Written by a parent, not a doctor. Nothing here is medical advice.

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Indiana program

Help paying a work-plan premium (Indiana premium payment program)

Indiana can pay an employer-plan premium when a Medicaid member's coverage meets its rules.

What it is

Indiana can pay an employer-plan premium when a Medicaid member's coverage meets its rules.

Premium help may reduce the cost of keeping an employer plan. Medicaid enrollment alone is not enough. Indiana's published rules exclude children enrolled through a Medicaid health plan, and the state must also find that buying the employer coverage saves money.

Eligibility rules
  • The child needs Indiana Medicaid and access to an employer group health plan.
  • The manual excludes members enrolled with a managed care entity. The caseworker must check whether the child receives fee-for-service coverage.
  • Indiana compares the cost of purchasing insurance with expected Medicaid spending.
  • Indiana pays the premium when keeping the work plan costs the state less than covering your child through Medicaid alone. A cancer diagnosis makes that comparison easier to pass, but a child in a Medicaid health plan is still excluded.
What you get
  • Payment of an approved employer-plan premium.
  • Premiums for other family members can be included when their enrollment is needed to cover the child.
What the help includes
  • Family members without Medicaid can be included when their enrollment is necessary to insure the Medicaid member.
  • The premium-payment office confirms which premium components are covered, who receives payment, the first payable month and whether payment is direct or reimbursed. Its written decision is needed before changing payroll deductions or stopping existing payments. Coverage of a necessary family premium does not automatically cover non-Medicaid relatives' medical cost sharing.
If you decide to apply
  1. Ask the Division of Family Resources about the Medical Insurance Questionnaire, State Form 46771.
  2. Have the employer plan booklet and premium amount ready.
  3. Ask the caseworker to check the child's Medicaid arrangement before relying on reimbursement.

Indiana Division of Family Resources, 800-403-0864 · Official page ↗

After you ask
  • The employer completes form 3510 when the state requests it.
  • The third-party liability unit makes the premium-payment decision.
  • DFR gathers the employer information and the premium-payment contractor decides the request. A notice goes to the member and DFR. The office confirms when the request is complete, any missing information and expected decision timing; ordinary Medicaid decision deadlines do not establish a premium-payment deadline.
Good to know

Having both Medicaid and work insurance is only the starting point. The child's Medicaid arrangement can rule this help out.

Other details
  • A premium-payment decision is separate from whether ordinary Medicaid can sit behind private insurance.
  • The published rules exclude Medicaid managed-care members. DFR must confirm any legitimate fee-for-service route; Medicaid approval does not create a right to switch solely for premium help. Before a permitted change, the oncology team checks the hospital, pharmacy, treatment approvals and transition arrangements.

Federal background: Help paying an employer health-plan premium.

Official sources
Ask your social worker

“Could Indiana help with an employer premium if our child has Medicaid? What coverage changes or drawbacks would that involve, and could you help request a review if our plan fits?”

Why I’m asking: I want to know whether premium help would lower our costs without disrupting treatment.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Ask for State Form 46771, and give the employer plan booklet and premium amount.

Your social worker

The employer completes form 3510 when the state asks for it.

The care team

Nothing, beyond confirming the diagnosis if the state asks.

Who decides
The third-party liability unit decides; the Division of Family Resources takes the forms.
Ask your social worker
“My child has Indiana Medicaid and we pay an employer premium. Can we be screened for premium payment help, and is my child fee-for-service rather than with a managed care plan?”

How to apply

First step: Call the Division of Family Resources on 800-403-0864 and ask for the Medical Insurance Questionnaire, State Form 46771.

  1. Ask the caseworker whether the child is fee-for-service or with a managed care entity.
  2. Ask for State Form 46771 and tell them the diagnosis is high cost.

Official application / program page ↗

Where it starts: Call the Division of Family Resources on 800-403-0864 and ask for the Medical Insurance Questionnaire, State Form 46771.

What to gather

  • The employer plan booklet and the premium amount
  • The Medicaid case number
  • The employer benefits contact

How long: Not published. Ask for the decision date when you file.

What a yes looks like

A notice from the third-party liability unit saying the premium is approved.

What a no looks like, and the next move

If the answer is that the child is with a managed care plan, ask what would have to change.

Watch out

  • The manual excludes members enrolled with a managed care plan, which is how most children are covered. Ask whether your child is fee-for-service first.
  • Decision times and how the money is paid are not published. Ask when you apply.

Dates that change this

1992-01-01: The published cost-effectiveness formula is a 1992 state plan attachment, the most recent posted. The decision clock, the payment method and who receives the money were NOT FOUND.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

The state can pay the employer-plan premium, including for family members whose enrolment is needed to cover the child.

Covers: Payment of the employer-plan premium · Premiums for other family members when their enrolment is required to cover the Medicaid child

Legal protection: A high-cost diagnosis removes the twice-the-cost criterion from the state formula

What it costs the family: No cost to the family when approved. No published dollar cap was found.

The eligibility facts, as published

Coverage
the child has Indiana Medicaid and an employer group health plan is available
Exclusions
members enrolled with a managed care entity are listed as an exception
Test
cost-effectiveness comparing the purchase cost of the insurance with expected Medicaid spending (State Plan Attachment 4.22-C, a 1992 document, the most recent posted)

The trap: The manual excludes members enrolled with a managed care entity, which is how most Hoosier Healthwise children are covered. Ask the caseworker whether the child is fee-for-service before counting on this.

Where I read this

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