Hoosier Healthwise (HHW) Benefits & Services
The HHW program covers children up to age 19 and some pregnant women. There is little or no cost for members. The plan covers:
- Doctor visits
- Prescription medicine
- Mental health care
- Dental care
- Hospitalizations
- Surgeries
- Family planning
- Immunizations and Vaccinations
HHW Benefit Packages
The State will let you know if you are eligible for HHW. They will choose the right plan for you.
Package A: Standard Plan. Package A is a full-service plan for children and pregnant women.
Package C: Children’s Health Insurance Program (CHIP). Package C is a full-service plan for children up to age 19. There is a small monthly payment and copay for some services. This is based on family income.
You must report income or household changes to the State. Go to the online benefits portal at www.fssabenefits.in.gov to report changes. Or call 1-800-403-0864.
HHW Benefit Summary
Below is a list of common services under each HHW Package. Please call Member Services if you do not see the service you need. Services provided by out-of-network health care providers need prior authorization.
Office Visits / Hospital | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Doctor Visits | Yes | Yes | No |
HealthWatch® – Early and Periodic Screening, Diagnostic and Testing (EPSDT) | Yes | Yes | No |
Checkups | Yes | Yes | No |
Chiropractors | Yes | Yes | Yes, after initial benefit is met. |
Family Planning Services | Yes | Yes | No |
Clinic Services | Yes | Yes | No |
Nurse Practitioner Services | Yes | Yes | No |
Urgent Care Services | Yes. Urgent Care services are covered if they are medically necessary. Urgent care is needed for non-life-threatening emergencies that cannot wait for a normal scheduled office visit. | Yes. Urgent Care services are covered if they are medically necessary. Urgent care is care needed for non-life-threatening emergencies that cannot wait for a normal scheduled office visit. | No |
Hospital Care | Yes | Yes | Yes |
Pharmacy and Medicine | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Preferred Drug List Drugs | Yes | $3 copay generic, compound and sole source drugs. $10 copay brand-name drugs. | Prior authorization is needed for some drugs that require step therapy, quantity, or medical necessity. |
Emergencies, Tests and Transportation | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Emergency Services | Yes | Yes | No |
Lab and X-ray Services | Yes | Yes | No |
Emergency Transportation | Yes | $10 copay for ambulance transportation | No. Prior authorization needed for airline or air ambulance (can get after services are rendered). |
Non-Emergency Transportation | Yes, | No. | No. Trips over 50 miles require prior authorization. |
Dental Benefits | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Oral Exams and X-Rays | Yes | Yes | No |
Dental Cleanings | Yes | Yes | No |
Other Preventive Services | Yes | Yes | No |
Minor Restorative Services (ex: Fillings) | Yes | Yes | Some services require a prior authorization. |
Major Restorative Services (Ex: Dentures) | Yes | Yes | Some services require a prior authorization. |
Periodontal Services | Yes | Yes | Some services require a prior authorization. |
Extractions and Oral Surgery | Yes | Yes | Yes |
Orthodontics | Yes | Yes | Yes |
If dental services are to be performed in hospital or ambulatory surgical center, a prior authorization is required. |
Special Services | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Anesthesia (including dental) | Yes | Yes | Yes |
Nursing Facility Services | Yes, less than 60 days | No | Yes |
Nursing Facility Services | Yes, less than 30 days | No | Yes |
Hospice Care | No* | No | No |
Nurse Midwife Services | Yes | Yes | No |
Foot Care | Laboratory services, x‑ray services, hospital stays and surgical procedures involving the foot are covered when medically necessary. No more than six routine foot care visits per year are covered. | Laboratory services, x‑ray services, hospital stays and surgical procedures involving the foot are covered when medically necessary. Routine foot care services are not covered. | Yes |
CareSource Life Services® and CareSource JobConnect™, support programs for non-medical barriers | Yes | Yes | No |
Home Health Services | Yes | Yes | Yes |
Stop Tobacco Use Quit Now Indiana 1-800-784-8669 | Yes | Yes | No |
Education / Training Services | Yes | Yes | No |
*Members requiring long-term care may qualify for hospice benefits under Traditional Medicaid. For more information, please call Member Services.
Mental Health and Addiction Services | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Assessments, Screenings, & Evaluations | Yes | Yes | No. Assessments and screenings do not require prior authorization. Diagnostic evaluations prior authorization is needed after one per benefit year. |
Counseling | Yes | Yes | Yes, individual counseling prior authorization is needed after 24 sessions. Yes, family counseling prior authorization is needed after 24 sessions. No, group counseling does not need prior authorization. |
Psychiatry | Yes | Yes | No |
Intensive Outpatient Treatment (IOT) | Yes | Yes | Yes, prior authorization needed for all visits. |
Partial Hospitalization Program (PHP) | Yes | Yes | Yes, prior authorization needed for all visits. |
Medication Assisted Treatment (MAT) | Yes | Yes | Prior authorization is not needed for preferred drug. Yes, prior authorization is needed for non-preferred drug. |
Withdrawal Management | Yes | Yes | Yes, prior authorization needed for all visits. |
Substance Use Disorder Residential Treatment | Yes | Yes | Yes, prior authorization needed for all visits. |
Inpatient Mental Health and Substance Use Disorder Treatment | Yes | Yes | Yes, prior authorization needed for all visits. |
Therapies / Habilitative Services | |||
Type of Service | Package A | Package C | Prior Authorization Needed? |
Applied Behavioral Analysis (for Autism Spectrum Disorder) | Yes | Yes | Yes, prior authorization needed for all visits. |
Speech Therapy | Yes | Yes | Yes, prior authorization needed for all visits. |
Respiratory Therapy | Yes | Yes | Yes, prior authorization needed for all visits. |
Occupational Therapy | Yes | Yes | Yes, prior authorization needed for all visits. |
Physical Therapy | Yes | Yes | Yes, prior authorization needed for all visits. |
CareSource Hoosier Healthwise (HHW) benefits are in agreement with the Indiana Health Coverage Programs requirements. Any updates to the benefits, how they are delivered, how they are authorized, or where the site of care will be posted will be no less than 30 days before the start date of the change. To stay current on benefit coverage and plan changes, CareSource members should read any communication sent in the mail, via email or text, posted on CareSource.com or on the member portal.
Call CareSource Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711) if you have any questions about your benefits. Learn more about Hoosier Healthwise on the state of Indiana’s Hoosier Healthwise website.