend coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($21,597 for an individual in 2025). The federal government initially covered the entire cost of this expansion until 2016, after which the federal portion gradually decreased to 90% by 2020. Indiana's HIP is also largely funded by the federal government, with 90% of the cost covered by federal funds and the remaining 10% by hospital fees and cigarette taxes.
HIP provides health insurance for adults aged 19 to 64 who are not disabled. It requires enrollees to make a minimal monthly contribution to their coverage. The program has been successful in enrolling a higher number of people than expected, with over 95,000 more enrollees than projected in May 2024. However, there have been concerns about the impact of increased eligibility checks and work requirements on coverage. Despite these concerns, Indiana has continued to move forward with these requirements, citing the need to direct services towards those who need them most and to address the rising costs of Medicaid for the state.
Indiana's Medicaid expansion has also been affected by the COVID-19 pandemic, which made work requirements difficult to enforce. The Biden administration notified the state in June 2021 that approval for the Medicaid work requirement was being withdrawn. Additionally, the pandemic led to challenges in eligibility verification, with a significant number of enrollees needing to have their eligibility verified during the "unwinding" of the continuous coverage requirement.
Indiana's Medicaid expansion has provided health insurance to a substantial number of its residents, but it has also faced challenges and criticisms. The state has had to navigate the complexities of balancing coverage expansion with fiscal sustainability, especially with the impact of the COVID-19 pandemic.
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Frequently asked questions
Yes, you can apply for Indiana Medicaid even if you have insurance. However, having private insurance may affect your eligibility. Indiana Medicaid is a program created to provide healthcare coverage to individuals who are not enrolled in managed care.
Indiana Medicaid eligibility is determined by several factors, including age, income, and health status. For example, the Healthy Indiana Plan is a health insurance program for adults aged 19 to 64 who are not disabled and have an income at or below the federal poverty level.
To apply for Indiana Medicaid, you need to fill out and submit an application, also known as an Indiana Application for Health Coverage. You can apply online, in person, by mail, or by phone. The application process can take up to 90 days to complete.
