Indiana Medicaid provides a healthcare safety net to over one million Hoosiers who are aged, disabled, blind, pregnant, or meet other eligibility requirements. The programs and services offered are incorporated under the umbrella of the Indiana Health Coverage Programs (IHCP). Healthcare benefits are administered through two delivery systems – the fee-for-service delivery system or the managed care delivery system. Providers will learn a member’s enrollment status and benefit plan assignment by verifying the member’s IHCP eligibility for each date of service.
What Is Covered by Indiana Medicaid
The benefits available under Indiana Medicaid are based on the member's eligibility category. Find a general description of the benefits available through Indiana Medicaid (other than the Healthy Indiana Plan) on the What is Covered by Indiana Medicaid web page.
Most IHCP members receive services through the managed care delivery system. Under managed care, members are enrolled in a health plan with a managed care entity (MCE) that is responsible for the members’ healthcare services. Each MCE maintains its own provider network, provider services unit, and member services unit for the health plans they offer. The MCE authorizes services, pays claims, and is responsible for subrogation activities. All providers wanting to offer services to members enrolled in managed care programs must first enroll with the IHCP and then contract one or more MCEs to deliver services to their members.
Programs or benefit plans that operate under the managed care delivery system include:
- Healthy Indiana Plan (HIP)
- Hoosier Care Connect
- Hoosier Healthwise
- Program for All-Inclusive Care to the Elderly (PACE)
The fee-for-service (FFS) delivery system reimburses providers on a per-service basis. Generally, members seek services from IHCP providers of their choice. The IHCP maintains centralized administrative oversite of the provider network and the associated provider and member services. Providers bill the appropriate IHCP claim-processing contractor for services rendered as follows:
- OptumRx for pharmacy services
- Souteastrans Inc for nonemergency medical transportation services
- DXC Technology for all other services
Programs or benefit plans that operate under the FFS delivery system include:
- Traditional Medicaid
- 590 Program
- Family Planning Eligibility Program
- Home and Community-Based Services (HCBS)
- Medicaid Rehabilitation Option (MRO) Services
- Medical Review Team (MRT) Services
- Medicare Savings Programs
- Emergency Services Only (See the Member Eligibility and Benefit Coverage module)
- Presumptive Eligibility*
*Note: Presumptive Eligibility – Adult members approved after January 1, 2019, are covered under the FFS delivery system. Those with an earlier PE determination date were assigned to managed care.