Indiana state form 55390 r7 8 17 2026

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The document is the Indiana Application for Health Coverage (State Form 55390), which provides a comprehensive form for individuals seeking health coverage assistance. It includes sections for personal information, health coverage needs, citizenship status, income details, employment information, and health plan selection. The application aims to gather necessary data to determine eligibility for various health programs in Indiana.

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Click ‘Get Form’ to open the Indiana State Form 55390 R7 8 17 in our editor.
Begin by filling out Section 1, providing your name and contact information if you are completing the application on behalf of someone else.
In Section 2, indicate the type of help needed by checking the appropriate box for health coverage or not applying.
Complete Section 3 with the home address and telephone number. Ensure all details are accurate for effective communication.
Proceed to Section 5 where you must sign the application. This is a crucial step, so ensure you have completed all previous sections before signing.
Continue through Sections 6 to 35, providing necessary information about ethnicity, citizenship, income, and health coverage as applicable.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (146 Votes)
2017	4.1 Satisfied (52 Votes)
2013	4.4 Satisfied (418 Votes)

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How much can you make and still qualify for Medicaid in Indiana?

Income / family size Family sizeIncome limit (per month) 1 $1,800.25 2 $2,433.15 3 $3,065.05 4 $3,698.001 more row

What is the Indiana Medicaid portal?

The IHCP Portal is an interactive, secure and easy-to-use tool for providers and other partners to exchange information with the IHCP through the internet. Providers that wish to enroll in the IHCP can use the IHCP Portal to submit an application.

How do I check the status of my Medicaid in Indiana?

You can check the status of your application online or by calling 1-800-403-0864. You will need to have your case number to check the status of your application.

How to look up an Indiana Medicaid number?

The MID number can be found on the front of your Hoosier Health Card.

How do I check if my Medicaid is active?

The Quick Guide to Checking Your Medicaid Status Visit your states Medicaid portal (search [Your State] Medicaid portal) Create an account or log in with your Medicaid ID, last name, and date of birth. Steer to Eligibility or Coverage Status in your dashboard. View your current status (Active, Pending, or Inactive)

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How do I apply for health insurance in Indiana?

To apply for Healthy Indiana Plan in person, visit a Division of Family Resources (DFR) office. You can find a DFR office near you by entering your ZIP code or clicking on your county of residence. You can also apply on the FSSA Benefits Portal. To apply by phone, call 877-GET-HIP9 (877-438-4479).

Indiana state form 55390 r7 8 17 2026

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How to use or fill out Indiana State Form 55390 R7 8 17 with Our Platform

See more indiana state form 55390 r7 8 17 versions

Complete this form in 5 minutes or less

Got questions?

How much can you make and still qualify for Medicaid in Indiana?

What is the Indiana Medicaid portal?

How do I check the status of my Medicaid in Indiana?

How to look up an Indiana Medicaid number?

How do I check if my Medicaid is active?

Security and compliance

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How do I apply for health insurance in Indiana?

indiana application for health coverage

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