Hoosier Healthwise
Overview
Hoosier Healthwise is a health care program for children up to age 19 and pregnant individuals. The program covers medical care such as doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost to the member or the member's family.
The Children's Health Insurance Program (CHIP) falls under the Hoosier Healthwise program. CHIP is for children up to age 19 whose families have slightly higher incomes. In CHIP, members are required to pay a low monthly premium for coverage as well as copays for certain services.
Hoosier Healthwise has two benefit packages:
- Package A - This is a full-service plan for children and pregnant individuals. Members do not have any cost-sharing obligations.
- Package C - This is a full-service plan for children enrolled in CHIP. There is a small monthly premium payment and co-pay for some services based on family income.
Covered Services
IMPORTANT: All Indiana Medicaid programs started covering over-the-counter Covid-19 tests on February 1, 2022, through the pharmacy benefit:
- If you are in a managed care program (HIP, Hoosier Healthwise, Hoosier Care Connect), you may go to a pharmacy in your health plan’s network and request up to two tests per member per seven days.
For a general description of the benefits and services under these benefit packages, refer to the Indiana Medicaid Covered Services page. Individual health plans, also known as managed care entities (MCEs), may offer additional services called enhanced benefits.
Member Information
- The Eligibility Guide provides you with eligibility information, including income guidelines for Hoosier Healthwise-Package A.
- The Premium Payments page provides you with eligibility information, including income requirements, as well as premium and copay information for Hoosier Healthwise-Package C.
- The Presumptive Eligibility page provides you with information on how pregnant individuals may be able to receive medical care while waiting for their application to be processed.
- The Hoosier Healthwise brochure provides you with more information about the program.
- When you enroll with Hoosier Healthwise, you must select a health plan. You may choose among the following:
- Anthem
- CareSource
- Managed Health Services
- MDwise
Refer to the Summary of the Health Plans and the Working With Your Health Plan page to select the best health plan for you.
- If you have questions about your benefits or your coverage, you should contact your health plan or the Indiana Medicaid enrollment broker, Maximus. You can find the phone numbers on the contact us webpage.
Provider Information
- The Hoosier Healthwise program is operated within the managed care delivery system. A managed care delivery system consists of contracted MCEs who arrange, administer, and pay for the delivery of healthcare services to members enrolled in their health plan. All services, except Medicaid Rehabilitation Option (MRO) services, are provided through the MCEs, including dental and pharmacy services.
- Four MCEs are contracted with the state of Indiana to serve the Hoosier Healthwise population. Links to their provider websites are listed below:
- The care of Hoosier Healthwise members is managed through a network of primary medical providers, specialists, and other providers that contract directly with the MCE. To be reimbursed for services provided to Hoosier Healthwise members, providers must be enrolled with the IHCP. Refer to the Become a Provider webpage for more information. After successfully enrolling in the IHCP, a provider can contract with one or more of the MCEs to serve their enrolling members.
- For more information or questions about the Hoosier Healthwise health plans, contact the MCEs directly. See the IHCP Quick Reference Guide for contact information.
- Additional provider resources regarding Hoosier Healthwise are available at the following links: