FAQ'S (Frequently Asked Questions)

Remember that program questions and answers are specific to each program area and all answers do not apply to all programs.

Organizations that can provide information/support:
  • Covering Kids and Families - Click here to find LOCAL, FREE  and unbiased help.
  • About Special Kids - 1-800-964-4746 – Serving Indiana families of children with special needs  

Do I qualify?

Each Medicaid program has different criteria for determining if a person or family qualifies for coverage. Eligibility could be based on income, assets, family size, medical need or a combination of these factors.

How do I apply?

We offer FREE, LOCAL and unbiased help to get individuals and families connected to healthcare coverage programs.  Click here for the map to find local help. 

Where is my local Covering Kids & Families office?

Click here for the map. 
 

What information do I need to know/take with me to apply for Medicaid?

For every person living in your household you must provide:
  • Birth Certificates for all persons in the home
  • Social Security Numbers for all persons in the home
  • Income from jobs or training (3-months pay statements – pay checks are not acceptable)
  • Award letters for Social Security, Supplemental Security Income (SSI), veteran's benefits, child support, Social Security Disability (SSD)
  • Proof of payments for adult or child care
  • Insurance cards for Health coverage you currently have or have had in the last 3 months
  • Proof of citizenship (if applicable)

How can I change my primary care physician (PMP)?

To change your PMP, call your health plan (Manged Care Entity - MCE) at the number listed below:
  • Anthem: 1-866-408-6131
  • MDwise: 1-800-356-1204
  • Managed Health Services: 1-877-MHS-4U4U or 1-877-647-4848
  • CareSource  1-800-418-0172

What is a health plan - Medical Care Entity (MCE)?

A health plan is a group of healthcare providers including primary care doctors, specialists, home healthcare providers, pharmacies, therapists, and so on. Each doctor is enrolled in one or more of these health plans. When you choose your doctor, you will also choose a health plan (MCE). It is important for you to know which health plan (MCE) you and your doctor are in because for most health care services, you must only use health care providers that are in your health plan (MCE).

How can I change my MCE?

You can change your health plan at certain times during the year:
1. During the first 90 days with a new health plan/MCE.
2. During redetermination. (exception: Healthy Indiana Plan (HIP) members may switch annually November 1 - December 15 during their "health plan selection period".
3.  If you file a grievance with your health plan/MCE & the State finds that you have a good reason to change health plans/MCE.
Another name for a "good reason" to change health plans (MCE) is "just cause." You must first contact your health plan (MCE) so they can attempt to help you. If you are still unhappy after contacting your health plan (MCE) you can call the Hoosier Healthwise Helpline at 1-800-889-9949 and they will review your request.

How do I file a complaint?

Call your health plan (MCE- Managed Care Entity) if you have a complaint or grievance. If you do not know which health plan you are enrolled in, please call the Hoosier Healthwise Helpline at 1-800-889-9949. The telephone numbers for all health plans (MCE) are listed below:
 
  • Anthem: 1-866-408-6131
  • MDwise: 1-800-356-1204
  • Managed Health Services: 1-877-MHS-4U4U or 1-877-647-4848
  • CareSource: 1-800-418-0172

How can I request a new card?

1-800-403-0864.
 

How can I change my address?

1-800-403-0864
 

Who do I call if I have questions about premium payments for the Children's Health Insurance Program (CHIP) also called Medicaid Package C?

CHIP members who have questions about premium payments can call 1-866-404-7113.

How do I pay my premium for the Children's Health Insurance Program (CHIP) also called Medicaid Package C?

To pay by phone:
1-855-765-8672
By Mail: 
Premium payment checks or money orders should be mailed to:
Hoosier Healthwise
P.O. Box 3127
Indianapolis
IN 46206-3127
Online:
Hoosier Healthwise Package C & M.E.D. Works Premium Portal

How do I file a complaint?

If you have a complaint or grievance regarding your PMP or health plan, you need to call your health plan. 
  • ADVANTAGE: 1-800-784-3981
  • MDwise: 1-800-356-1204 or 317-630-2831 in Indianapolis 
  • If you do not know which health plan you belong to, contact the enrollment broker helpline at 1-866-963-7383. This is a free call.

What is Presumptive Eligibility (PE)?

The Presumptive Eligibility (PE) process allows qualified providers to make PE determinations for certain eligibility groups to receive temporary health coverage under the Indiana Health Coverage Programs (IHCP) until official eligibility is determined.  The chart below outlines who can apply for PE and who can be a Qualified Provider (QP).
Aid categories
  • Infants
  • Children
  • Pregnant women
  • Adults ages 19-64 without Medicare
  • Parents/caretakers
  • Former foster care children (ages 19-26)
  • Individuals seeking family planning services
Qualified providers*
  • Acute care hospitals
  • Psychiatric hospitals
  • Federally qualified health centers (FQHCs)
  • Rural health clinics (RHCs)
  • Community mental health centers (CMHCs)
  • Local health departments
  • Advanced practice nurse practitioners*
  • Family/general practitioners*
  • Certified nurse midwives*
  • General internists*
  • Obstetricians or gynecologists*
  • General pediatricians*
  • Medical clinics*
  • Family planning clinics*
Delivery system Fee-for-service, except PE Adult, which is managed care
 

How can I apply for Presumptive Eligibility (PE)?

You can apply for PE at Federally Qualified Health Clinics (FQHCs). If you do not know where to locate a clinic, contact your local Covering Kids & Families office
 
Covering Kids Families will direct you to a local clinic where you will have a pregnancy test. Some clinics will assist you in applying for PE and your benefits will begin that day.  
 
You MUST apply for Hoosier Healthwise for your benefits to continue throughout your pregnancy.
  

What should I bring with me to the designated clinic or doctor's office to apply for presumptive eligibity?

To have a pregnancy test and apply for presumptive eligibility (PE) you MUST provide the following:
  • Name
  • Address
  • Phone Number
  • Social Security Number
  • Number of People in Your Family
  • Dollar Amount of Monthly Family Income

Will my baby have healthcare coverage if I am covered by Medicaid for the baby's delivery?

If you have Medicaid coverage, your baby will also be covered from the day of birth.
 
If you do not have Medicaid coverage for labor and delivery, including those who had PE but did not qualify for Medicaid coverage, you must apply for Medicaid coverage for your newborn baby. The hospital should assist you or you can contact your local Covering Kids & Families office.

If I qualify for presumptive eligibility (PE) will I have to choose a health plan and a doctor?

Yes, you must choose your health plan and your doctor while you are at the designated clinic or doctor's office applying for PE. You will make your choice by calling the enrollment broker. The clinic or doctor's office will help you with this process while you are in their office.
 
 

Have more questions? Contact us!

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