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FSSA/OMPP wants to make Medicaid better for members and they need your help. Apply to join Indiana Medicaid’s NEW Beneficiary Advisory Council (BAC) to share your experience. The BAC, composed of current and former Medicaid members and caretakers, will discuss policy and program changes. To apply, complete the BAC application and submit it via email or mail. Additionally, here is the website link for the FSSA BAC page: https://www.in.gov/fssa/ompp/advisory-committees/beneficiary-advisory-council

Cost-share

What is Cost-sharing?

Cost-sharing is the out-of-pocket amount that an individual pays for their health care. Indiana Medicaid cost-sharing requirements include copayments and premiums (also called member contributions for HIP).

Copayments are paid to the provider at the time of service (or might be billed to the patient to pay later). Service cannot be refused due to inability to pay copayments at the time of service.

Premiums and POWER Account Contributions are invoiced and paid monthly to the MCE (for HIP). Ongoing coverage might be impacted if monthly premiums are not paid. There is a 60-day grace period for premium payment--as long as payment is made within 60 days of the due date, coverage will continue.

5% Out-of-Pocket Maximum* – individual cost-sharing obligations are capped at 5% of family income as calculated on a quarterly basis. Once 5% cost-sharing is met, the MCE will turn off cost-sharing for the remainder of the quarter and resume at the beginning of the next quarter. For HIP Plus categories, if the 5% cost-share limit is met, their PAC will be reduced to $1 for the remainder of the quarter. *For CHIP, the 5% cost-share limit is calculated on an annual basis and must be tracked by the individual. If the individual feels they have met the 5% cost-share limit they must contact MDwise.

Health Coverage Type Copayment amounts Monthly Premium/Contributions amounts (based on HH income)
Hoosier Healthwise – Package C (CHIP) $3 – 10 for prescriptions,
$10 for ambulance transportation services 		$22 – 70 per month

Package C – CHIP Premium Amounts

This chart lists the income standards for children from birth through 18 years of age (MA 10), which is Package C, Children's Health Plan. The standard is based on 250% of the Federal Poverty Level (FPL) and effective March 1, 2024. For children with income above 158% FPL standard and below the 250% FPL standard, there are tiers to determine the premium amount, which will also take into account the number of children covered.

Income (As a percent of FPL) One Child Two or More Children
Over 150 to 175 percent $22.00 $33.00
Over 175 to 200 percent $33.00 $50.00
Over 200 to 225 percent $42.00 $53.00
Over 225 to 250 percent $53.00 $70.00

CHIP - At application, premium payment is required in order for coverage to begin. After that, CHIP members under age 19 are in a 12-month continuous eligibility period and cannot be disenrolled for nonpayment. At the end of the continuous eligibility period, the eligibility is subject to redetermination. At that time, the enrollment will not be renewed unless all monthly premiums have been paid for the previous eligibility period.

Copayments for COVID-19 Related Services

As of 10/1/2024, the following can be expected for these services moving forward:

  • COVID-19 vaccinations will continue to have no copayment requirement for all Indiana Health Coverage programs.
  • COVID-19 testing:
    • No copayments for HIP Plus/Maternity, Hoosier Healthwise-Package A, HCC/MEDworks, FFS, or Presumptive Eligibility
    • Hoosier Healthwise-Package C (CHIP) will have a $3 or $10 copayment for prescriptions for at-home COVID-19 tests
    • HIP Basic will have a copayment of $4 or $8 for prescriptions for at-home COVID tests and outpatient services.
  • COVID-19 Related Treatments:
    • HIP Basic will have $4 to $8 copayments for prescriptions and outpatient services, and $75 copayment for inpatient hospitalizations
    • CHIP (Package C) will have $3 or $10 copayments for prescriptions.

Those Exempt from Cost-Sharing

  • American Indian/Alaska Native – verified member of a federally recognized tribe
  • Pregnant and 12 months postpartum

Services That Are Exempt from Copayments

(For applicable codes, see the table of covered procedure codes in Family Planning Eligibility Program Codes, accessible from the Code Sets page at Indiana Medicaid: Providers: Home):

  • Emergency Services
  • Family Planning Services
  • Pregnancy-related services
  • Preventive care services for children and treatment for any conditions identified via EPSDT screening (EPSDT)
  • Preventive care services for HIP

Take Action to Help Keep Health Coverage

Update Your Info Online with FSSA

  • Are your address and phone number correct?
  • What is your income?
  • What is your employment standing?
  • What is your family size?

Update Your Info Now

How to Update Your Member Info

Upload Verification Documents

Some members may need to upload verification documents. Verification documents can include proof of income, such as a pay stub.

Upload Documents

Return Your Eligibility Notice for Health Coverage Form

Some members will receive a Medicaid eligibility review packet in the mail from FSSA. The form determines your eligibility for the next coverage period and is part of the Indiana Medicaid renewal process. Complete the Eligibility Notice for Health Coverage form included in this packet as soon as possible so you can remain insured with MDwise if you qualify. You must return it by the due date listed on the form.

Need Help Filling Out Your Renewal Form?

MDwise can help! Call us at 1-833-414-1997 and we’ll be happy to assist you with completing your Eligibility Notice for Health Coverage form. If you prefer to speak with someone in person, you can visit MDwise at our Indianapolis office at 2955 N. Meridian Street, Indianapolis, IN 46208 Monday through Wednesday from 8:30 am to 5:00 pm ET.