Healthy Indiana Plan

State:	Indiana
Waiver Authority:	1115
Status:	Pending

Waiver Dates

Approval:	01/27/2015
Effective:	02/01/2015
Expiration:	12/31/2030

Supporting Documents

Pending Application(s) and Related Documents

Date	Title
12/20/2024	Pending Application – IN SUD-SMI Extension (PDF, 1.03 MB)	View/Submit Comments

Approved Application(s) and Related Documents

Date	Title
03/21/2023	Demonstration Approval (PDF, 9.68 MB)
07/26/2022	COVID-19 Amendment Approval (PDF, 285.98 KB)

Administrative Record

Date	Title
01/02/2025	CMS Completeness Letter (PDF, 148.85 KB)
11/27/2024	SUD and SMI Quarterly Metrics Report (Part A) – April to June 2024 (XLSX, 1.15 MB)
11/27/2024	SUD and SMI Quarterly Report (Part B) – April to June 2024 (PDF, 428.69 KB)
08/29/2024	SUD and SMI Quarterly Metrics Report (Part A) – January to March 2024 (XLSX, 1.15 MB)
08/29/2024	SUD and SMI Quarterly Report (Part B) – January to March 2024 (PDF, 434.66 KB)
05/30/2024	SUD and SMI Quarterly Metrics Report (Part A) - October to December 2023 (XLSX, 1.15 MB)
05/30/2024	SUD and SMI Quarterly Report (Part B) - October to December 2023 (PDF, 472.53 KB)
04/16/2024	SUD and SMI Retrospective Quarterly Report (Part B) - January 2020 - June 2023 (PDF, 814.08 KB)
03/29/2024	SUD and SMI Quarterly Metrics Report (Part A) – July – September 2023 (XLSX, 1.15 MB)
03/29/2024	SUD and SMI Quarterly Report (Part B) – July – September 2023 (PDF, 478.92 KB)
02/28/2024	SMI Mid-Point Assessment (PDF, 4.09 MB)
12/29/2023	SUD Mid-Point Assessment (PDF, 4.04 MB)
12/22/2023	CMS Letter to the State (PDF, 254.42 KB)
11/29/2023	SUD and SMI Quarterly Metrics Report (Part A) April - June 2023 (XLSX, 1.15 MB)
08/29/2023	SUD and SMI Quarterly Metrics Report (Part A) January - March 2023 (XLSX, 1.15 MB)
06/16/2023	SUD and SMI Quarterly Metrics Report (Part A) October - December 2022 (XLSX, 1.15 MB)
05/22/2023	CMS Approved HIP COVID-19 PHE Managed Care Rate Differential Evaluation Design (PDF, 278.23 KB)
03/27/2023	SUD and SMI Quarterly Metrics Report (Part A) July - September 2022 (XLSX, 1.15 MB)
03/21/2023	CMS Approved Eligibility and Coverage Evaluation Design (PDF, 1.7 MB)
03/21/2023	CMS Approved SMI/SED Evaluation Design (PDF, 2.34 MB)
03/21/2023	CMS Approved SUD Evaluation Design (PDF, 1.05 MB)
03/02/2023	CMS Approved Eligibility and Coverage Monitoring Protocol (Part A) (XLSX, 209.18 KB)
03/02/2023	CMS Approved Eligibility and Coverage Monitoring Protocol (Part B) (PDF, 340.89 KB)
03/02/2023	Demonstration Approval – CMS Approved Eligibility and Coverage Monitoring Protocol (PDF, 5.18 MB)
12/30/2022	SUD and SMI Quarterly Metrics Report (Part A) April - June 2022 (XLSX, 1.15 MB)
08/28/2022	SUD and SMI Quarterly Metrics Report (Part A) January - March 2022 (XLSX, 1.15 MB)
08/02/2022	State Acceptance Letter - COVID-19 Amendment (PDF, 185.68 KB)
06/30/2022	CMS Approved SUD Summative Evaluation Report (PDF, 8.57 MB)
06/16/2022	SUD and SMI Quarterly Metrics Report (Part A) October - December 2021 (XLSX, 1.14 MB)
06/15/2022	CMS Approved SMI Summative Evaluation Report (PDF, 3.2 MB)
06/09/2022	SUD and SMI Quarterly Report - January-March 2022 (PDF, 430.02 KB)
03/30/2022	HIP DY 7 Annual Report 2021 (PDF, 423.95 KB)
03/30/2022	SUD and SMI Quarterly Metrics Report (Part A) July - September 2021 (XLSX, 1.15 MB)
01/28/2022	State Public Health Emergency Application (PDF, 348.95 KB)
11/29/2021	Budget Neutrality Workbook July-September 2021 (XLSM, 437.86 KB)
11/29/2021	Quarterly Report July-September 2021 (PDF, 388.05 KB)
11/29/2021	SUD and SMI Quarterly Metrics Report (Part A) April - June 2021 (XLSX, 1.15 MB)
08/27/2021	Budget Neutrality Workbook April-June 2021 (XLSM, 437.45 KB)
08/27/2021	Quarterly Report April-June 2021 (PDF, 424.71 KB)
08/27/2021	SUD and SMI Quarterly Metrics Report (Part A) January - March 2021 (XLSX, 1.15 MB)
07/22/2021	CMS Approved SMI Monitoring Protocol Part A (XLSX, 5.42 MB)
07/22/2021	CMS Approved SMI Monitoring Protocol Part B (PDF, 369.44 KB)
07/22/2021	CMS Approved SUD Monitoring Protocol Part A (XLSX, 193.52 KB)
07/22/2021	CMS Approved SUD Monitoring Protocol Part B (PDF, 340.71 KB)
07/22/2021	Demonstration Approval - CMS Approved SUD and SMI Monitoring Protocols (PDF, 2.79 MB)
06/30/2021	Budget Neutrality Workbook July- September 2020 (XLSM, 434.02 KB)
06/30/2021	Budget Neutrality Workbook October- December 2020 (XLSM, 433.15 KB)
06/30/2021	SUD and SMI Quarterly Metrics Report (Part A) October - December 2020 (XLSX, 1.14 MB)
06/24/2021	CMS Withdrawal - Community Engagement (PDF, 1.91 MB)
05/30/2021	Budget Neutrality Workbook January- March 2021 (XLSM, 437.52 KB)
05/30/2021	Quarterly Report January-March 2021 (PDF, 428.35 KB)
03/31/2021	SUD and SMI Annual Report - January-December 2020 (PDF, 557.89 KB)
03/31/2021	SUD and SMI Quarterly Metrics Report (Part A) July - September 2020 (XLSX, 1.15 MB)
03/10/2021	Letter from State (PDF, 153.22 KB)
02/12/2021	CMS Letter to State (PDF, 39.46 KB)
02/12/2021	CMS Letter to State about Demonstration (PDF, 313.33 KB)
12/16/2020	CMS Approval – SMI Evaluation Design (01/01/2020 – 12/31/2020) (PDF, 7.52 MB)
12/16/2020	CMS Approved SMI Evaluation Design (01/01/2020 – 12/31/2020) (PDF, 864.63 KB)
12/09/2020	CMS Approved SMI Monitoring Protocol Part A (01/01/2020 – 12/31/2020) (XLSM, 141.62 KB)
12/09/2020	CMS Approved SMI Monitoring Protocol Part B (01/01/2020 – 12/31/2020 (PDF, 431.38 KB)
12/09/2020	CMS SMI Monitoring Protocol Approval (PDF, 6.89 MB)
11/30/2020	CMS Approval – HIP Evaluation Design (02/01/2018 – 12/31/2020) (PDF, 7 MB)
11/30/2020	CMS Approved HIP Evaluation Design (02/01/2018 – 12/31/2020) (PDF, 2.74 MB)
11/30/2020	HIP Quarterly Report July-September 2020 (PDF, 391.81 KB)
11/30/2020	SUD Quarterly Report July - September 2020 (Part A) (XLSX, 620.77 KB)
11/30/2020	SUD Quarterly Report July - September 2020 (Part B) (PDF, 406.59 KB)
11/30/2020	SUD Retrospective Report October 2019 - June 2020 (Part A) (XLSX, 1.6 MB)
11/30/2020	SUD Retrospective Report October 2019 - June 2020 (Part B) (PDF, 230.07 KB)
11/30/2020	SUD and SMI Quarterly Metrics Report (Part A) – April – June 2020 (XLSX, 1.14 MB)
11/24/2020	State Acceptance Letter- HIP Extension (PDF, 282.5 KB)
10/26/2020	CMS Approval - Extension Request (PDF, 9.32 MB)
09/09/2020	CMS Approval – SUD Monitoring Protocol (02/01/2018 – 12/31/2020) (PDF, 4.2 MB)
09/09/2020	CMS Approved Indiana HIP SUD Monitoring Protocol (Part A) (XLSX, 213.79 KB)
09/09/2020	CMS Approved Indiana HIP SUD Monitoring Protocol (Part B) (PDF, 227.64 KB)
09/01/2020	Budget Neutrality Workbook April-June 2020 (XLSM, 430.81 KB)
08/26/2020	HIP Quarterly Report April-June 2020 (PDF, 932.31 KB)
08/26/2020	SUD and SMI Quarterly Metrics Report (Part A) – January – March 2020 (XLSX, 1.15 MB)
07/09/2020	Final SUD Interim Evaluation Report (02/01/2018 – 12/31/2020) (PDF, 4.38 MB)
05/29/2020	Budget Neutrality Workbook January-March 2020 (XLSM, 430.55 KB)
05/29/2020	Budget Neutrality Workbook October-December 2019 (XLSM, 430.76 KB)
05/29/2020	Final SUD Mid-Point Assessment Report (02/01/2018 – 12/31/2020) (PDF, 3.53 MB)
05/29/2020	State Quarterly Report January – March 2020 (PDF, 817.6 KB)
04/01/2020	State Annual Report January – December 2019 (PDF, 1.06 MB)
03/20/2020	CMS Technical Corrections – SMI/SED Amendment (PDF, 3.52 MB)
02/12/2020	CMS Completeness Letter – 2020 Extension Request (PDF, 986.58 KB)
01/31/2020	State Extension Application Request (PDF, 12.21 MB)	View Comments
01/17/2020	State Acceptance Letter of HIP SMI Amendment (PDF, 1.74 MB)
12/20/2019	CMS SMI Amendment Approval (PDF, 3.45 MB)
12/20/2019	Draft SUD Interim Evaluation Report (02/01/2018 – 12/31/2020) (PDF, 3.42 MB)
12/09/2019	HIP SUD Quarterly Report July - September 2019 (ZIP, 482.58 KB)
11/26/2019	Budget Neutrality Workbook July-September 2019 (XLSM, 430.28 KB)
11/26/2019	HIP Quarterly Report July – September 2019 (ZIP, 975.82 KB)
09/13/2019	CMS Completeness Letter – SMI/SED Amendment (PDF, 953.78 KB)
08/30/2019	HIP Quarterly Report April – June 2019 (PDF, 363.88 KB)
08/30/2019	HIP SUD DY 4 Annual Report (ZIP, 5.29 MB)
08/30/2019	HIP SUD Quarterly Report April – June 2019 (ZIP, 2.11 MB)
08/30/2019	SMI/SED Amendment Application (PDF, 4.39 MB)	View Comments
08/08/2019	CMS Completeness Letter - Workforce Bridge Account Amendment (PDF, 954.45 KB)
06/06/2019	HIP SUD Evaluation Design (PDF, 1.51 MB)
05/31/2019	HIP Quarterly Report January–March 2019 (PDF, 760.81 KB)
04/11/2019	HIP DY 4 Annual Report (PDF, 924.71 KB)
03/01/2019	CMS Draft Evaluation Design Feedback (PDF, 325.46 KB)
11/30/2018	SUD Quarterly Report July – September 2018 (PDF, 762.39 KB)
11/27/2018	HIP Draft Evaluation Design (PDF, 538.14 KB)
11/27/2018	HIP Quarterly Report July – September 2018 (PDF, 822.46 KB)
08/31/2018	HIP Quarterly Report April-June 2018 (PDF, 583.58 KB)
08/31/2018	SUD Quarterly Report April-June 2018 (PDF, 483.3 KB)
06/06/2018	Substance Use Disorder Health Information Technology Plan Approval (PDF, 501.04 KB)
05/31/2018	HIP Quarterly Report February–March 2018 (PDF, 581.82 KB)
05/31/2018	SUD Quarterly Report February–March 2018 (PDF, 465.51 KB)
04/30/2018	HIP 2.0 Year 3 Annual Report (February 2017-January 2018) (PDF, 566.01 KB)
03/31/2018	IN Quarterly Report November-December 2017 (PDF, 307.82 KB)
02/28/2018	HIP Approval State Acceptance Letter (PDF, 541.93 KB)
02/01/2018	CMS Amendment Approval (PDF, 2.09 MB)
02/01/2018	SUD Implementation Protocol Approval (PDF, 624.1 KB)
01/22/2018	CMS Temporary Extension Letter (PDF, 90.54 KB)
01/22/2018	IN January 2018 Metrics Report (PDF, 81.39 KB)
12/31/2017	IN Quarterly Report – August-October 2017 (PDF, 374.85 KB)
12/19/2017	IN December 2017 Metrics Report (PDF, 79.53 KB)
12/01/2017	Response from CMS on POWER Account Tiers (12/01/2017) (PDF, 111.13 KB)
11/29/2017	Letter from the State on POWER Account Tiers (11/29/2017) (PDF, 86.6 KB)
11/19/2017	IN November 2017 Metrics Report (PDF, 79.45 KB)
10/19/2017	IN October 2017 Metrics Report (PDF, 76.78 KB)
10/04/2017	IN 2016 Emergency Room Co-Payment Assessment Report (PDF, 1.67 MB)
10/01/2017	IN Quarterly Report – May-July 2017 (PDF, 442.17 KB)
09/25/2017	IN Provider Payment Report (PDF, 626.93 KB)
09/19/2017	IN September 2017 Metrics Report (PDF, 81.25 KB)
08/21/2017	IN August 2017 Metrics Report (PDF, 79.43 KB)
07/20/2017	Demonstration Application – Amendment (PDF, 2.32 MB)	View Comments
07/19/2017	IN July 2017 Metrics Report (PDF, 79.44 KB)
06/30/2017	IN Quarterly Report – February-April 2017 (PDF, 306.44 KB)
06/19/2017	IN June 2017 Metrics Report (PDF, 79.64 KB)
06/09/2017	CMS Completeness Letter (6/9/2017) (PDF, 110.51 KB)
05/21/2017	IN May 2017 Metrics Report (PDF, 79.73 KB)
04/30/2017	IN April 2017 Metrics Report (PDF, 79.62 KB)
03/31/2017	POWER Account Contribution Assessment (3/31/2017) (PDF, 1.77 MB)
03/31/2017	Quarterly Report November 2016 – January 2017 (3/31/2017) (PDF, 122.28 KB)
03/28/2017	IN March 2017 Metrics Report (PDF, 79.63 KB)
02/15/2017	Demonstration Application (PDF, 5.34 MB)	View Comments
02/03/2017	CMS Completeness Determination (2/3/17) (PDF, 102.71 KB)
02/02/2017	HIP 2.0 Monthly Report: October 2016 (PDF, 79.54 KB)
12/30/2016	Quarterly Report August 2016 - October 2016 (12/30/2016) (PDF, 381.72 KB)
11/25/2016	CMS Approval - Indiana NEMT Temporary Extension (11/25/2016) (PDF, 128.36 KB)
11/02/2016	HIP 2.0 NEMT Final Evaluation (11/02/2016) (PDF, 1.47 MB)
09/30/2016	Quarterly Report May 2016 - July 2016 (09/30/2016) (PDF, 391.32 KB)
09/16/2016	IN HIP 2.0 Emergency Room Copay 1916(f) Extension Letter (09/16/2016) (PDF, 65.9 KB)
08/12/2016	Completeness Letter (08/12/2016) (PDF, 65.59 KB)
08/12/2016	Indiana NEMT Extension Request (08/12/2016) (PDF, 1.85 MB)	View Comments
07/29/2016	CMS Letter to Indiana on Lockouts and Prior Claims Payment (7/29/2016) (PDF, 86.47 KB)
07/20/2016	HIP 2.0 Monthly Report: July 2016 (07/20/2016) (PDF, 79.71 KB)
07/06/2016	HIP 2.0 Monthly Report: June 2016 (07/06/2016) (PDF, 81.57 KB)
07/06/2016	Interim Evaluation Report (07/6/2016) (PDF, 4.48 MB)
06/30/2016	Quarterly Report: Feb 2016- Apr 2016 (06/30/2016) (PDF, 534.17 KB)
06/10/2016	CMS letter to Indiana on Federal Evaluation DUA (06/10/2016) (PDF, 111.47 KB)
06/01/2016	HIP 2.0 Monthly Report: May 2016 (06/01/2016) (PDF, 75.05 KB)
04/29/2016	HIP 2.0 Year 1 Annual Report (February 2015-January 2016) (PDF, 1.06 MB)
04/28/2016	Indiana Letter to CMS on Lockouts and Prior Claims Payment (4/28/2016) (PDF, 1.91 MB)
04/20/2016	HIP 2.0 Monthly Report: April 2016 (PDF, 75.11 KB)
03/31/2016	Quarter Report - Nov 2015 - Jan 2016 (03/31/2016) (PDF, 458.77 KB)
03/21/2016	HIP 2.0 Monthly Report: March 2016 (03/21/2016) (PDF, 77.94 KB)
03/11/2016	NEMT Evaluation - Updated 3/11/16 (PDF, 1.65 MB)
02/26/2016	Indiana HIP 2.0: Evaluation of Non-Emergency Medical Transportation Waiver (02/26/2016) (PDF, 1.89 MB)
02/22/2016	HIP 2.0 Monthly Report: February 2016 (02/22/2016) (PDF, 78.55 KB)
02/04/2016	CMS Approved Emergency Department Copayment Protocol (02/04/2016) (PDF, 166.88 KB)
01/19/2016	HIP 2.0 Monthly Report: January 2016 (01/19/2016) (PDF, 77.86 KB)
12/29/2015	HIP 2.0 Provider Payment Report (12/29/2015) (PDF, 473 KB)
12/29/2015	HIP 2.0 Quarterly Report - Demo Year 1 Qtr 3 (12/29/2015) (PDF, 162.64 KB)
12/28/2015	Indiana HIP 2.0: Final Evaluation Design (12/28/2015) (PDF, 2.68 MB)
12/22/2015	HIP 2.0 Monthly Report: December 2015 (12/22/2015) (PDF, 77.83 KB)
12/22/2015	HIP 2.0 Response Letter (12/22/2015) (PDF, 72.73 KB)
11/30/2015	Presumptive Eligibility Standards Proposal (11/30/2015) (PDF, 116.11 KB)
11/24/2015	HIP 2.0 Monthly Report: November 2015 (11/24/2015) (PDF, 77.83 KB)
11/05/2015	HIP 2.0 Evaluation Letter (11/05/2015) (PDF, 790.12 KB)
10/29/2015	HIP 2.0 Draft Evaluation Design (10/29/2015) (PDF, 1.01 MB)
10/27/2015	HIP Prior Claims Payment Report (10/27/2015) (PDF, 571.3 KB)
10/23/2015	HIP 2.0 Monthly Report: October 2015 (10/23/2015) (PDF, 77.82 KB)
10/22/2015	HIP 2.0 Link Protocol - Approved (10/22/2015) (PDF, 370.57 KB)
10/08/2015	HIP 2.0 Quarterly Report - Demo Year 1 Qtr 2 (10/08/2015) (PDF, 219.97 KB)
09/21/2015	HIP 2.0 Monthly Report: September 2015 (09/21/2015) (PDF, 73.78 KB)
08/31/2015	HIP Passive Verification Report (08/31/2015) (PDF, 169.52 KB)
08/31/2015	HIP Presumptive Eligibility Standards Report (08/31/2015) (PDF, 120.56 KB)
08/12/2015	CMS Approval - POWER Account OP (08/12/2015) (PDF, 91.58 KB)
08/05/2015	HIP 2.0 Quarterly Report - Demo Year 1 Qtr 1 (08/05/2015) (PDF, 215.16 KB)
06/01/2015	Draft State Evaluation Design (06/01/2015) (PDF, 946.19 KB)
05/26/2015	HIP Link Draft Protocol (PDF, 1.64 MB)
05/14/2015	Technical Corrections Demonstration Approval (PDF, 545 KB)
05/01/2015	Emergency Room Copay Protocol (PDF, 315.06 KB)
02/26/2015	POWER Account and Copay Protocol (02/26/2015) (PDF, 536.44 KB)
01/30/2015	Approval Letter (01/30/2015) (PDF, 98.98 KB)
01/27/2015	HIP 2.0 Fact Sheet (PDF, 29.06 KB)
01/27/2015	HIP Approval (PDF, 372.24 KB)
08/22/2014	CMS Completeness Letter (PDF, 74.94 KB)
08/21/2014	Report to CMS Indiana Tribal Consultation (PDF, 137.35 KB)
07/02/2014	Healthy Indiana Plan Demonstration Application to Expand (PDF, 1.56 MB)
06/23/2014	Healthy Indiana Plan Expansion Proposal (PDF, 108.86 KB)
03/26/2013	Benchmark Equivalent Coverage Analysis (PDF, 2.47 MB)
	Anthem Blue Cross and Blue Shield (PDF, 300.15 KB)
	Health Benefit Booklet (PDF, 901.12 KB)
	Healthy Indiana Plan Member Handbook (PDF, 2.09 MB)

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