Complete this section if the applicant answered Yes to question #12 concerning child care expenses or care for an incapacitated adult. Does the person for. Fill Apply For Hoosier Healthwise Online, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile with PDFfiller ✓ Instantly. APPLICATION FOR HOOSIER HEALTHWISE. FOR CHILDREN AND PREGNANT WOMEN. State form (R8 / ) / FI Completed by Enrollment.

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Advanced Search Browse All Medications: Hoosier Healthwise Indiana Hoosier Healthwise is a health insurance program for Indiana children, pregnant women, and low-income families. Health care is provided at little or no cost to Indiana families enrolled in the program.

The enrolled member chooses a doctor to get regular checkups and health care for illnesses. Appliccation health needs such as prescriptions, dental care, vision care, family planning services, and mental health services are also available as part of the Hoosier Healthwise program.

Call to get information about the Hoosier Healthwise program or choose one of the items below. Select one of the links below to download the application or go to the program site for more information on how to apply.


Indiana Medicaid Application & Eligibility | MHS Indiana

Once you fill out your application, send it to the address on the application. Goosier Healthwise is Indiana’s health care program for children, pregnant women, and low-income working families.

Based on family income, children up to age 19 may be eligible for premium-free coverage, or low-cost coverage under the Children’s Health Plan – Benefit Package C www. Pregnant women can be eligible for full coverage under Package A, or for pregnancy-related coverage under Package B, depending on family income and assets.

Low-income families can be eligible for Hoosier Healthwise Package A, if there are children under the age of 18 living with their parent s or other caretaker relative. Young adults 18, 19, and 20 who live with a caretaker relative who applicatkon the financial requirements can be covered; however their caretaker relative is not eligible.

Hoosier Healthwise

In determining the family size for the pregnancy categories, the number of unborn children are included. For example, a woman who is carrying one baby and lives with her husband and another child will have a family size of 4.


Family size generally does not include step-parents. For blended families, income of step-parents cannot cause their step-children to be ineligible. It’s best to go ahead and file your application because using the above chart to include the whole family in the family size may not be correct in your situation.

In determining if your income is within the guidelines above, certain deductions apply: If you work part-time or have children age 2 or older, the maximum amount deducted for childcare is slightly less.

Non citizens who meet all financial and categorical requirements can be eligible applicatin either full coverage or coverage limited to emergencies, depending on immigration status. Except for the Low-Income Families category, the bealthwise thresholds are based on percentages of the federal poverty guidelines and are adjusted annually after the new poverty guidelines are published.

The income limits listed above were last updated effective March 1, Directory Support Important Links.