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 (FFS) 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 webpage.
Managed Care
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 that operate under the managed care delivery system include:
- Healthy Indiana Plan
- Hoosier Care Connect
- Hoosier Healthwise
- Program for All-Inclusive Care to the Elderly
Fee-for-Service
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 oversight 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
- Southeastrans for nonemergency medical transportation services
- Gainwell Technologies 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)*
- Medical Review Team
- Medicare Savings Programs
- Emergency Services Only (See the Member Eligibility and Benefit Coverage module)
- Presumptive Eligibility (PE)**
*Note: MRO and HCBS benefit plans are available to eligible members as an add-on to their primary coverage plan. Managed care members may be approved to receive MRO or HCBS 1915(i) benefits; however, these services are carved out of the managed care delivery system and reimbursed as FFS for all eligible members. (HCBS 1915(c) waiver services are available only to FFS members.)
**Note: Presumptive Eligibility – Adult members approved after Jan. 1, 2019, are covered under the FFS delivery system. Those with an earlier PE determination date were assigned to managed care.