Indiana Medicaid Income Limits : Eligible for Medicaid

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Indiana Medicaid Income Limits
Indiana Medicaid Income Limits

What is Indiana Medicaid Program?

The Medicaid Program provides medical benefits to low income individuals without medical insurance or adequate medical insurance. The Federal government establishes general guidelines for the administration of Medicaid benefits. However, specific eligibility requirements to receive Medicaid benefits, as well as the type and scope of services provided, are determined by each individual state.

Thus, a person who is eligible for Medicaid in one state may not qualify in another state. You must check with the Medicaid office in the state of Indiana to confirm your eligibility to receive benefits.

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Purpose of the Indiana Medicaid Program

The Indiana Medicaid Program serves as a crucial healthcare safety net for eligible individuals and families in the state of Indiana. The program is designed to achieve several important purposes:

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  • Healthcare Access for Low-Income Individuals: The primary purpose of the Indiana Medicaid Program is to provide access to essential healthcare services for low-income individuals and families who might not otherwise afford necessary medical care. Medicaid serves as a key component of the social safety net, ensuring that vulnerable populations receive medical assistance.
  • Coverage for Eligible Low-Income Residents: Medicaid in Indiana extends health coverage to various eligible groups, including low-income children, pregnant women, parents and caretaker relatives, individuals with disabilities, and low-income adults. This broad coverage aims to address the diverse healthcare needs of different populations within the state.
  • Prevention and Early Intervention: Medicaid emphasizes preventive care and early intervention to address health issues before they become more severe and costly. This proactive approach helps improve health outcomes and reduces the overall burden on the healthcare system.
  • Support for Vulnerable Populations: The program places a particular emphasis on supporting vulnerable populations, such as pregnant women, children, and individuals with disabilities. By providing access to comprehensive healthcare services, Medicaid contributes to the well-being of these groups.
  • Long-Term Care Services: Medicaid plays a significant role in funding long-term care services, including nursing home care and home- and community-based services for individuals with chronic conditions or disabilities. This support helps individuals maintain a level of independence and dignity.
  • Financial Assistance for Healthcare Costs: Medicaid provides financial assistance to eligible individuals and families by covering a wide range of healthcare costs, including hospital stays, physician visits, prescription medications, preventive services, and more. This assistance helps alleviate the financial burden of healthcare expenses.
  • Federal and State Partnership: Medicaid operates as a joint federal and state program. The federal government provides matching funds to states to support Medicaid services. This partnership allows states like Indiana to tailor their Medicaid programs to meet the unique needs of their residents.
  • Health Equity and Inclusivity: Medicaid is designed to promote health equity by ensuring that individuals with limited financial means have access to quality healthcare services. The program contributes to reducing health disparities and promoting inclusivity in healthcare access.
  • Coverage for Essential Health Benefits: Indiana Medicaid provides coverage for essential health benefits, including hospital and doctor visits, prescription drugs, preventive services, mental health services, and maternity care. This ensures that beneficiaries have access to a comprehensive range of healthcare services.
  • Public Health and Well-Being: By expanding access to healthcare services, Medicaid contributes to public health and overall community well-being. The program supports healthier communities by addressing health issues at both the individual and population levels.

In summary, the Indiana Medicaid Program serves as a critical component of the healthcare infrastructure, aiming to provide affordable and comprehensive healthcare coverage to eligible low-income individuals and families, promote preventive care, and support the health and well-being of vulnerable populations.

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Indiana Medicaid Income Limits For Pregnant Woman

Pregnant individuals typically fall into the Hoosier Health wise program. Please review all eligibility criteria below.

Eligibility factors
  • Pregnancy
  • Income
  • Family size
Income / family size
Family sizeIncome limit (per month)
2$3,501
3$4,414
4$5,325
5$6,237

Additional details – Family size is based on the tax household, including the unborn child(ren). If you do not file taxes, the household includes the pregnant individual, their child(ren) (biological, adopted, and step), their unborn child(ren), and their spouse, if married. These income standards are effective March 1, 2023.

You can receive immediate medical attention by applying for Presumptive Eligibility for Pregnant Women while you wait for your Medicaid application to be completed.

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Indiana Medicaid Income Limits For Children

Children who are not disabled and not living in an institution will be served through Hoosier Healthwise. If your child is disabled or living in an institution, please refer to the aged, blind, and disabled section.

Eligibility factors

  • Age – These programs serve children through the age of 18.
  • Current health insurance coverage – Having private insurance may affect eligibility.
  • Income – See limits below.

Income / family size

Family sizeIncome limit (per month)
1$3,099
2$4,191
3$5,284
4$6,375
5$7,467

Additional details – Family size is based on the tax household. If you do not file taxes, the household includes the child(ren), the child(ren)’s parent(s) (biological, adopted, and step), and the child(ren)’s sibling(s) (biological, adopted, and step). These income standards are effective March 1, 2023.

Based on income, you may have a monthly premium. You can learn more about the premiums by visiting the Hoosier Healthwise and M.E.D. Works premium payments webpage.

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Indiana Medicaid Benefits

The Indiana Medicaid Program provides a wide range of benefits to eligible individuals and families, offering comprehensive healthcare coverage to address various medical needs. Here are key benefits associated with the Indiana Medicaid Program:

  • Doctor Visits: Medicaid covers visits to healthcare providers, allowing beneficiaries to receive medical care from primary care physicians, specialists, and other healthcare professionals.
  • Hospital Services: Beneficiaries have access to hospital services, including inpatient care, outpatient care, and emergency room visits. Medicaid helps cover the costs associated with hospital stays and related medical services.
  • Prescription Medications: Medicaid provides coverage for prescription medications, ensuring that beneficiaries have access to necessary drugs prescribed by healthcare providers.
  • Preventive Services: Medicaid emphasizes preventive care, covering a range of services such as vaccinations, screenings, and wellness check-ups. This focus on prevention helps identify and address health issues early on.
  • Mental Health Services: Medicaid includes coverage for mental health services, including counseling, therapy, and psychiatric care. This support is crucial for addressing mental health conditions and promoting overall well-being.
  • Maternity and Newborn Care: Pregnant women and newborns are covered under Medicaid for maternity care, prenatal services, and postpartum care. This ensures comprehensive support for maternal and infant health.
  • Family Planning Services: Medicaid covers family planning services, including contraceptives and reproductive health counseling, allowing individuals to make informed decisions about family planning.
  • Dental Services: Medicaid provides coverage for dental services, including preventive care, routine check-ups, and necessary dental treatments. Dental health is an integral part of overall well-being.
  • Vision Care: Beneficiaries have access to vision care services, including eye exams and corrective lenses. This helps ensure good vision and eye health.
  • Long-Term Care: Medicaid supports long-term care services, including nursing home care and home- and community-based services for individuals with chronic conditions or disabilities.
  • Rehabilitative Services: Coverage includes rehabilitative services such as physical therapy, occupational therapy, and speech-language pathology services to aid in recovery and improve functionality.
  • Home Health Care: Medicaid covers home health care services for individuals who require medical care at home. This includes services provided by nurses and home health aides.
  • Transportation Assistance: Medicaid may provide transportation assistance to ensure beneficiaries can access necessary medical appointments and services.
  • Health Screenings and Diagnostic Tests: Beneficiaries have access to a variety of health screenings and diagnostic tests to detect and address health issues early on.
  • Medically Necessary Services: Medicaid covers medically necessary services deemed essential for the health and well-being of beneficiaries, ensuring that individuals receive the care they need.

These benefits contribute to the overall goal of the Indiana Medicaid Program, which is to provide affordable and comprehensive healthcare coverage to eligible individuals and families, promoting health and well-being throughout the state.

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Indiana Medicaid Income Limits For Adults

Generally, adults who are not disabled or institutionalized will be served through the Healthy Indiana Plan. If you are disabled or living in an institution, please refer to the aged, blind, and disabled section.

Eligibility factors
  • Age – Individuals must be age 19 or older.
  • Current health insurance coverage – Having private insurance may affect eligibility.
  • Income – See limits below.

Income / family size

Family sizeIncome limit (per month)
1$1,677
2$2,268
3$2,860
4$3,450
5$4,041

Additional details – Family size is based on the tax household. If you do not file taxes, the household includes the child(ren), the child(ren)’s parent(s) (biological, adopted, and step), and the child(ren)’s sibling(s) (biological, adopted, and step). These income standards are effective March 1, 2023.

If eligible for HIP, you will be required to make a monthly contribution of 2% of your family income to receive HIP Plus benefits. To learn more about HIP Plus and HIP Basic, visit the Healthy Indiana Plan webpage.

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Who is eligible for Indiana Medicaid Program?

To be eligible for Indiana Medicaid, you must be a resident of the state of Indiana, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. Most non-disabled adults will be covered under the Healthy Indiana Plan (HIP).

Disabled individuals or those living in a Medicaid-certified institution may have higher income limits and are subject to an asset limit.

Some categories require the payment of a monthly premium or contribution based on family size and income.

A disregard of 5% of the annual Federal Poverty Limit will be applied to family income for the Healthy Indiana Plan.

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 Indiana Medicaid Program Income Limits

Household Size*Maximum Income Level (Per Year)
1$16,971
2$22,930
3$28,888
4$34,846
5$40,805
6$46,763
7$52,722
8$58,680

*For households with more than eight people, add $5,958 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.

Home And Community Based Services

Home- and Community-Based Services allow individuals with special medical or developmental needs to live in the least restrictive setting while receiving the medical care and supports they need.

Specialized Programs

If you do not qualify for any of the above Indiana Medicaid programs, you may qualify for one of the following specialized programs:

  • Family planning eligibility program
  • Emergency services only
  • End-stage renal disease

Indiana Medicaid Program Income Limits 2024

The income limits for the Indiana Medicaid program in 2024 are based on the size of the household. These limits are designed to reflect the financial realities of individuals and families, ensuring that those who need assistance the most can access healthcare services. Here is a breakdown of the maximum annual income allowed for different household sizes:

  • 1 person: $16,971
  • 2 persons: $22,930
  • 3 persons: $28,888
  • 4 persons: $34,846
  • 5 persons: $40,805
  • 6 persons: $46,763
  • 7 persons: $52,722
  • 8 persons: $58,680

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Understanding Household Size and Income Limits

Understanding household size and income limits is crucial when determining eligibility for various assistance programs, including Medicaid. Here’s an explanation of these terms:

  • Household Size:
    • Household size refers to the number of people living together in a single dwelling, sharing common living arrangements and expenses. It includes individuals related by blood, marriage, or legal adoption, as well as non-relatives who share the same residence.
    • In the context of income eligibility for assistance programs, including Medicaid, household size is a key factor. The number of individuals in a household affects the income limits and the determination of whether a household qualifies for certain benefits.
  • Income Limits:
    • Income limits represent the maximum amount of income a household can have to qualify for a particular program or benefit. These limits are set by the program’s guidelines and are often based on the federal poverty level (FPL) or other relevant standards.
    • For example, when considering Medicaid eligibility, the income limits are designed to ensure that assistance is targeted toward individuals and families with limited financial means. The limits take into account the household size, with larger households generally having higher income limits.
  • Federal Poverty Level (FPL):
    • The federal poverty level is a measure of income used by the U.S. government to determine eligibility for various assistance programs. It considers both household size and income. The FPL is updated annually, and different programs may use a percentage of the FPL to establish income eligibility.
    • Medicaid, as well as other programs like the Supplemental Nutrition Assistance Program (SNAP) and the Children’s Health Insurance Program (CHIP), often use the FPL as a reference point for income limits.
  • Percentage of the Federal Poverty Level:
    • Many assistance programs express income limits as a percentage of the federal poverty level. For instance, a program might set the income eligibility limit at 150% of the FPL, meaning that households with income up to 150% of the federal poverty level may qualify.
  • Adjustments for Household Size:
    • Income limits are typically adjusted for household size to account for the additional financial needs of larger families. As household size increases, the income limits generally rise to accommodate the greater financial responsibilities associated with more individuals.

Understanding the relationship between household size and income limits is essential when applying for assistance programs. Individuals and families should carefully review program guidelines, consider the size of their household, and assess whether their income falls within the specified limits. It’s advisable to check with the specific program or agency administering the assistance to obtain the most accurate and up-to-date information on income eligibility criteria.

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How can I contact someone?

To learn more about the Medicaid program and the specific eligibility requirements and program benefits in Indiana, visit the Indiana Medicaid website. Recipient hotline: 1-800-403-0864

FAQs. Indiana Medicaid Income Limits

Q 1. What are the income limits for Medicaid in Indiana?

Medicaid income limits in Indiana vary based on factors such as household size and the specific Medicaid category. Income limits are typically expressed as a percentage of the federal poverty level (FPL). For the most accurate and up-to-date information, individuals should check with the Indiana Family and Social Services Administration (FSSA) or visit the official Medicaid website.

Q 2. How is household size considered in Medicaid income eligibility?

Medicaid income limits take into account the number of individuals in a household. Larger households generally have higher income limits to accommodate the increased financial responsibilities associated with more people.

Q 3. Which Medicaid categories have different income limits in Indiana?

Different Medicaid categories, such as Medicaid for pregnant women, children, parents, and adults, may have different income limits. Some categories may also have specific eligibility criteria. It’s important to check the specific guidelines for the category that applies to your situation.

Q 4. What is the federal poverty level (FPL), and how does it relate to Medicaid income limits?

The federal poverty level is a measure of income used to determine eligibility for various assistance programs, including Medicaid. Medicaid income limits are often expressed as a percentage of the federal poverty level. The FPL is updated annually, and different categories may have different percentage thresholds.

Q 5. Are there different income limits for children and adults in Medicaid?

Yes, Medicaid may have separate income limits for children and adults. Children may qualify for Medicaid under different categories, such as the Children’s Health Insurance Program (CHIP), with specific income limits for each category.

Q 6. Do Medicaid income limits change annually?

Yes, Medicaid income limits can change annually. The income limits are often adjusted to account for changes in the federal poverty level and other factors. It’s important to check with the Indiana FSSA or visit the official Medicaid website for the most current information.

Q 7. Can I apply for Medicaid if my income is near the income limit?

Yes, individuals with incomes near the Medicaid income limit should still apply. Eligibility determination considers various factors, and there may be additional considerations or deductions that could affect your eligibility.

Q 8. How do I apply for Medicaid in Indiana?

Individuals can apply for Medicaid in Indiana by visiting the Indiana Medicaid website or contacting the Indiana FSSA. The application process may involve submitting information about income, household size, and other relevant details.

Q 9. If I qualify for Medicaid, what healthcare services are covered?

Medicaid in Indiana covers a wide range of healthcare services, including doctor visits, hospital care, prescription medications, preventive services, and more. Specific coverage details may vary based on the Medicaid category.

Q 10. Where can I get more information about Medicaid income limits in Indiana?

For more information about Medicaid income limits in Indiana, individuals can visit the Indiana Medicaid website or contact the Indiana FSSA. Additionally, local healthcare providers or community organizations may assist with information and application assistance.

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