INDIANA ELIGIBILITY MODERNIZATION
Voluntary Community Assistance Network
Healthy Indiana Plan (HIP)
HIP is a
•Uninsured,
•Parents or caretaker relatives of dependent children from 22% to 200% of federal poverty level (FPL);
•Childless adults (maximum of 34,000 adults may be covered);
•Hoosiers who are ineligible for
•U.S. citizens, legal immigrants (for at least 5 years), or a qualified
•Hoosiers who are uninsured for at least 6 months.
To apply for HIP, an applicant may complete a paper HIP application, which may be found online at www.HIP.in.gov. Local DFR offices, Hoosier Healthwise Enrollment Centers and participating
Medicaid Disability (MA-D)
To apply for
12 “Is this person blind, disabled or incapacitated?” The
•Indiana Application for Assistance is completed, signed and submitted;
•FSSA Service Center mails an Interview Appointment notice to the applicant;
•Applicant gathers medical provider information;
•FSSA Service Center conducts interview (by phone, unless
o Applicant gives medical provider contact information during interview
•FSSA Service Center mails: 2032 Pending Verifications Notice to applicant (if documents are needed) and 251A to medical provider;
•FSSA Service Center sends records to Medical Review Team (MRT);
•MRT makes disability determination;
•State worker makes Medicaid eligibility determination; and
•FSSA Service Center mails approval/denial notice to applicant.
Medicare Savings Program
The Medicare Savings Program application is used for specific Medicaid categories: Qualified Medicare Beneficiary (QMB), Specified
To apply, applicants may complete the Indiana Application for Assistance online, over the phone, or on paper, or complete the Medicare Savings Program paper application (State Form 49228). MSP applications are processed within 45 days of application date.
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