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Indiana Medicaid Eligibility Policy

Medicaid health coverage assists nearly 800,000 Indiana residents as of 2010. Eligibility and coverage vary depending on the specific Medicaid program. Different types of Medicaid include traditional Medicaid, Hoosier Healthwise, managed care programs, M.E.D. Works and Medicaid Waivers. Determining factors for eligibility include income and resources, age, the presence of a disability and/or whether an individual is pregnant or has dependent children.

  1. Traditional Medicaid

    • Traditional Medicaid covers the elderly, children under the age of 21 in inpatient psychiatric facilities, individuals covered under Refugee Medical Assistance and women with breast cancer. Individuals who do not have Supplemental Security Income and have more than $690 in unearned income, such as Social Security disability or retirement benefits, must pay a spend-down each month before traditional Medicaid will pay for medical costs. For example, if an individual receives $1,000 in disability, she will be required to pay the first $310 in medical expenses each month.

    Hoosier Healthwise

    • Hoosier Healthwise provides health insurance coverage to infants born to women receiving Medicaid, children under age 19, pregnant women and low-income families at little or no cost. Hoosier Healthwise offers five packages. Package A is the standard plan, which serves low-income families. Those eligible include children under the age of 19 whose families earn no more than 150 percent of the federal poverty level (FPL) and adults with children who earn no more than 100 percent of FPL. Pregnant women could be eligible for Package A or B depending on family income and assets. Package A would provide full coverage, while Package B covers only pregnancy-related services. Women who quality for Package A based on income and later become pregnant remain in Package A rather than changing to Package B. Package B covers pregnant women whose income does not exceed 150 percent of FPL.

      Package C, also called the Children's Health Plan or CHIP, covers children younger than 19 whose family income is greater than 150 percent, but not exceeding 200 percent, of FPL. The child cannot have had health insurance for three months prior to application for Hoosier Healthwise coverage. Package D covers persons with disabilities and chronic illnesses and Package E provides coverage for unqualified immigrants and covers only emergency services such as labor and delivery.

    Care Select

    • Care Select provides coverage for wards of the Department of Child Services (DCS) who are in foster care and receiving federal assistance under Title IV-E Foster Care, children under 19 with Adoption Assistance through DCS, former foster children age 18 to 20, individuals age 65 and over, blind and disabled individuals and M.E.D. Works participants. Traditional Medicaid income limits apply to the aged blind and disabled populations, who could choose to enroll in Traditional Medicaid instead. Care Select will cover illegal immigrants or individuals with spend-downs, covered by Medicare, residing in nursing homes or state-operated facilities.

    M.E.D. Works

    • The M.E.D. Works program provides coverage for employees with disabilities. To be eligible, a member must be age 16 to 64, meet Medicaid income and resource guidelines, have a physical or mental disability and be working. Income cannot exceed 350 percent of the FPL. Work income must be verifiable by tax documents or paystubs. A premium, based on income, must be paid monthly.

    Medicaid Waivers

    • In order to quality for one of the HCBS Waiver Programs, members must meet the Medicaid guidelines and require intensive services to avoid institutionalization. The income limit is 300 percent of the SSI maximum benefit rate. Resource limits also apply. In addition, the total Medicaid cost of serving the individual on the waiver cannot exceed the total cost to Medicaid for serving the recipient in an institutional setting.

      Two specific types of waivers include the Aged and Disabled Waiver (A&D) and Traumatic Brain Injury (TBI) Waiver. These waivers assist individuals either with remaining in their own homes or moving from a nursing facility to their own homes. In order to receive the A&D Waiver, an individual must be over age 65. There are also three waivers to assist individuals who meet Intermediate Care Facility for the Mentally Retarded (ICF-MR) level of care; they include the Autism Waiver, Developmental Disability Waiver (DD) and the Support Services Waiver (SSW).

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