Indiana Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Indiana's plan contracts, statutes and notices. For 20 of 22 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 20of 22
- Plans on record
- 16
- Directed payments
- 0
- Capitation cells
- —not published
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans must pay at least thisPlans must pay at least the published rate | 9,652 | Paid by the state, outside plans |
| Hospital outpatient | Plans must pay at least thisPlans must pay at least the published rate | 4,536 | Paid by the state, outside plans |
| Equipment & supplies | Plans must pay at least thisPlans must pay at least the published rate | 3,736 | Paid by the state, outside plans |
| Radiology | Plans must pay at least thisPlans must pay at least the published rate | 1,999 | |
| Lab & pathology | Plans must pay at least thisPlans must pay at least the published rate | 1,783 | |
| Hospital inpatient | Plans must pay at least thisPlans must pay at least the published rate | 1,560 | Paid by the state, outside plans |
| Pharmacy | Plans must pay at least thisPlans must pay at least the published rate | 1,102 | Paid by the state, outside plans |
| Hospice | Plans must pay at least thisPlans must pay at least the published rate | 994 | |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 964 | |
| Nursing facility | Plans must pay at least thisPlans must pay at least the published rate | 502 | |
| Vision & hearing | Plans must pay at least thisPlans must pay at least the published rate | 355 | |
| Dental | Plans must pay at least thisPlans must pay at least the published rate | 301 | |
| Other home & community services | Paid by the state, outside plansPaid directly by the state, outside managed care | 234 | Plans must pay at least this |
| Behavioral health | Paid by the state, outside plansPaid directly by the state, outside managed care | 189 | Plans must pay at least this |
| Clinics (FQHC/RHC) | State wraparound guaranteeThe state guarantees the encounter rate on top of plan payment | 189 | |
| Transportation | Paid by the state, outside plansPaid directly by the state, outside managed care | 82 | Plans must pay at least this |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 71 | Plans must pay at least this |
| Therapy (PT/OT/speech) | Plans must pay at least thisPlans must pay at least the published rate | 52 | Paid by the state, outside plans |
| ABA / autism services | Plans must pay at least thisPlans must pay at least the published rate | 51 | |
| Home health | Plans must pay at least thisPlans must pay at least the published rate | 9 | |
| Private duty nursing | Paid by the state, outside plansPaid directly by the state, outside managed care | 2 | |
| Other | Plans must pay at least thisPlans must pay at least the published rate | 1 |
Frequently asked questions
Do Indiana Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital outpatient, Equipment & supplies, Radiology, Lab & pathology, Hospital inpatient, Pharmacy, Hospice, Nursing facility, Vision & hearing, Dental, Other home & community services, Behavioral health, Clinics (FQHC/RHC), Transportation, Personal care & attendant, Therapy (PT/OT/speech), ABA / autism services, Home health, Other. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Indiana's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.