Establishment of plan; eligibility requirements; oversight of marketing; promotion; standards; provider participation in Medicaid required; exemptions
Ind. Code § 12-15-44.5-3
in effectSec. 3. (a) The healthy Indiana plan is established. The secretary shall oversee the plan and has the authority to set policy for the plan in compliance with this chapter.
(b) The office, under the direction of the secretary, shall administer the plan.
(c) The adult group described in 42 CFR 435.119 may be eligible for the plan if the conditions in section 4 of this chapter are met and if the individual meets at least one (1) of the following:
(1) Is working at least eighty (80) hours per month.
(2) Is participating in and complying with the requirements of a work program for at least eighty (80) hours per month.
(3) Is volunteering or performing community service at least eighty (80) hours per month.
(4) Undertakes a combination of the activities described in subdivision (1), (2), or (3) for a combined total of at least eighty (80) hours per month.
(5) Participates in and complies with the work requirements of the TANF program or SNAP.
(6) Has:
(A) a monthly income of at least the applicable minimum wage requirement under 29 U.S.C. 206, multiplied by eighty (80) hours; or
(B) an average monthly income in the preceding six (6) months that is not less than the applicable minimum wage requirements under 29 U.S.C. 206, multiplied by eighty (80) hours and is a seasonal worker as defined under 26 U.S.C. 45R(d)(5)(B).
(7) Participates in a drug addiction or alcoholic treatment and rehabilitation program, as defined in 7 U.S.C. 2012(h).
(8) Is medically certified as medically frail (as defined in 42 CFR 440.315(f)).
(9) Is:
(A) pregnant;
(B) entitled to postpartum medical assistance under 42 U.S.C. 1396a(e)(5) or 42 U.S.C. 1396a(e)(16); or
(C) a parent, guardian, or caretaker relative responsible for the care of a dependent child less than fourteen (14) years of age.
(10) Is a family caregiver under Section 2 of the RAISE Family Caregivers Act personally providing the care for an individual with a serious medical condition or a disability.
(11) Is an individual who is an inmate of a public institution.
(12) Is an Indiana resident enrolled in and attending an accredited educational program at least half time.
(13) Is, as set forth in the Indian Health Care Improvement Act:
(A) an Indian;
(B) an urban Indian; or
(C) a California Indian;
or has otherwise been determined eligible as an Indian by the federal Indian Health Service.
(14) Is eligible for medical assistance under 42 U.S.C. 1396a(a)(10)(A)(i)(IX).
(15) Is a veteran with a disability rated as total under 38 U.S.C. 1155.
An individual must meet the Medicaid residency requirements under IC 12-15-4-4 and this article to be eligible for the plan.
(d) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare program (42 U.S.C. 1395 et seq.).
(2) An individual who is otherwise eligible and enrolled for medical assistance.
(e) The department of insurance and the office of the secretary shall provide oversight of the marketing practices of the plan.
(f) The office shall promote the plan and provide information to potential eligible individuals who live in medically underserved rural areas of Indiana.
(g) The office shall, to the extent possible, ensure that enrollment in the plan is distributed throughout Indiana in proportion to the number of individuals throughout Indiana who are eligible for participation in the plan.
(h) The office shall establish standards for consumer protection, including the following:
(1) Quality of care standards.
(2) A uniform process for participant grievances and appeals.
(3) Standardized reporting concerning provider performance, consumer experience, and cost.
(i) A health care provider that provides care to an individual who receives health coverage under the plan shall also participate in the Medicaid program under this article.
(j) The following do not apply to the plan:
(1) IC 12-15-12.
(2) IC 12-15-13.
(3) IC 12-15-14.
(4) IC 12-15-15.
(5) IC 12-15-21.
(6) IC 12-15-26.
(7) IC 12-15-31.1.
(8) IC 12-15-34.
(9) IC 12-15-35.
(10) IC 16-42-22-10.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.27; P.L.152-2017, SEC.32; P.L.241-2023, SEC.16; P.L.126-2025, SEC.9; P.L.63-2026, SEC.17.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026