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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

10

Approval Date:

Section 3 Methods of Delivery and Utilization Controls (Section 2102)(a)(4))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 4.

3.1. Describe the methods of delivery of the child health assistance using Title XXI funds to targeted low-income children. Include a description of the choice of financing and the methods for assuring delivery of the insurance products and delivery of health care services covered by such products to the enrollees, including any variations. (Section 2102)(a)(4) (42CFR 457.490(a))

Public health insurance in Indiana is provided via the Medicaid program. CHIP enrollees are enrolled in the Hoosier Healthwise program (risk-based capitated managed care program). Children eligible for the Medicaid expansion component (referred to specifically as MCHIP) are enrolled in Hoosier Healthwise under Benefit Package A. Those eligible for the State- designed component of Indiana’s CHIP program (referred to as the CHIP population) are enrolled in Hoosier Healthwise under Benefit Package C. The Hoosier Healthwise program is governed by the Indiana Medicaid State Plan, Indiana’s section 1115 demonstration project and a 1915(b) waiver. Please refer to the Indiana Medicaid State Plan, Indiana’s section 1115 demonstration project and the 1915(b) waiver for more information regarding the delivery system and structure. To clarify, the MCHIP population is located on the 1915(b) waiver and the CHIP population is only governed by the state plan. It is not on the 1115 demonstration.

3.2. Describe the utilization controls under the child health assistance provided under the plan for targeted low-income children. Describe the systems designed to ensure that enrollees receiving health care services under the state plan receive only appropriate and medically necessary health care consistent with the benefit package described in the approved state plan. (Section 2102)(a)(4) (42CFR 457.490(b))

Hoosier Healthwise has a number of utilization control mechanisms in place that are designed to ensure that health care use is appropriate and medically necessary.