1620.00.00 HOOSIER HEALTHWISE (MED 3)

Medical coverage is available to certain parents/caretakers, infants, and children, former foster children ages 18 to 26 who were enrolled in Medicaid (any state) on their 18th birthday, and pregnant women under the Hoosier Healthwise Program. Additionally, medical coverage under the Healthy Indiana Plan (HIP) is available to adults between ages 19 and 64, effective February 1, 2015. Hoosier Healthwise is funded by Title XIX-Medicaid and by the Children’s Health Insurance Program-Title XXI and is composed of three benefit packages. Coverage under these packages is generally comprehensive, with a few exceptions, which are noted below. The packages are as follows: • Package A (Standard Plan) provides comprehensive healthcare coverage to some eligible parents and other caretaker adults, infants and children, former foster children ages 18 to 26 who were enrolled in Medicaid (any state) on their 18th birthday, and pregnant women. There are no premiums or co-payments for children under age 18. IEDSS category codes under this package are MA F, MAGP, MA X, MA Y, MA Z, MA 2, MA 9, and MA 15. • Children who are wards of the State, children in the Adoption Assistance Program, foster children and former foster children (MA 4, MA 8, MA 15) may opt out of Traditional Medicaid FFS and voluntarily enroll in Hoosier Care Connect, a coordinated care program (see 1610.00.00 for a description of the Hoosier Care Connect program). HIP is funded through a Section 1115 demonstration waiver with the CMS, Indiana’s existing cigarette tax revenues, and from a Hospital Assessment Fee. HIP coverage is available to adults aged between 19 and 64 years, who do not have Medicare, have income equal to or less than 133% of the FPL, and are not eligible for any other Medicaid category excluding low-Income parents/caretakers and transitional Medical Assistance. Under HIP, a person will qualify for either State Plan Benefits or Regular Plan Benefits. Within each plan exists Plus and Basic. Please, refer to IHCPPM 3500.00 to see the difference in benefits and cost sharing between HIP Plus and HIP Basic. To receive coverage under either HIP State Plan Plus (MASP) or HIP Regular Plan Plus (MARP), a person must make financial contributions towards a Personal Wellness and Responsibility (POWER) account that is based on their income and the FPL percentage range that the member falls in, but can be no less than $1 per month, regardless of a person’s income. To receive coverage under either HIP State Plan Basic (MASB) or HIP Regular Plan Basic (MARB), the income standard is 100% of the FPL. • HIP State Plan Plus (MASP) benefits, refer to 3520.10.00 • HIP State Plan Basic (MASB) benefits, refer to 3520.15.00 • HIP Regular Plan Plus (MARP) benefits refer to 3520.25.00. • HIP Regular Plan Basic (MARB) benefits, refer to 3520.30.00 A woman who is a member of any HIP category who becomes pregnant will be moved into the MAMA category unless income increases at the same time. If this happens, she should go into MAGP.