1. Indiana Health Coverage Programs

2. Learning Objectives
Outline the basics of Medicaid and Indiana Health Coverage Programs (IHCP)
Identify and define eligibility, goals and specifics of IHCP programs
Discuss the standard elements of Medicaid and IHCP Eligibility
Examine eligibility notices, appeals and redeterminations for Medicaid and IHCP

3. What is Medicaid?
Enacted in 1965 by Title XIX of the Social Security Act
The federal government matches state spending on Medicaid
In Indiana, Medicaid is called Indiana Health Coverage Programs which is administered by the Office of Policy Planning (OMPP) and Family and Social Services Administration (FSSA)
Provides free or low-cost health insurance coverage to low-income:
Children
Pregnant women
Parents and caretakers
Blind
Disabled
Aged
Income limits are based on the Federal Poverty Level (FPL)
Offers variety of programs with varying criteria

4. Indiana’s Medicaid
The Office of Medicaid Policy and Planning (OMPP) is responsible for:
Administering Indiana Health Coverage Programs (IHCP) at the State level, including the following functions:
Medical policy development
Program and contract compliance
Contracting with MCEs
Addressing cost containment issues
Establishing IHCP policies
Program reimbursement
Program integrity, including claims analysis and recovery

5. Indiana’s Medicaid
The Department of Family Resources (DFR) is the division of FSSA responsible for processing applications and making eligibility decisions.
The County Offices of the DFR administer IHCP at the local level
Online applications for Medicaid are located on the DFR’s Benefit Portal

6. New Eligibility Groups
As of January 1, 2014, the states must cover:
Former foster children
Under age 26
Receiving Indiana Medicaid when aged out of the system
Not subject to income limits until age 26
Children age 6-18
Up to 133% FPL
Pregnant Women:
Verification of pregnancy no longer required for Medicaid application
Counted as 2 people
Coverage continues 60 days postpartum

7. What are the Indiana Health Coverage Programs?
Hoosier Healthwise (HHW)
Healthy Indiana Plan (HIP)
Care Select
Traditional Medicaid
Medicaid for Employees with Disabilities (M.E.D. Works)
Home and Community-Based Service Waivers (HCBS Waivers)
Medicare Savings Program
Family Planning Services
Spend-Down—Eliminated June 1, 2014
Breast and Cervical Cancer Programs

8. What are Federal Poverty Guidelines (FPL)?
Also known as Federal Poverty Level (FPL)
Issued each year by the Department of Health and Human Services (HHS)
Measure of pre-tax income used to determine what is considered poverty in the United States
It is also used to determine eligibility for IHCP and coverage through the federal Marketplace
Anyone living at 100% or below the FPL is considered living in poverty
In 2014, an individual with a pre-tax income of $11,670 or less is living in poverty, and so is a family of 4 with pre-tax income at or below $23,850.

9. What are Federal Poverty Guidelines (FPL)?
2014 FPL for the 48 Contiguous States and the District of Columbia
 House-hold Size
 100%
133%
 150%
200%
250%
 300%
400%  1
$11,670
$15,521
$17,505
$23,340
$29,175
$35,010
$46,680  2
15,730
 20,921
23,595
  31,460
39,325
47,190
62,920  3
19,790
 26,321
29,685
  39,580
49,475
59,370
79,160  4
23,850
 31,721
35,775
  47,700
59,625
71,550
95,400  5
27,910
 37,120
41,865
  55,820
69,775
83,730
111,640  6
31,970
 42,520
47,955
  63,940
79,925
95,910
127,880  7
36,030
 47,920
54,045
  72,060
90,075
108,090
144,120  8
40,090
 53,320
60,135
80,180
100,225
120,270
160,360

10. Hoosier Healthwise
GOALS
ELIGIBILITY
SPECIFICS
Provide health care coverage for low-income parents/caretakers, pregnant women and children at little or no cost
Children up to age 19
Pregnant women
Low income parents/caretakers of children under age of 18
Offers different benefit packages
State determines eligibility and coverage
Member selects MCE and PMP
Enrollees excluded from mandatory enrollment in Hoosier Healthwise include:
Individuals in nursing homes and other long-term care institutions
Undocumented individuals who are eligible only for emergency services (Package E)
Individuals receiving hospice or home and community-based waiver services
Individuals enrolled in Medicaid on the basis of age, blindness or disability
Wards of the court and foster children

11. Hoosier Healthwise HHW PACKAGE DESCRIPTION A—Standard
Full-service plan for children, pregnant women and families
No premiums
C– Children’s Health Insurance Program (CHIP)
Full service plan for children only (under age 19)
Small monthly premium payment & co-pay for some services based on income
P—Presumptive Eligibility
Ambulatory prenatal coverage for pregnant women who are determined “presumptively eligible” while their Indiana Application for Health Coverage is being processed

12. Services Available under Hoosier Healthwise
Medicaid provides coverage for the following:
Medical care
Hospital care
Physician office visits
Check-ups
Well-child visits
Clinic services
Prescription drugs
Over the counter drugs
Lab & X-Rays
Mental health care
Substance abuse services
Home health care
Nursing facility services
Dental
Vision
Therapies
Hospice
Transportation
Family planning
Foot care
Chiropractors

13. Parents & Caretaker Relatives
Hoosier Healthwise
Monthly Income Limits
Family Size
Parents & Caretaker Relatives
Children
Pregnant Women 1
n/a
$2,432 2
$247
$3,278
$2,727 3
$310
$4,123
$3,431 4
$373
$4,969
$4,134 5
$435
$5,815
$4,838

14. Children’s Health Insurance Program (CHIP)
Child cannot be covered by other comprehensive health insurance
Individuals in CHIP are responsible for monthly premiums and must pay the first premium prior to coverage becoming effectuated (There is a 60-day grace period)
A child whose coverage was dropped voluntarily may not receive CHIP coverage for 90 days following the month of termination with some exceptions
Family FPL
Monthly Premium
for 1 Child
for 2 or More Children
158% up to 175%
$22
$33
175% up to 200%
$50
200% up to 225%
$42
$53
225% up to 250%
$70

15. Healthy Indiana Plan (HIP)
GOALS
ELIGIBILITY
SPECIFICS
Reduce the number of uninsured, low-income Hoosiers
Reduce barriers and improve statewide access to health care services
Promote value-based decision making and personal health responsibility
Promote primary prevention
Prevent chronic disease progression with secondary prevention
Provide appropriate and quality-based health care services
Assure State fiscal responsibility and efficient management of the program
Hoosier adults between the ages of 19-64
Household income at or less than the FPL
Not otherwise eligible for Medicaid
Provides full health benefits including free preventative services ($500), hospital services, mental health care, physician services, prescriptions and diagnostic exams
Does not provide vision, dental or maternity services
No co-pays except for non-emergency use of a hospital ER
Provides a Personal Wellness and Responsibility (POWER) Account valued at $1,100 per adult to pay for medical costs
Enrollee contributes 2-5% of gross income
Employers and non-profits can contribute

16. Healthy Indiana Plan (HIP)
HIP provides a basic commercial benefits package. Covered services include:
Physician services
Prescriptions
Diagnostic exams
Home health services
Outpatient, inpatient hospital and hospice services
Preventive services
Family planning
Case & disease management
Mental health coverage
Vision, dental and maternity services are not currently covered by HIP

17. Healthy Indiana Plan (HIP) Enrollment
Individuals who fail to make their monthly POWER Account contribution after a 60-day grace period are disenrolled for 12 months.
If individuals fail to complete their annual redetermination, then they will be disenrolled from the program.
Family Size
Monthly Income Threshold 1
$973 2
$1,311 3
$1,649 4
$1,988 5
$2,326 6
$2,665 7
$3,003 8
$3,441

18. Healthy Indiana Plan (HIP) Key Dates
In September 2013, the State received authorization from CMS to continue the HIP program for one year (through December 31, 2014).
Due to problems with the roll-out of the federal marketplace, HIP eligibility was extended to those over 100% FPL (including the 5% disregard) through April 2014 to allow for transition to the Marketplace.
On May 15, 2014, Indiana Governor Mike Pence announced a plan to expand HIP from 100% to 138% of the FPL.
As of July 2014, Indiana has submitted the HIP 2.0 waiver application to CMS for approval

19. Managed Care Entities (MCEs)
MCEs provide the following services and functions to Hoosier Healthwise & HIP enrollees:
Case management and disease management
Member services helpline
Screening enrollees for special health care needs
24-hour Nurse Call Line
Managing grievances and appeals
Provide member handbooks
Hoosier Healthwise & HIP enrollees select one of the three MCEs (Anthem, MDWise, MHS), or they are auto-assigned 14 days after enrollment

20. Managed Care Entities (MCEs)
Some factors for beneficiaries to consider when selecting an MCE include the following:
Provider network
Is the individual’s doctor available in the MCE network?
Are the locations of network providers easily accessible for the enrollee?
Are the locations convenient to the individual’s work, home or school?
Special programs & enhanced services
Is there a service or program offered by the MCE that is particularly important or attractive to the enrollee?

21. Managed Care Entities (MCEs)
Hoosier Healthwise enrollees can change MCE:
Anytime during the first 90 days with a health plan
Annually during an open enrollment period
Anytime when there is a “just cause”
Lack of access to medically necessary services covered under the MCE’s contract with State
The MCE does not, for moral or religious objections, cover the service the enrollee seeks
Lack of access to experienced providers
Poor quality of care
Enrollee needs related services performed that are not all available under the MCE network
HIP enrollees can change MCE:
In the first 60 days or until they make the first POWER Account contribution
Annually at eligibility redetermination
Anytime there is a “just cause” as outlined for Hoosier Healthwise enrollees

22. Managed Care Entities (MCEs)
MEMBER SERVICES
WEBSITE

23. Primary Medical Providers
Once a beneficiary is enrolled in an MCE, he or she also selects a Primary Medical Provider (PMP).
Enrollees must see their PMP for all medical care;
If specialty services are required the PMP will provide a referral.
Provider types eligible to serve as a PMP include Indiana Health Coverage Program enrolled providers with the following specialties:
Family practice
General practice
Internal medicine
Obstetrics (OB)/Gynecology (GYN )
General pediatrics

24. Care Select will phase-out January 1, 2015 due to a new coordinated care program
GOALS
ELIGIBLITY
SPECIFICS
Promotion of preventative care
Promotion of treatment regimens for chronic illnesses to better conform evidence-based practices
Promotion of less fragmented and more holistic care
Aged, blind, disabled, a ward of the court or foster child, or a child receiving adoptive services or adoption assistance
MUST have one of the following: Asthma, Diabetes, Congestive, Heart Failure Coronary Artery Disease, Chronic Obstructive Pulmonary Disease, Hypertension, Severe Mental Illness, Serious Emotional Disturbance (SED) Depression, Chronic Kidney Disease w/o dialysis, co-morbidity of diabetes and hypertension or other combinations, or other approved serious or chronic conditions
Enrollees select or are assigned to:
Care Management Organization (CMO) (oversees & coordinates care)
Primary Medical Provider (PMP) (provides care & referrals)

25. Care Management Organization
Care Select
Individuals do not specifically apply for Care Select.
Medicaid enrollees in an eligible aid category with one of the qualifying conditions, as evidenced by claims history or their medical provider contacting the Enrollment Broker at , have the option to participate
Care Select enrollees choose or are assigned to both a Care Management Organization (CMO) and PMP (Primary Medical Provider).
Member services contact information for the State’s two CMOs is as follows:
Care Management Organization
Phone Number
Website
Advantage
MDwise

26. Traditional Medicaid (Fee-for-Service)
The following individuals who meet income and resource requirements are eligible:
Blind, Disabled, and Aged persons
Persons in nursing homes & other long-term care institutions
Undocumented aliens who do not meet a specified qualified status; lawful permanent residents who have lived in the USA less than five years; or those whose alien status remains unverified receiving Emergency Services only
Persons receiving home and community-based waiver or hospice services
Dual eligibles (individuals receiving Medicaid & Medicare)
Persons eligible on the basis of having breast or cervical cancer
Refugees who do not qualify for another aid category
Former Independent Foster Children up to age 18, IV-E Foster Care Children, IV-E Adoption Assistance Children, and Former foster children under the age of 26 who were enrolled in Indiana Medicaid as of their 18th birthday

27. Traditional Medicaid (Fee-for-Service)
In Traditional Medicaid, beneficiaries are not enrolled in a Managed Care Entity (MCE) or Care Management Organization (CMO) and can see any Indiana Health Coverage Program enrolled provider.
All provider claims are paid fee-for-service by the State’s Fiscal Agent, Hewlett-Packard.

28. Traditional Medicaid (Fee-for-Service)
BENEFIT PACKAGE
DESCRIPTION
Standard Plan
Full Medicaid coverage
Medicare Savings Program
QMB: Medicare Part A & B premiums, deductibles, & coinsurance
SLMB/QI: Medicare Part B premiums
QDWI: Medicare Part A premiums
Package E
Emergency Services only– for certain immigrants who do not qualify for full Medicaid coverage
Family Planning
Family planning services only

29. M.E.D. Works GOALS ELIGIBILITY SPECIFICS
Provide full Medicaid for working people with disabilities
Ages 16-64
Fall below 350% FPL
Disabled according to Indiana’s definition of disability
Not exceed asset limit (Single: $2,000 or Couple: $3,000)
Be working (there is no minimum work effort for program)
Full Medicaid benefits
Members pay small monthly premium based on income
Individual only program
Members can put up to $20,000 in Savings for Independence and Self-Sufficiency Account
Members can have employer insurance

30. M.E.D. Works
Enrollees are responsible for monthly premiums based on income of the applicant and spouse
Monthly Income
Premium
Single
$1,459 - $1,702
$48
$1,703 – $1,945
$69
$1,946 - $2,432
$107
$2,433 - $2,918
$134
$2,919 - $3,404
$161
$3,405
$187
Married
$1,967 - $2,294
$65
$2,295 - $2,622
$93
$2,623 - $3,278
$145
$3,279 - $3,933
$182
$3,934 - $4,588
$218
$4,589
$254

31. 590 Program Provides coverage for residents of state-owned facilities
Does not cover incarcerated individuals residing in Department of Corrections (DOC) facilities
Eligible for Package A benefits with the exception of transportation

32. Home and Community Based Waivers (HCBS)
ELIGIBILITY
SPECIFICS
Aged and Disabled
Income: Up to 300% Supplemental Security Income (SSI) benefit
Parental income & resources disregarded for children under 18
Meets “Level of Care”
Would otherwise be place in institution such as nursing home without waiver or other home-based services
Complex medical condition which required direct assistance
Traumatic Brain Injury
Diagnosis of Traumatic Brain Injury
Community Integration & Habilitation
Diagnosis of intellectual disability which originates before age 22
Individual requires 24 hours supervision
Family Supports

33. Home and Community Based Waivers (HCBS)
To apply for the Aged and Disabled waiver or the Traumatic Brain Injury Waiver, individuals can go the local Area Agencies on Aging (AAA) or call for more information.
To apply for the Community Integration & Habilitation or Family Supports waiver, individuals can go the local Bureau of Developmental Disabilities Services (BDDS) office or call for more information.
There are currently waiting lists for the Family Supports waiver and the Traumatic Brain Injury waiver.

34. Behavioral and Primary Healthcare Coordination Program (BPHC)
Assists individuals with serious mental illness (SMI) who otherwise won’t qualify for Medicaid or other third party reimbursement
Individuals meet the following eligibility criteria:
Age 19+
MRO-eligible primary mental health diagnosis (e.g. schizophrenia, bipolar disorder, major depressive disorder)
Demonstrated need related to management of behavioral and physical health and need for assistance in coordinating physical and behavioral healthcare
ANSA Level of Need 3+
Income below 300% FPL
Single: $2,918/month
Married: $3,933/month
Page 69-70
*ANSA refers to the score on the Adult Needs and Strengths Assessment (ANSA), a behavioral health screening tool

35. Behavioral and Primary Healthcare Coordination Program (BPHC)
Individuals may apply for the BPHC program through a Community Mental Health Center (CMHC) approved by the FSSA Division of Mental Health and Addiction (DMHA) as a BPHC provider.
A list of approved CMHCs can be found at

36. Medicare Savings Program
Covers low-income Medicare beneficiaries
Helps pay for out-of-pocket Medicare costs.
Individuals must be eligible for Medicare Part A
Program
Income Threshold
Resource Limit
Benefits
Qualified Medicare Beneficiary (QMB)
100% FPL
Single: $7,080
Couple: $10,620
Medicare Part A & B Premiums
Co-pays, deductibles, coinsurance
(Specified Low Income) SLMB
120% FPL
Part B Premiums
Qualified Individual (QI)
135% FPL
Qualified Disabled Worker (QDW)
200% FPL
Part A Premiums

37. Family Planning Program
GOALS
ELIGIBILITY
SPECIFICS
Prevent or delay pregnancy
Provide family planning services and supplies
Does not qualify for any other category of Medicaid
Meets citizenship or immigration status requirements
Not pregnant
Have not had hysterectomy or sterilization
Have income at or below 141% FPL
Includes, but not limited to:
Annual family planning visits
Pap smears
Tubal ligation
Vasectomies
Hysteroscopic sterilization with an implant device
Laboratory tests, if medically indicated as part of the decision-making process regarding contraceptive methods
FDA approved anti-infective agents for initial treatment of STD/STI

38. Family Planning Program
Services not covered:
Abortions
Artificial insemination
IVF, fertility counseling or fertility drugs
Inpatient hospital stays
Treatment for any chronic condition
Individuals must request to be considered for this program on their Indiana Application for Health Coverage if not eligible for full Medicaid benefits

39. Breast and Cervical Cancer Program (BCCP)
GOALS
ELIGIBILITY
SPECIFICS
Provide Medicaid coverage to women diagnosed with breast and cervical cancer diagnosed through the Indiana State Department of Health (ISDH)
ISDH diagnosis OR
Age 19-64
Need treatment for breast or cervical cancer
Not eligible for Medicaid under any other program
No health insurance to cover treatment
Uninsured or underinsured Indiana residents below 200% FPL (age 40+) may qualify for free breast and cervical cancer screenings and tests
Age
Eligible Services
40-49
Free office visit & Pap test
50-64
Free office visit, Pap test, and mammogram
65 and older
Free office visit, Pap test, and mammogram only if not enrolled in Medicare

40. Presumptive Eligibility (PE)
Allows individuals meeting eligibility requirements access to services covered and paid for by Medicaid as they wait for their application determination for full Medicaid
Entails a simplified application process:
Applicant must know gross family income & citizenship status
Verification documents not required—applicant attests to information

41. Presumptive Eligibility (PE)
The PE period extends from the date an individual is determined presumptively eligible until…
When an Indiana Application for Health Coverage is filed:
Day on which a decision is made on that application
When an Indiana Application for Health Coverage is not filed:
Last day of the month following the month in which the PE determination was made

42. Presumptive Eligibility for Pregnant Women
GOALS
ELIGIBILITY
SPECIFICS
Temporary coverage of prenatal care services while Medicaid applications are pending
Ensure timely access to critical prenatal care
Not currently receiving Medicaid
Pregnant
Indiana resident
US citizen (or qualified immigrant)
Family income less than 208% FPL
One PE period per pregnancy
Includes doctor visits, tests, lab work, dental care, prescription drugs and other care for pregnancy
Does not pay for hospital stays, hospice, long term care, abortion, postpartum services, labor and deliver, or services unrelated to pregnancy

43. Qualified Providers
Qualified providers (QPs) make PE determinations in accordance with Indiana eligibility policy and procedures.
QPs must meet the following criteria:
Be enrolled as an Indiana Health Coverage Program (IHCP) provider
Attend a provider training
Provide outpatient hospital, rural health clinic or clinic services
Be able to access HP Web interchange, internet, printer & fax machine
Allow PE applicants to use an office phone to facilitate the PE and Hoosier Healthwise enrollment process
May include hospitals, pediatricians, family/general practitioner, internist, medical clinic, rural health clinic among others

44. Hospital Presumptive Eligibility
All states are required to permit hospitals that meet state requirements to make PE determinations.
In Indiana, the eligibility groups or populations for which hospitals will be permitted to determine eligibility presumptively are:
Low-income infants and children
Low-income parents or caretakers
Former foster care children up to the age of 26
Low-income pregnant women
Individuals seeking family planning services only

45. General Medicaid Eligibility and Requirements
Each Medicaid assistance category has specific eligibility requirements such as:
Age
Income
Pregnancy status
Indiana Residency
Citizenship/Immigration
Provide Social Security Number (SSN)
Provide information on other insurance coverage
File for other benefits

46. Requirement: Residency
Applicant must be resident of the state
State of residency is:
Where individual lives
Including without a fixed address OR
Has entered the state with a job commitment OR seeking employment
A homeless individual or residents of shelters in Indiana meet this requirement
There is no minimum time period for state residency to be Medicaid eligible
Individuals are permitted to be temporarily absent from the state without losing eligibility

47. Requirement: Citizenship/Immigration Status
Individual must be US citizen, a US non-citizen national or an immigrant who is in a qualified immigration status
Lawful permanent residents are eligible for full Medicaid after 5 years
Electronic data sources through the Federal Hub verify status
If not, paper documentation is required, and a “reasonable opportunity” period is granted to otherwise Medicaid eligible individuals– this period lasts 90 days from the date on the eligibility notice
Those exempt from citizenship verification process:
Individuals receiving SSI or SSDI
Individuals enrolled in Medicare
Individuals in foster care & who are assisted under Title IV-B
Individuals who are beneficiaries of foster care maintenance or adoption assistance payments under Title IV-E
Newborns born to a Medicaid enrolled mother

48. Medicaid Eligible Immigration Status under Immigration & Naturalization Act (INA)
ELIGIBILITY
Lawful Permanent Resident
Full Medicaid eligible if residing in US prior to 8/22/96
If entered US on or after 8/22/96 eligible for Package E for 5 years; full Medicaid after 5 years
Refugees under Section 207 & Iraqi & Afghani Special Immigrants under Section 101(a)(27)
Full Medicaid
Conditional entrants under Section 203(a)(7) prior to April 1, 1980
Parolees under Section 212(d)(5)
Full Medicaid eligible if granted this status for at least 1 year & entered US prior to 8/22/96
If entered US on or after 8/22/96 eligible for Package E
Asylees under Section 208
Persons whose deportation is withheld under Section 243(h)
Amerasians admitted pursuant to Section 584 of P.L & amended by P.L
Cuban & Haitian entrants
Other immigrants, visitor and non-immigrants
Eligible for emergency Medicaid only

49. Requirement: Provide Social Security Number
Each Medicaid applicant must supply social security number (SSN) with the following exceptions:
Individual ineligible to receive SSN
Individual does not have SSN and may only be issued one for a valid non-work reasons
Individual refuses to obtain one due to well-established religious objections
Individual is only eligible for emergency services due to immigration status
Individual is a deemed newborn
Individual is receiving Refugee Cash Assistance and is eligible for Medicaid
Individual has already applied for SSN

50. Requirement: File for Other Benefits
Individuals must apply for all other benefits for which they may be eligible as a condition of eligibility unless good cause can be show for not doing so; these include:
Pensions from local, state or federal government
Retirement benefits
Disability
Social Security benefits
Veterans’ benefits
Unemployment compensation benefits
Military benefits
Railroad retirement benefits
Workers’ Compensation benefits
Health and accident insurance payments

51. Requirement: Report and Use Other Insurance
Medicaid enrollees can have access to other insurance (third liability); however…
Individuals cannot have other insurance and enroll in CHIP or HIP
Applicants must provide information on other insurance they have or change in insurance status
Medicaid is the payer of last resort– other insurance is the primary payer

52. Modified Adjusted Gross Income (MAGI)
Methodology for income counting and determining household size and composition
Used to determine eligibility for Indiana Health Coverage Programs (IHCP) and tax credits on the Marketplace
Not counted toward income:
Assets such as homes, stocks or retirement account
Scholarships, awards or fellowships not used toward living expenses
Income disregards (except tax deductions) and non-taxable income
Child support received, Worker’s compensation and Veteran’s benefits

53. Modified Adjusted Gross Income (MAGI)
Tax Excluded Foreign Earned Income
Tax Exempt Interest
Tax Exempt Title II Security Income
MAGI

54. Modified Adjusted Gross Income (MAGI)
MAGI impacts:
New applicants:
Adults
Parents and Caretaker relatives
Children
Pregnant Women
MAGI does NOT impact:
Aged
Blind
Disabled
Those needing long-term care
Former foster children under age 26
Deemed newborns

55. Modified Adjusted Gross Income (MAGI)
2014 Household Composition Rules
Household = tax filer and all tax dependents
Married couples living together are included in the same household
Stepparents, stepchildren & stepsiblings now included in the household
Income of children & siblings who are required to file a tax return is counted
Adult children claimed as a tax dependent are now included in the household of the tax filer
For a pregnant woman under MAGI rules, her unborn child(ren) is counted in determining her household size

56. Modified Adjusted Gross Income (MAGI)
MAGI Conversion
The goal is to establish a MAGI-based income standard that is not less than the effective income eligibility according to the ACA
Income disregards are not allowed with the exception of a general 5% FPL deduction in certain cases
Steps:
Calculate the average size of the disregards for individuals whose net income falls within 25% of the FPL below the net income standard
Add this average disregard amount to the net income eligibility standard
Step 1 + Step 2 = MAGI eligibility standard for the eligibility group

57. Indiana Application for Health Coverage
The Indiana Application for Assistance includes:
SNAP, cash assistance and Health Coverage
Application methods:
Online (Recommended)
Telephone
Fax
Mail, or
In Person at Division of Family Resources (DFR) office
Medicaid eligibility determinations are made within 45 days or 90 days for determination based on disability
Applicants can check status of online application using:
Case number
Case name
Date of birth
Last four digits of SSN

58. Authorized Representatives
Individual or organization which acts on a Medicaid applicant or beneficiary’s behalf in assisting with the application, redetermination process and ongoing communications with the state
Commonly a trusted family member, but can also be a third party entity
Designation must be in writing and signed by the applicant or beneficiary and the authorized representative
State Form can be used

59. Verifying Factors of Eligibility
States only permitted to collect paper documentation from Medicaid applicants when electronic data sources are not available or reasonably compatible
Data sources used to verify:
Social Security Administration
Department of Homeland Security
TALX Work Number
State Wage Information Collection Agency
State Unemployment Compensation
Vital Statistics

60. Eligibility Notices
DFR provides written notice, via mail, to applications and beneficiaries regarding any decision affecting eligibility
Types of notices include, but not limited to:
Approvals
Denials
Terminations
Suspensions of eligibility
Changes in benefit package or aid category

61. Eligibility Notices What to expect with eligibility notices:
State sends notice within 24 hours + mailing time
Member ID card, referred to as the Hoosier Health Card, sent within 5 business days + mailing time
HIP enrollees receive member ID card from their MCE
CHIP & M.E.D. Works receive premium invoices
HIP eligible individuals receive POWER Account contribution notices
Individuals can be determined Medicaid eligible for up to 3 months of retroactive eligibility from the date of application
Does not apply to HIP or CHIP

62. Eligibility Appeals
Individuals wishing to challenge disability eligibility decisions appeal to the Social Security Administration (SSA) or Indiana Medicaid depending on the reason for the denial.
Regarding an SSA disability on file: appeal to SSA
Indiana Medical Review Team (MRT) decision: Indiana Medicaid

63. Eligibility Redeterminations
Conducted every 12 months for MAGI categories
The State renews if there is sufficient information, effective December 2014
If there is not sufficient information, a pre-populated renewal form will be sent beginning in 2015
Eligibility is terminated if the form is not submitted in a timely manner
If eligibility is terminated but the documents are submitted within 90 days of the original due date, the documents will be reviewed without the need to submit a new application
An individual enrolled in Medicaid on or before December 31, 2013 cannot be denied Medicaid eligibility solely because of the implementation of MAGI rules before March 31, 2014

64. Reporting Changes
Enrollees are required to report changes to the state (FSSA)
Examples of changes include:
Change in address
Income
Family composition
Babies born to Medicaid enrollees receive coverage for the first year of life without the need for a separate application
They will be covered under Hoosier Healthwise and enrolled in the mother’s Managed Care Entity (MCE)

65. IHCP Application Methods
Program
Application Process
Aged & Disabled Waiver
Apply at Area Agencies on Aging (AAA) or call
Breast & Cervical Cancer Program (BCCP)
Apply for Medicaid coverage, option 3; Family Helpline:
Care Select
Contact Enrollment Broker: MAXIMUS:
Community Integration & Habilitation or Family Supports Waiver
Apply at Bureau of Developmental Disabilities Services (BDDS) office or call
Family Planning Eligibility Program
Division of Family Resources (DFR) Toll-Free at OR online
Healthy Indiana Plan (HIP)
Print or pick-up application at a DFR office
Hoosier Healthwise (HHW)
Apply though FSSA Benefits Portal, by phone ( ), or in person at DFR office
Traditional Medicaid
Apply at DFR office, online/phone, Community Enrollment Centers

66. Helpful Resources Hoosier Healthwise Helpline
Healthy Indiana Plan (HIP) Helpline
1-877-GET-HIP-9
FSSA Benefits Portal
Apply for cash assistance, SNAP and health coverage
Indiana Medicaid Website
Eligibility Screening Tools
Guide to programs