Michael R. Pence, Governor State of Indiana Office of Medicaid Policy and Planning MS 07, 402 W. WASHINGTON STREET, ROOM W382 INDIANAPOLIS, IN 46204-2739 Dear It has been determined that you are not eligible for Hospital Presumptive Eligibility. The reason for your denial is: Your Hospital Presumptive Eligibility ID number is: If you have any questions regarding this determination, you will need your ID number for reference. You may apply for Indiana Medicaid if you still believe you are eligible, or you may apply for health coverage at the federal health insurance marketplace by visiting www.healthcare.gov. To apply for Indiana Medicaid, you may complete and submit an Indiana Application for Health Coverage:    Online at www.dfrbenefits.in.gov; Over the phone at 1-800-403-0864; or At a Division of Family Resources (DFR) local office. You may want to also consider applying for the Healthy Indiana Plan (HIP). For more information about the eligibility requirements and application process for HIP, please refer to the website at http://www.in.gov/fssa/hip/ or call toll-free at 1-877-438-4479. Sincerely, The Hospital Presumptive Eligibility Program www.IN.gov/fssa Equal Opportunity/Affirmative Action Employer