Care & Disease Management

CareSource offers care and disease management programs. These programs can help you learn about your health and how you can better manage your specific health conditions. Our goal is to make sure you have the right tools to stay as healthy as possible. These programs are available to you at no cost.

Care Management

CareSource has nurses, social workers, and community health workers who can work with you one-on-one to help coordinate your health and non-health care needs. They can contact you by phone:

• If your doctor requests one to contact you
• If you request a phone call
• If our Care Management staff feels their services would be helpful to you or your family

Our staff is trained to help you and your family with any special medical problems like asthma, cancer, pregnancy, depression, being medically frail or with other medical conditions. We can also work with you if you need help figuring out when to get medical care from your doctor, an urgent care center or the emergency room.

For more information about Care Management or to talk with a staff member, call Member Services at the number below. You can also self-refer to Care Management.

Disease Management

Our goal is to make sure you have the right tools to stay as healthy as possible. We offer disease management for adults and kids. Our disease management (DM) programs can help you:

• Learn about your health and how you can care for yourself
• Adopt a healthy lifestyle
• Work with your doctor better manage your specific health conditions. These programs are available to you at no cost.

We offer disease management programs for:

If your doctor, pharmacy or other health care provider tells us that you would benefit from one of these programs, we will send you information about the program. You can also ask to be in our Disease Management programs.

If you believe you could benefit from our Disease Management programs or if you would like additional information, please call 1-844-438-9498 (TTY: 1-800-743-3333 or 711).

If at any time you choose to not take part in the program, you may opt out by calling us at 1-844-438-9498.

If you are a HIP member and qualify as medically frail, you have more benefits in the HIP State Plan. This will include benefits like dental and vision. HIP Basic does not have standard dental and vision benefits. You may be medically frail if you have one or more of these conditions:

• Disabling mental disorder
• Chronic substance use disorder
• Serious and complex medical condition
• Physical, intellectual or developmental disability that significantly impairs the individual’s ability to perform one or more activities of daily living
• Disability determination from the Social Security Administration

If we verify you are medically frail, you will get HIP State Plan benefits. We may check these conditions based on your claims (medical care you get). You may also call us at the number listed at the bottom of the page if you believe you may qualify as medically frail. Call us or go to www.in.gov/fssa/hip/am-i-eligible/conditions-that-may-qualify-you-as-medically-frail/to learn more. You have the right to appeal if you do not agree with our decision.

Medically Frail and HIP POWER Account Payments

Due to COVID-19, the state has stopped the collection of POWER Account contributions. It will last for as long as Indiana is experiencing a public health emergency. During this period, you will not receive a POWER account statement or invoice. Additionally, copayments will not be required for any service. 

What do I need to do?

Nothing. You do not have to make payments for these months. We will notify you when you need to make payments again. You will have 60 days to make your first payment once you receive an invoice.

You must make your POWER Account payments in order to access HIP State Plan Plus benefits. If you do not make your POWER Account payment, your benefits will fall under HIP State Plan Basic. This means you will need to make copays when getting health services.

However, if you earn more than 100 percent of the poverty level, you are medically frail and you do not make your POWER Account Contribution, you will keep your HIP State Plan Plus benefits but will need to make copays when getting health services. This is called the HIP State Plan Plus Copays. In addition to copays, you will be billed for your monthly POWER Account Contribution. And, you will need to make copays for health services received until your POWER Account Contribution balance is paid to date.

You must contact us in order to confirm your health condition. If your health condition cannot be confirmed, you will still receive full benefits including coverage for vision and dental through HIP Plus as long as you continue to make your monthly POWER Account payment. However, the HIP State Plan benefits will not be available to you.

Note: to learn if your condition is medically frail, call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711) to ask about next steps.

Right Choices Program

If you are enrolled in RCP, you will be sent a letter explaining the program. You are assigned one primary medical provider and one pharmacy you must see unless you have an emergency. If you are in RCP, you have a CareSource care manager assigned to you. They will help you manage your care and ensure your needs are being met. Call your assigned care manager with any questions.