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INDIANA ELIGIBILITY MODERNIZATION
Voluntary Community Assistance Network (V-CAN)
Figure 10: Authorized Representative Form (available on the FSSA website)
2.1.11 Other Application Processes
mps, Cash Assistance
ion processes relevant
he following programs:
• Medicaid Disability; and
• Medicare Savings Program.
Hoosier Healthwise
To apply for Hoosier Healthwise, applicants can complete the Hoosier Healthwise application (State
Form 43202), or complete the Indiana Application for Assistance. When completing the Hoosier
Healthwise application at a Hoosier Healthwise Enrollment Center, make sure to include the Enrollment
Center code and name of the Enrollment Center staff member completing the interview on the paper
application. NOTE: When completing the Hoosier Healthwise paper application, Question 14 labeled
“Assignment of Rights” should be signed when a pregnant adult woman applies for the program. A non-
applicant parent who is applying only for children does not have to sign Question 14.
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V-CAN User Guide 17 vcan@us.ibm.com
Applicants may designate up to three Authorized Representatives per program (i.e.,
nce/TANF, Food Stamps and Medicaid). Cash Assista
In addition to using the Indiana Application for Assistance to apply for Food Sta
(TANF) and Health Coverage, there are several other program-specific applicat
to V-CAN members. The following section highlights the application methods for t
• Hoosier Healthwise;
• Healthy Indiana Plan;