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Participant Eligibility

Program Summary




Extracts from the Enabling Legislation

Extracts: Title 410, Article 3.2


For Trips to the Health Care Provider

Travel Reimbursement


Household Income Guidelines

Household Income Table

NOTE: CSHCS determines financial eligibility by total gross. Income verification must be provided for everyone receiving income that is part of the household (e.g. related or not related). Include copies of all documentation used to prove income. Preferred documentation is the most recent three (3) consecutive paycheck stubs for all household members. Other acceptable documentation is an employer’s letter (on company letterhead) signed and dated, showing how much you earn and how often received. If you are  self-employed and have other income that is not reflected on your paycheck stubs you must provide a copy of all household members latest federal tax form 1040 or other documents that can verify income. Additional documentation may be requested.


CSHCS Application

CSHCS Enrollment Packet

Note: A CSHCS application must be processed 30 days from the date the application was signed and dated. The effective date of coverage will be determined based on the date the application is received by the program for processing.

CSHCS Application Instructions



Restrictions on Public Benefits Form

Hoosier Healthwise Application



Religious Non-Exemption

Religious Non-Exemption


Notification of Privacy Practices




Each participants family must also apply for Medicaid on the websites.

Participant Manual - English

Participant Manual - Spanish

Where to Apply:

First Steps

Office Locations(for children age 0 to 3)
Contact the Intake Coordinator listed

Riley Hospital

Room 1669
705 Riley Hospital Dr.
Indianapolis IN 46202

Other Resources: