As required by the Patient Protection and Affordable Care Act (ACA), the Office of Medicaid Policy and Planning (OMPP) will implement changes to Indiana Medicaid eligibility. Open enrollment for Indiana Medicaid and the Health Insurance
Marketplace begins in October 2013, leading up to full implementation of the federal healthcare reform law on January 1, 2014.
Beginning in October, Indiana Medicaid will use the Indiana Application for Health Coverage for all Indiana Medicaid programs except the Healthy Indiana Plan (HIP). HIP will continue to use a separate application unique to that program. Individuals may apply for Indiana Medicaid through the Internet, by mail, or over the telephone. Additionally, applications for food stamps (SNAP) and cash assistance (TANF) will now be separate from applications for health coverage.
Income eligibility methodology
Effective January 1, 2014, Indiana Medicaid is required to use a new methodology for determining income eligibility known as the Modified Adjusted Gross Income (MAGI). In preparation for full implementation, Indiana Medicaid will begin
applying this new methodology to applications received in October. Individuals applying to Indiana Medicaid before January 1, 2014, will have their income eligibility calculated using both the new MAGI rules and the previous income determination rules. Individuals found eligible under current rules will be enrolled on determination. Individuals found eligible only under the MAGI rules will be enrolled effective January 1, 2014. For current Indiana Medicaid members, the MAGI rules
will be applied at the time of their annual redetermination.
Under the MAGI rules, income eligibility for certain groups will be determined based on an individual’s or a family’s federaltax filing status. MAGI rules are used to determine the income eligibility of children, parents and caretakers, pregnant
women, and adults. This includes the Children’s Health Insurance Program (CHIP) and HIP programs. MAGI rules will not be used to determine eligibility for anyone who is aged, blind, or disabled, or who qualifies for Medicare.
The core of the MAGI calculation is that it counts all taxable income for purposes of determining eligibility under Medicaid or CHIP. If the income is nontaxable, it is not considered under MAGI calculations. In addition, asset or resource tests are
no longer considered when determining eligibility. Therefore, an individual’s or a family’s home, cars, personal belongings, and other assets are irrelevant when calculating an applicant’s financial eligibility for Medicaid or CHIP.
The MAGI eligibility rules will apply to the following aid categories:
Ages 0 to1
Ages 1 to 5
Ages 6 to 18
Former Foster Children
Healthy Indiana Plan
Family Planning Eligibility Program
Inpatient Psychiatric Facility
All other aid categories will continue to use the same non-MAGI eligibility rules
Hospital Presumptive Eligibility program
Effective January 1, 2014, Indiana Medicaid will implement a Hospital Presumptive Eligibility (HPE) program. The HPE program will allow acute-care hospitals to enroll with Indiana Medicaid as Qualified Providers (QPs). Hospitals enrolled
as QPs will be allowed to enroll qualified individuals into one of the following presumptively eligible aid categories:
Former Foster Care Children
Future IHCP publications will provide additional information about the HPE program.
Presumptive Eligibility for Pregnant Women program
Pregnant women who qualify for Indiana Medicaid through the Presumptive Eligibility for Pregnant Women (PEPW) program will now receive a “Pregnancy PE ID” rather than a recipient identification (RID) number.
Hoosier Healthwise Package B
Effective January 1, 2014, Hoosier Healthwise Package B (Pregnancy Coverage) will be used only for the Hospital Presumptive Eligibility (HPE) program. Women who complete the full Indiana Application for Health Coverage and are eligible for pregnancy-only coverage will be assigned to Hoosier Healthwise Package A.
Former Foster Children
Effective January 1, 2014, individuals eligible for the aid category MA 14: Former Foster Children will no longer be enrolled in Care Select. Individuals in this aid category will be eligible for Hoosier Healthwise Package A.
If you have questions about this publication, please
contact Customer Assistance at (317) 655-3240 in the
Indianapolis local area or toll-free at 1-800-577-1278.
Feel free to contact us at Family Voices Indiana if you have questions. 317 944 8982 firstname.lastname@example.org