THE COMPLETE INDIANA NAVIGATOR
CERTIFICATION EXAM STUDY GUIDE
2026-2027 Verified Questions and
Answers with Detailed Rationales
Program Eligibility and Enrollment
1. What is the Federal Poverty Level (FPL) threshold for HIP Plus
eligibility?
Answer: 138%
Rationale: HIP Plus, the comprehensive plan under the Healthy
Indiana Plan, is available to adults aged 19-64 with incomes at or
below 138% of the Federal Poverty Level. This threshold is critical for
determining program eligibility.
2. What is the income threshold for HIP Basic eligibility?
Answer: 100% FPL
Rationale: HIP Basic is the plan for individuals with income between
100% and 138% FPL. Members in this plan have copays and a POWER
account, but cost-sharing responsibilities differ from HIP Plus .
3. What is the age range for HIP eligibility?
, Answer: 19-64
Rationale: The Healthy Indiana Plan specifically serves the adult
population aged 19 to 64. Individuals outside this age range may
qualify for other programs like Hoosier Healthwise (children) or
Hoosier Care Connect (65+, blind, disabled) .
4. What is the FPL limit for Presumptive Eligibility (PE) for infants?
Answer: 213%
Rationale: PE allows qualified providers to grant temporary Medicaid
coverage. Infants have the highest FPL threshold at 213% to ensure
access to early healthcare services .
5. What is the FPL limit for PE for children aged 1-18?
Answer: 163%
Rationale: Children in this age group qualify for temporary Medicaid
benefits under PE if their family income is at or below 163% of the
FPL.
6. What is the FPL limit for PE for pregnant women?
Answer: 213%
Rationale: Pregnant women have an elevated FPL threshold at 213%
to support prenatal care and maternal health. Under PE, they receive
limited coverage (not labor and delivery services) until a full
application is processed .
7. What is the FPL limit for PE for adults?
Answer: 138%
, Rationale: Adults qualify for PE at 138% FPL, aligning with the HIP
Plus eligibility threshold. Adults receive limited coverage under PE,
equivalent to HIP Basic benefits .
8. What is the FPL limit for PE for family planning services?
Answer: 146%
Rationale: The Family Planning Eligibility Program covers services
intended to prevent or delay pregnancy. The 146% FPL threshold
allows more individuals to access these preventive services .
9. Which programs consider an unborn child when determining family
size?
Answer: Presumptive Eligibility and Hoosier Healthwise
Rationale: For eligibility determinations, both PE and Hoosier
Healthwise count an unborn child as a household member, which can
help families qualify for coverage during pregnancy.
10. What are the five HIP plan options and their FPL requirements?
Answer: HIP Plus (138% FPL), HIP Basic (100% FPL), HIP State Plan
Basic (100% FPL), HIP State Plan Plus (138% FPL), HIP Maternity (138%
FPL)
Rationale: The HIP program offers multiple coverage tiers. HIP State
Plan options provide additional benefits like transportation for
medically frail individuals. HIP Maternity covers pregnant women with
no cost-sharing .
Managed Care Entities and Programs
, 11. What are the four Managed Care Entities (MCEs) that administer
Hoosier Healthwise and HIP?
Answer: Anthem, Caresource, MDwise, and Managed Health Services
(MHS)
Rationale: These four MCEs are contracted by the state to deliver
managed care services. Members may choose from these plans or be
auto-assigned if they don't select one within 14 days .
12. What is auto-assignment in the context of HIP/Hoosier
Healthwise?
Answer: The process where individuals who do not select an MCE
within 14 days of application submission are automatically assigned to
one
Rationale: Auto-assignment ensures continuous coverage and
prevents gaps in care. Members are assigned to an MCE based on
geographic availability and performance metrics .
13. What is Hoosier Healthwise?
Answer: Indiana's Medicaid program for low-income pregnant
women and children up to age 19
Rationale: Hoosier Healthwise provides comprehensive coverage
including doctor visits, prescriptions, mental health care, dental care,
and hospitalizations at little to no cost. It offers Package A for lower-
income children and Package C (CHIP) for higher-income children .
14. What is the Children's Health Insurance Program (CHIP)?
Answer: A program providing health coverage to children whose
family income is too high to qualify for Medicaid but too low to afford
private insurance
CERTIFICATION EXAM STUDY GUIDE
2026-2027 Verified Questions and
Answers with Detailed Rationales
Program Eligibility and Enrollment
1. What is the Federal Poverty Level (FPL) threshold for HIP Plus
eligibility?
Answer: 138%
Rationale: HIP Plus, the comprehensive plan under the Healthy
Indiana Plan, is available to adults aged 19-64 with incomes at or
below 138% of the Federal Poverty Level. This threshold is critical for
determining program eligibility.
2. What is the income threshold for HIP Basic eligibility?
Answer: 100% FPL
Rationale: HIP Basic is the plan for individuals with income between
100% and 138% FPL. Members in this plan have copays and a POWER
account, but cost-sharing responsibilities differ from HIP Plus .
3. What is the age range for HIP eligibility?
, Answer: 19-64
Rationale: The Healthy Indiana Plan specifically serves the adult
population aged 19 to 64. Individuals outside this age range may
qualify for other programs like Hoosier Healthwise (children) or
Hoosier Care Connect (65+, blind, disabled) .
4. What is the FPL limit for Presumptive Eligibility (PE) for infants?
Answer: 213%
Rationale: PE allows qualified providers to grant temporary Medicaid
coverage. Infants have the highest FPL threshold at 213% to ensure
access to early healthcare services .
5. What is the FPL limit for PE for children aged 1-18?
Answer: 163%
Rationale: Children in this age group qualify for temporary Medicaid
benefits under PE if their family income is at or below 163% of the
FPL.
6. What is the FPL limit for PE for pregnant women?
Answer: 213%
Rationale: Pregnant women have an elevated FPL threshold at 213%
to support prenatal care and maternal health. Under PE, they receive
limited coverage (not labor and delivery services) until a full
application is processed .
7. What is the FPL limit for PE for adults?
Answer: 138%
, Rationale: Adults qualify for PE at 138% FPL, aligning with the HIP
Plus eligibility threshold. Adults receive limited coverage under PE,
equivalent to HIP Basic benefits .
8. What is the FPL limit for PE for family planning services?
Answer: 146%
Rationale: The Family Planning Eligibility Program covers services
intended to prevent or delay pregnancy. The 146% FPL threshold
allows more individuals to access these preventive services .
9. Which programs consider an unborn child when determining family
size?
Answer: Presumptive Eligibility and Hoosier Healthwise
Rationale: For eligibility determinations, both PE and Hoosier
Healthwise count an unborn child as a household member, which can
help families qualify for coverage during pregnancy.
10. What are the five HIP plan options and their FPL requirements?
Answer: HIP Plus (138% FPL), HIP Basic (100% FPL), HIP State Plan
Basic (100% FPL), HIP State Plan Plus (138% FPL), HIP Maternity (138%
FPL)
Rationale: The HIP program offers multiple coverage tiers. HIP State
Plan options provide additional benefits like transportation for
medically frail individuals. HIP Maternity covers pregnant women with
no cost-sharing .
Managed Care Entities and Programs
, 11. What are the four Managed Care Entities (MCEs) that administer
Hoosier Healthwise and HIP?
Answer: Anthem, Caresource, MDwise, and Managed Health Services
(MHS)
Rationale: These four MCEs are contracted by the state to deliver
managed care services. Members may choose from these plans or be
auto-assigned if they don't select one within 14 days .
12. What is auto-assignment in the context of HIP/Hoosier
Healthwise?
Answer: The process where individuals who do not select an MCE
within 14 days of application submission are automatically assigned to
one
Rationale: Auto-assignment ensures continuous coverage and
prevents gaps in care. Members are assigned to an MCE based on
geographic availability and performance metrics .
13. What is Hoosier Healthwise?
Answer: Indiana's Medicaid program for low-income pregnant
women and children up to age 19
Rationale: Hoosier Healthwise provides comprehensive coverage
including doctor visits, prescriptions, mental health care, dental care,
and hospitalizations at little to no cost. It offers Package A for lower-
income children and Package C (CHIP) for higher-income children .
14. What is the Children's Health Insurance Program (CHIP)?
Answer: A program providing health coverage to children whose
family income is too high to qualify for Medicaid but too low to afford
private insurance
