Medicaid & Pregnancy in Indiana

The Indiana Family and Social Services Administration's Office of Medicaid Policy and Planning (OMPP) administers managed care program for pregnant women known as Hoosier Healthwise, Risk Based Managed Care (RBMC). OMPP guarantees prepaid health care for pregnant women by paying Hoosier Healthwise RBMC managed care organizations a monthly premium for every member enrolled.

Managed Care Organizations

• Hoosier Healthwise's three managed care organizations (MCOs) are Anthem, Managed Health Services and MDwise. Contact information for each of these MCOs can be found on the Indiana Medicaid contact information Web page. This page also contains claims submission information and numbers for additional services provided including transportation, nurse advice lines and pharmacies.

Auto Assignment

• Once found eligible, enrolled members are expected to choose from a list of medical doctors who provide primary care. If a member fails to choose, a primary care provider is assigned via a member eligibility and information maintenance database. Assignment is based on previous provider-patient relationships and distance.

Managed Care by Region

• Hoosier Healthwise managed care organizations serve different regions of Indiana. To know which MCO serves your city, you must locate your city on the Indiana map in order to know what region it lies in on the managed care structure breakdown.

Member Grievance Process

• The Hoosier Healthwise member grievance process allows enrollees to express grievances verbally and in writing. If a grievance is of a nature that is potentially hazardous or lethal to the life of a member, she may ask for an expedited review process, forcing a problem to be resolved in 72 hours as opposed to 20 days.

Presumptive Eligibility in Pre-approval Status

• While Medicaid applications are pending, Indiana pregnant women qualify for the state's Presumptive Eligibility program. It temporarily covers prenatal care until Medicaid applicants are deemed eligible.