reglab/statecodes huggingface dataset:
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-18. Financial Resources; State or Federal Higher Education Awards

Sec. 18. Except as provided by federal law, if an individual receives a state or federal higher education award that is paid directly to an approved postsecondary educational institution for the individual's benefit:
(1) the individual is not required to report that award as income or as a resource of the individual when applying for Medicaid; and
(2) the award may not be considered as income or a resource of the individual in determining initial or continuing eligibility for Medicaid.
[Pre-1992 Revision Citation: 12-1-7-57.]
As added by P.L.2-1992, SEC.9. Amended by P.L.2-2007, SEC.160.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-19. Acquisition of Property, Income, or Resources; Notification of County Office; Alteration or Cancellation of Assistance; Recovery of Excess Assistance

Sec. 19. (a) If, while receiving Medicaid, a recipient becomes the owner of any:
(1) property;
(2) income; or
(3) resources;
in excess of the amount owned when the recipient's eligibility was determined, the recipient shall immediately notify the county office of the receipt of possession of the property or income.
(b) After an investigation of circumstances under subsection (a), the county office shall recommend to the office the cancellation or alteration of the amount of Medicaid in accordance with the circumstances.
(c) Assistance paid after the recipient acquires possession of:
(1) property;
(2) income; or
(3) resources;
in excess of the recipient's needs is recoverable by the office from the recipient or the estate of the recipient.
(d) However, an eligible individual is not required to notify the division or county office of a Holocaust victim's settlement payment received by the individual. A county office may not cancel or alter the amount of Medicaid received by the individual after the individual's receipt of the payment. Assistance paid after the individual's receipt of the payment is not recoverable by the office from the individual or the estate of the individual.
[Pre-1992 Revision Citation: 12-1-7-24.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.112; P.L.5-1993, SEC.125; P.L.128-1999, SEC.20.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-20. Conviction of Certain Offenses and Ineligibility for Medicaid Assistance Time Frame; Removal for Medicaid Fraud; Appeal; Rules

Sec. 20. (a) A person convicted of an offense under IC 35-43-5 or IC 35-43-10 related to the application for or receipt of Medicaid assistance is ineligible to receive Medicaid assistance under this article for the following time:
(1) One (1) year if the conviction is for the person's first offense.
(2) Two (2) years if the conviction is for the person's second offense.
(3) Ten (10) years if the conviction is for the person's third or subsequent offense.
(b) A person's ineligibility period for Medicaid assistance described in subsection (a) begins either:
(1) on the date the person is sentenced, if the person's sentence does not include incarceration; or
(2) on the date the individual is released from incarceration.
(c) Upon receipt of substantiated evidence that a person has committed fraud concerning the application for or receipt of Medicaid assistance, the office may remove the person from receiving Medicaid assistance for one (1) year. If the office determines that a person receiving Medicaid assistance is to be removed from receiving Medicaid assistance under this subsection, the person may appeal the determination. An appeal under this subsection is subject to IC 4-21.5.
(d) The office may adopt rules under IC 4-22-2 to implement this section.
As added by P.L.46-1995, SEC.36. Amended by P.L.241-2003, SEC.3; P.L.197-2013, SEC.10.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-21. Ineligibility Due to Noncompliance

Sec. 21. Notwithstanding any other provision of this article, a person who is ineligible for assistance under IC 12-14-2 because of noncompliance with IC 12-14-2-21, IC 12-14-2-24, IC 12-14-2-26, or IC 12-14-5.5 is ineligible for Medicaid under this article.
As added by P.L.46-1995, SEC.37.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-22. Determination of Eligibility; Certain Equity Value in Motor Vehicle May Not Be Considered

Sec. 22. When the office applies a resource standard to determine an applicant's or a recipient's eligibility for Medicaid under this chapter, the office may not consider five thousand dollars ($5,000) of equity value (as defined in 470 IAC 10.1-3-1) in one (1) motor vehicle belonging to:
(1) the applicant or recipient; or
(2) a member of the applicant's or recipient's family.
As added by P.L.126-1998, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-23. Look Back; Exemption for Certain Contributions

Sec. 23. (a) This section is effective beginning October 1, 2009.
(b) When the office conducts a look back (as described in 42 U.S.C. 1396p(c)) to determine, for purposes of eligibility, whether an individual improperly transferred assets, the office shall not consider in total one thousand two hundred dollars ($1,200) per year of contributions made by the individual to a:
(1) family member; or
(2) nonprofit organization;
as an improper transfer.
(c) Any rule adopted by the office of the secretary concerning a transfer of property may not apply to a transfer of property that occurred before the effective date of the rule.
As added by P.L.14-2009, SEC.1. Amended by P.L.229-2011, SEC.123.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-23.5. Implementation of Federal Deficit Reduction Act of 2005

Sec. 23.5. (a) This section is effective beginning October 1, 2009.
(b) In implementing the federal Deficit Reduction Act of 2005, the office shall comply with the following:
(1) A rule adopted may not apply to the transfer of property or another transaction that occurred before the passage of the rule.
(2) The office may not require an individual to return all assets in order to reduce a penalty period for the transfer of assets. The office shall allow a penalty period to be proportionally reduced for a partial return of assets.
As added by P.L.14-2009, SEC.2. Amended by P.L.229-2011, SEC.124.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-24. Eligibility; Community Spouse Resource Requirements

Sec. 24. (a) This section applies to determining eligibility for an individual who:
(1) resides in a nursing facility or another medical institution; and
(2) has a community spouse.
(b) In determining eligibility for an individual described in subsection (a), the office shall, beginning in calendar year 2006, use the greater of the following community spouse resource allowances:
(1) Nineteen thousand twenty dollars ($19,020), subject to an adjustment described in 42 U.S.C. 1396r-5(g).
(2) The lesser of:
(A) the spousal share computed under 42 U.S.C. 1396r-5(c)(1); or
(B) ninety-five thousand one hundred dollars ($95,100), subject to an adjustment described in 42 U.S.C. 1396r-5g.
(3) An amount established by a court order or an administrative hearing if the community spouse's income is less than the minimum monthly needs allowance established under 42 U.S.C. 1396r-5(d)(3) and an increased amount is necessary to increase the community spouse's income to the minimum monthly needs allowance.
(c) An institutionalized spouse shall not be ineligible for the program because of resources if:
(1) the institutionalized spouse:
(A) establishes that the individual has a right to receive support from the community spouse; and
(B) assigns to the office the right to receive support from the community spouse; or
(2) the office determines that the denial of eligibility would result in an undue hardship to the institutionalized spouse.
(d) The office shall adopt rules under IC 4-22-2 to calculate the amount of resources necessary to provide income to the community spouse under subsection (b).
As added by P.L.246-2005, SEC.102.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-25. Eligibility; Retention of Income to Support Community Spouse

Sec. 25. (a) This section applies to an individual who:
(1) is eligible for Medicaid;
(2) resides in a nursing facility or another medical institution; and
(3) has a community spouse.
(b) An individual described in subsection (a) is entitled to retain an income allowance for the purpose of supporting a community spouse if:
(1) the community spouse's income is less than the minimum monthly needs allowance established under 42 U.S.C. 1396r-5(d)(3); and
(2) an increased amount is necessary to increase the community spouse's income to the minimum monthly needs allowance.
(c) If either spouse establishes that a higher allowance is needed due to exceptional circumstances resulting in significant financial duress, the minimum monthly needs allowance may be increased after an administrative hearing or by a court order.
(d) The office shall adopt rules under IC 4-22-2 setting forth the manner in which the office will determine the existence of exceptional circumstances resulting in significant financial duress under subsection (c).
As added by P.L.246-2005, SEC.103.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2. Eligibility › 12-15-2-26. Eligibility for Medicare Beneficiaries

Sec. 26. (a) This section applies beginning the later of the following:
(1) The date that the office is informed that the United States Department of Health and Human Services has approved Indiana's conversion to 1634 status within the Medicaid program.
(2) January 1, 2014.
(b) As used in this section, "qualified Medicare beneficiary" means an individual defined in 42 U.S.C. 1396d(p)(1).
(c) As used in this section, "qualifying individual" refers to an individual described in 42 U.S.C. 1396a(a)(10)(E)(iv).
(d) As used in this section, "specified low-income Medicare beneficiary" refers to an individual described in 42 U.S.C. 1396a(a)(10)(E)(iii).
(e) The following individuals are eligible for the specified coverage under this section:
(1) A qualified Medicare beneficiary whose:
(A) income does not exceed one hundred fifty percent (150%) of the federal income poverty level; and
(B) resources do not exceed the resource limits established by the office;
is eligible for Medicare Part A and Medicare Part B premiums, coinsurance, and deductibles.
(2) A specified low-income Medicare beneficiary whose:
(A) income does not exceed one hundred seventy percent (170%) of the federal income poverty level; and
(B) resources do not exceed the resource limits set by the office;
is eligible for coverage of Medicare Part B premiums.
(3) A qualifying individual whose:
(A) income does not exceed one hundred eighty-five percent (185%) of the federal income poverty level; and
(B) resources do not exceed the resource limits set by the office;
is eligible for coverage of Medicare Part B premiums.
(f) The office may adopt rules under IC 4-22-2 to implement this section.
As added by P.L.278-2013, SEC.8.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-1. Applicability of Chapter

Sec. 1. This chapter applies to a woman who is eligible for Medicaid under IC 12-15-2-13.5.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-2. "Qualified Entity"

Sec. 2. As used in this chapter, "qualified entity" means an entity that:
(1) is eligible to receive payments and provide items and services under this article;
(2) provides outpatient hospital services, rural health clinic services, and any other ambulatory services offered by a rural health clinic, or clinic services furnished by or under the direction of a licensed physician; and
(3) meets all other requirements set forth in 42 U.S.C. 1396r-1b(b)(2).
As added by P.L.152-2001, SEC.3. Amended by P.L.7-2015, SEC.34.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-3. Qualified Entities to Establish Eligibility

Sec. 3. A qualified entity may establish the presumptive eligibility of a woman described in section 1 of this chapter.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-4. Identity of Qualified Entities

Sec. 4. The office shall consider the following to be qualified entities:
(1) A disproportionate share provider under IC 12-15-16-1(a) or IC 12-15-16-1(b).
(2) A federally qualified health clinic.
(3) A rural health clinic.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-5. Qualified Entities Provided With Application Forms and Information

Sec. 5. The office shall provide each qualified entity with the following:
(1) Application forms for Medicaid.
(2) Information on how to assist a woman described in section 1 of this chapter in completing and filing the application forms.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-6. Period During Which Services Provided

Sec. 6. The office shall provide Medicaid services to a woman described in section 1 of this chapter during a period that:
(1) begins on the date on which a qualified entity determines on the basis of preliminary information that the woman is eligible for Medicaid under IC 12-15-2-13.5; and
(2) ends on the earlier of the following:
(A) The date on which a determination is made by a representative of the county office with respect to the eligibility of the woman under IC 12-15-2-13.5.
(B) The last day of the month following the month in which the qualified entity makes the determination described in subdivision (1).
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-7. Woman's Eligibility Determined by Qualified Entity

Sec. 7. A woman described in section 1 of this chapter may only have a presumptive eligibility determination made by an entity described in section 2 of this chapter.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-8. Actions Taken After Establishment of Eligibility

Sec. 8. A qualified entity that determines that a woman described in section 1 of this chapter is presumptively eligible for Medicaid shall do the following:
(1) Notify the office of the determination within five (5) working days after the date on which the determination is made.
(2) Inform the woman at the time a determination is made that an application for Medicaid is required to be made at the county office in the county where the woman resides or an enrollment center (as provided in IC 12-15-4-1) not later than the last day of the month following the month during which the determination is made.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-9. Completion of Application

Sec. 9. If a woman described in section 1 of this chapter is determined to be presumptively eligible for Medicaid under this chapter, the woman must complete an application for Medicaid as provided in IC 12-15-4 not later than the last day of the month following the month during which the determination is made.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-11. Reimbursement for Care During Presumptive Eligibility

Sec. 11. If a woman described in section 1 of this chapter is:
(1) determined to be presumptively eligible for Medicaid under this chapter; and
(2) subsequently determined not to be eligible for Medicaid;
a qualified entity under section 4(1) or 4(2) of this chapter that determined that the woman was presumptively eligible for Medicaid shall reimburse the office for all funds expended by the office in paying for care for the woman during the woman's period of presumptive eligibility.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-12. Rules

Sec. 12. The office shall adopt rules under IC 4-22-2 to implement this chapter, including rules that may impose additional requirements for qualified entities that are consistent with federal regulations.
As added by P.L.152-2001, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer › 12-15-2.3-13. Annual Appropriation to Provide Services

Sec. 13. There is annually appropriated to the office of the secretary of family and social services from the state general fund an amount sufficient to provide services to those individuals eligible for Medicaid under IC 12-15-2-13.5 and this chapter.
As added by P.L.16-2009, SEC.18.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance › 12-15-2.5-1. Refugees

Sec. 1. A person who is classified as a refugee (as defined in 8 U.S.C. 1101) is eligible for all services under this article as if the person were classified as a citizen of the United States.
As added by P.L.46-1995, SEC.38.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance › 12-15-2.5-2. Lawful Permanent Residents; Exceptions

Sec. 2. (a) Except as provided in subsection (b), a person who is a lawful permanent resident is eligible for Medicaid assistance under this article for a period of one (1) year.
(b) This subsection applies to the eligibility of an individual or the individual's dependent for Medicaid assistance and Medicaid waiver services. An individual who:
(1) is a legal Indiana resident;
(2) is an active member of the armed forces of the United States (as defined in IC 5-9-4-3) or the national guard;
(3) is assigned to a duty station outside Indiana or deployed; and
(4) except for meeting the state residency requirements, is otherwise eligible for Medicaid assistance or Medicaid waiver services under this article;
or the individual's dependent is eligible for Medicaid assistance or Medicaid waiver services under this article for one (1) year following the individual's discharge from service in the armed forces of the United States or the national guard or postdeployment in the armed forces of the United States or the national guard.
(c) The office shall allow an individual described in subsection (b) or a dependent of the individual to be placed on a Medicaid waiver waiting list if the individual or the individual's dependent does not reside in Indiana due to the individual's military assignment outside Indiana. When residency has been reestablished, the office shall resume:
(1) Medicaid assistance; and
(2) Medicaid waiver services, subject to the availability of a waiver slot under federal regulations;
for the individual or the individual's dependent if the individual or the individual's dependent is otherwise eligible under this section.
As added by P.L.46-1995, SEC.38. Amended by P.L.161-2007, SEC.36; P.L.116-2016, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance › 12-15-2.5-3. Illegal Aliens

Sec. 3. A person who is in the United States without permission of the United States Citizenship and Immigration Services is not entitled to receive assistance under this article.
As added by P.L.46-1995, SEC.38. Amended by P.L.1-2007, SEC.121.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance › 12-15-2.5-4. Child Born in United States

Sec. 4. A child who:
(1) is born in the United States to a person described in section 2 or 3 of this chapter; and
(2) otherwise meets the requirements for assistance under this article;
is eligible to receive Medicaid under this article.
As added by P.L.46-1995, SEC.38.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance › 12-15-2.5-4.5. Assistance to Child or Pregnant Woman Who Is Not Lawful Permanent Resident

Sec. 4.5. (a) This section applies to the following individuals who are lawfully residing in the United States as set forth in 42 U.S.C. 1396b(v)(4):
(1) A pregnant individual during:
(A) the pregnancy; and
(B) the maximum amount of time allowable under federal law that does not exceed the twelve (12) month period beginning on the last day of the pregnancy.
(2) An individual who is less than twenty-one (21) years of age.
(b) An individual described in subsection (a) who:
(1) meets any other requirement under federal law; and
(2) is otherwise eligible for Medicaid under this article;
is entitled to receive assistance under this article without a waiting period as allowed under 42 U.S.C. 1396b(v).
(c) The office of the secretary shall apply for any Medicaid state plan amendment or waiver necessary to implement this section.
As added by P.L.213-2023, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance › 12-15-2.5-5. Violation of Federal Law

Sec. 5. Any provision of this chapter that violates a federal law or federal regulation is void.
As added by P.L.46-1995, SEC.38.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-0.5. Applicability of Chapter

Sec. 0.5. This chapter does not apply to an individual participating in the Medicaid buy-in program beginning July 1, 2002, established under IC 12-15-41.
As added by P.L.287-2001, SEC.7.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-1.5. Eligibility of Aged, Blind, Disabled; Spouse Assets

Sec. 1.5. (a) This section applies beginning the later of the following:
(1) The date that the office is informed that the United States Department of Health and Human Services has approved Indiana's conversion to 1634 status within the Medicaid program.
(2) January 1, 2014.
(b) The office shall determine eligibility for a Medicaid applicant or Medicaid recipient who is aged, blind, or disabled under IC 12-15-2-3.5.
(c) If an individual:
(1) resides in a nursing facility or another medical institution; and
(2) has a spouse who does not reside in a nursing facility or another medical institution;
the total cash value of money, stock, bonds, and life insurance that may be owned by the couple to be eligible for Medicaid is determined under IC 12-15-2-24.
As added by P.L.278-2013, SEC.11.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-4. Repealed

[Pre-1992 Revision Citation: 12-1-7-18.5(d).]
As added by P.L.2-1992, SEC.9. Repealed by P.L.32-2021, SEC.30.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-5. Limitation on Total Cash Value of Money, Stocks, Bonds, and Life Insurance Owned by Applicants or Recipients Not Described in Ic 12-15-3-1

Sec. 5. Except as provided in section 7 of this chapter, the office may set the total cash value of money, stock, bonds, and life insurance that an applicant for or a recipient of Medicaid may own without being ineligible for Medicaid in cases not described in section 1 of this chapter.
[Pre-1992 Revision Citation: 12-1-7-18.5(e).]
As added by P.L.2-1992, SEC.9. Amended by P.L.196-2011, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-6. Purchase of Qualified Long Term Care Insurance Policy; Computation Under This Chapter

Sec. 6. A computation under this chapter concerning an individual who purchases a qualified long term care insurance policy under IC 12-15-39.6 must take into consideration the asset disregard established under IC 12-15-39.6-10.
[Pre-1992 Revision Citation: 12-1-7-18.5(f).]
As added by P.L.2-1992, SEC.9. Amended by P.L.24-1997, SEC.47; P.L.1-2006, SEC.187.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-7. Effect of Certain Applicants' Assignment of Life Insurance Benefits to State on Applicants' Medicaid Eligibility

Sec. 7. (a) As used in this section, "value" includes the following:
(1) The face value of a life insurance policy.
(2) The cash value of a life insurance policy.
(b) The value of a life insurance policy that is in force and owned by an applicant or a recipient who is at least fifty-five (55) years of age or permanently institutionalized may not be considered as a resource in determining the applicant's or recipient's eligibility for Medicaid if the applicant or recipient:
(1) makes an irrevocable election to name the state as a beneficiary of the life insurance policy for an amount that is not greater than:
(A) Medicaid benefits provided to the recipient under IC 12-15-5 or IC 12-14-17; plus
(B) premiums or expenses paid by the office to the insurer that issued the life insurance policy; or
(2) collaterally assigned the life insurance policy to the state under a written agreement submitted to and recorded by the insurer that issued the life insurance policy.
(c) Any designation of the state as an irrevocable beneficiary or any collateral assignment in favor of the state is void if the application for Medicaid benefits is not approved.
As added by P.L.196-2011, SEC.7.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 3. Ineligibility; Financial Limitations › 12-15-3-8. 529 Education Savings Plan

Sec. 8. Except as otherwise provided under federal law, the money in an account (as defined in IC 21-9-2-2) of an education savings program (as defined in IC 21-9-2-11) may not be considered as a resource or asset in determining an applicant's or recipient's eligibility for Medicaid.
As added by P.L.70-2017, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 4. Application for Assistance › 12-15-4-1. Applying for Medicaid; Enrollment Centers; Duties of Authorized Workers; Final Determination; Submitting Application

Sec. 1. (a) An application or a request for Medicaid for an individual must be made in the manner required by the office:
(1) at enrollment centers specified by the office; or
(2) through the United States mail, as described in subsection (h), if the individual has a developmental disability.
(b) Enrollment centers:
(1) shall be located at each county office; and
(2) may be located at other locations including the following:
(A) A hospital licensed under IC 16-21.
(B) The office of a provider who is eligible to receive payments under this article.
(C) A public or private elementary or secondary school.
(D) A day care center licensed under IC 12-17.2.
(E) The county health department.
(F) A federally qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)).
(G) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
(c) An entity described in subsection (b) other than the county office must enter into an agreement with the office for authorization to serve as an enrollment center where individuals may apply for Medicaid.
(d) One (1) or more authorized workers at each enrollment center may:
(1) accept applications for Medicaid;
(2) conduct interviews with applicants; and
(3) accept applications for services under a Medicaid waiver by an individual who has a developmental disability;
during hours and days of the week agreed upon by the office and the enrollment center.
(e) The office shall provide each enrollment center with the materials and training needed by the enrollment center to comply with this section.
(f) An enrollment center shall provide:
(1) each application taken by the enrollment center; and
(2) any accompanying materials;
to the county office located in the same county as the enrollment center at least one (1) time each week by any reasonable means. Except as provided in subsection (g), the county office staff shall make the final determination of an applicant's eligibility for Medicaid.
(g) The office shall make the final determination of eligibility of an individual who has a developmental disability to receive services under a Medicaid waiver.
(h) An individual who has a developmental disability may submit to the office through the United States mail an application to receive services under a Medicaid waiver.
(i) The office shall make available:
(1) on the Internet;
(2) at an enrollment center; and
(3) through the United States mail;
an application form for an individual who has a developmental disability to receive services under a Medicaid waiver.
[Pre-1992 Revision Citation: 12-1-7-19 part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.113; P.L.5-1993, SEC.126; P.L.58-1998, SEC.9; P.L.184-2003, SEC.6.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 4. Application for Assistance › 12-15-4-2. Tanf Assistance Recipients; Necessity of Making Medicaid Application

Sec. 2. An individual who is receiving monthly assistance payments in the TANF category is not required to make an application for Medicaid.
[Pre-1992 Revision Citation: 12-1-7-19 part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.161-2007, SEC.37.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 4. Application for Assistance › 12-15-4-2.5. Department of Correction and Sheriff as Medicaid Authorized Representative

Sec. 2.5. (a) The department of correction is, for an inmate described in IC 11-10-3-7(b), the inmate's Medicaid authorized representative.
(b) A sheriff who:
(1) agrees to the requirements set forth in IC 36-2-13-19; and
(2) applies for Medicaid for a person who:
(A) is subject to lawful detention; and
(B) is described in IC 36-2-13-19;
is the inmate's Medicaid authorized representative.
As added by P.L.185-2015, SEC.11.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 4. Application for Assistance › 12-15-4-3. Records of Applicants' Circumstances and Other Information

Sec. 3. Whenever the county office receives an application or a request for Medicaid, a record shall promptly be made of the following:
(1) The circumstances of the applicant to ascertain the facts supporting the application or request made under the terms of the Medicaid program.
(2) Other information required by the office.
[Pre-1992 Revision Citation: 12-1-7-20.]
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.114; P.L.5-1993, SEC.127.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 4. Application for Assistance › 12-15-4-4. Grant of Assistance; Eligibility Requirements

Sec. 4. Medicaid shall be granted to an applicant who is eligible for assistance under IC 12-15-2 and who meets the following requirements:
(1) Has made an application or a request for Medicaid in the manner required by the office or for whom an application or a request has been made.
(2) Is a resident of Indiana, including a resident temporarily absent from Indiana, and minor children who are under the care, supervision, and control of a parent or other relative who is a resident of Indiana.
(3) Has not made a transfer of property for the purpose of making the applicant eligible for Medicaid.
(4) Does not have a spouse having sufficient income to furnish medical assistance, or a parent having sufficient income to furnish medical assistance if the applicant is a child who is blind or has a disability and who is less than eighteen (18) years of age.
[Pre-1992 Revision Citation: 12-1-7-18.]
As added by P.L.2-1992, SEC.9. Amended by P.L.67-2000, SEC.2; P.L.99-2007, SEC.95.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-1. Services and Supplies Provided; Exceptions

Sec. 1. (a) Except as provided in IC 12-15-2-12, IC 12-15-6, and IC 12-15-21, the following services and supplies are provided under Medicaid:
(1) Inpatient hospital services.
(2) Nursing facility services.
(3) Physician's services, including services provided under IC 25-10-1 and IC 25-22.5-1.
(4) Outpatient hospital or clinic services.
(5) Home health care services.
(6) Private duty nursing services.
(7) Physical therapy and related services.
(8) Dental services.
(9) Prescribed laboratory and x-ray services.
(10) Prescribed drugs and pharmacist services.
(11) Eyeglasses and prosthetic devices.
(12) Optometric services.
(13) Diagnostic, screening, preventive, and rehabilitative services.
(14) Podiatric medicine services.
(15) Hospice services.
(16) Services or supplies recognized under Indiana law and specified under rules adopted by the office.
(17) Family planning services except the performance of abortions.
(18) Nonmedical nursing care given in accordance with the tenets and practices of a recognized church or religious denomination to an individual qualified for Medicaid who depends upon healing by prayer and spiritual means alone in accordance with the tenets and practices of the individual's church or religious denomination.
(19) Services provided to individuals described in IC 12-15-2-8.
(20) Services provided under IC 12-15-34 and IC 12-15-32.
(21) Case management services provided to individuals described in IC 12-15-2-13.
(22) Any other type of remedial care recognized under Indiana law and specified by the United States Secretary of Health and Human Services.
(23) Examinations required under IC 16-41-17-2(a)(10).
(24) Inpatient substance abuse detoxification services.
(25) Chronic pain management.
(26) Donated breast milk that meets requirements developed by the office of Medicaid policy and planning.
(b) The office shall do the following:
(1) Apply to the United States Department of Health and Human Services for any state plan amendment or waiver necessary to implement the services or supplies described in subsection (a)(26).
(2) Develop requirements for donated breast milk as described in subsection (a)(26).
(3) As soon as practicable, but not later than January 1, 2023, the office shall:
(A) seek any necessary approval from the United States Department of Health and Human Services; and
(B) adopt any written policies, procedures, or regulations determined necessary;
to provide reimbursement for long-acting reversible contraception. This subdivision expires June 30, 2023.
[Pre-1992 Revision Citation: 12-1-7-14.6 part.]
As added by P.L.2-1992, SEC.9. Amended by P.L.24-1997, SEC.48; P.L.149-2001, SEC.1; P.L.274-2013, SEC.1; P.L.154-2015, SEC.2; P.L.210-2015, SEC.47; P.L.149-2019, SEC.4; P.L.117-2022, SEC.3; P.L.180-2022(ss), SEC.15.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-2. Necessity of Federal Financial Participation

Sec. 2. Medicaid does not include a service or supply for which federal financial participation is not available.
[Pre-1992 Revision Citation: 12-1-7-14.6 part.]
As added by P.L.2-1992, SEC.9.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-5. Office May Provide Drug Coverage; Requirements for Drug Coverage in Managed Care

Sec. 5. (a) The office may provide a prescription drug benefit to a Medicaid recipient in a Medicaid risk based managed care program.
(b) If the office provides a prescription drug benefit to a Medicaid recipient in a Medicaid risk based managed care program:
(1) the office shall develop a procedure and provide the recipient's risk based managed care provider with information concerning the recipient's prescription drug utilization for the risk based managed care provider's case management program; and
(2) the provisions of IC 12-15-35.5 apply.
(c) If the office does not provide a prescription drug benefit to a Medicaid recipient in a Medicaid risk based managed care program, a managed care organization shall provide coverage and reimbursement for outpatient single source legend drugs subject to IC 12-15-35-46, IC 12-15-35-47, and IC 12-15-35.5.
As added by P.L.231-1999, SEC.1. Amended by P.L.101-2005, SEC.1; P.L.152-2017, SEC.5.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-7. Reimbursement for Doula Services; Rules

Sec. 7. (a) Pregnancy services provided under this article may include reimbursement for doula services.
(b) The office may apply for any state plan amendment or waiver necessary to implement this section.
(c) The office may adopt rules under IC 4-22-2 to implement this section.
As added by P.L.35-2019, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-8. Maintenance Drugs; Prescriptions; Internet Based Pharmacies

Sec. 8. (a) As used in this section, "maintenance drug" means a medication that is dispensed under a single prescription for a period of not less than one hundred eighty (180) days, excluding authorized refills, for the ongoing treatment of a chronic medical condition or disease or congenital condition or disorder.
(b) The office may designate:
(1) a mail order pharmacy;
(2) an Internet based pharmacy (as defined in IC 25-26-18-1);
(3) a pharmacy that agrees to sell a maintenance drug at the same price as a mail order or an Internet based pharmacy; or
(4) all the pharmacies listed in subdivisions (1) through (3);
through which a recipient may obtain a maintenance drug.
(c) If the office makes a designation under subsection (b), a managed care organization that has a contract with the office under IC 12-15-12 is not required to use a pharmacy that is designated under subsection (b).
(d) If a Medicaid recipient's physician prescribes a maintenance prescription drug, the Medicaid recipient may purchase the maintenance prescription drug from a pharmacy that is designated under subsection (b).
(e) The office shall apply to amend the state Medicaid plan if the office determines that an amendment is necessary to carry out this section.
(f) The office may require a recipient to pay the maximum copayment allowable under federal law if the recipient obtains a maintenance drug from a pharmacy other than a pharmacy described in subsection (b).
As added by P.L.246-2005, SEC.105.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-9. Provision of Self-Directed Care Options

Sec. 9. The office shall have self-directed care options and services available for an eligible individual who:
(1) is a Medicaid waiver recipient; and
(2) chooses self-directed care services.
As added by P.L.47-2009, SEC.3.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-10. Care Available for Individuals Receiving Medicaid Waiver Services; Eligibility Not Affected by Receipt of Services

Sec. 10. (a) An individual who receives Medicaid services through a Medicaid waiver shall receive the following:
(1) The development of a care plan addressing the individual's needs.
(2) Advocacy on behalf of the individual's interests.
(3) The monitoring of the quality of community and home care services provided to the individual.
(4) Information and referral services concerning community and home care services if the individual is eligible for these services.
(b) The use by or on behalf of an individual receiving Medicaid waiver services of any of the following services or devices does not make the individual ineligible for services under a Medicaid waiver:
(1) Skilled nursing assistance.
(2) Supervised community and home care services, including skilled nursing supervision.
(3) Adaptive medical equipment and devices.
(4) Adaptive nonmedical equipment and devices.
As added by P.L.47-2009, SEC.4.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-11. "Telehealth Services"; Reimbursement; Prohibition on Distance Restrictions and Location Requirements; Waiver of Confidentiality; Community Mental Health Centers; Rules

Sec. 11. (a) As used in this section, "telehealth services" has the meaning set forth for "telehealth" in IC 25-1-9.5-6.
(b) The office shall reimburse the following Medicaid providers for medically necessary telehealth services:
(1) A federally qualified health center (as defined in 42 U.S.C. 1396d(l)(2)(B)).
(2) A rural health clinic (as defined in 42 U.S.C. 1396d(l)(1)).
(3) A community mental health center certified under IC 12-21-2-3(5)(C).
(4) A critical access hospital that meets the criteria under 42 CFR 485.601 et seq.
(5) A home health agency licensed under IC 16-27-1.
(6) A provider, as determined by the office to be eligible, providing a covered telehealth service.
(c) The office may not impose any distance restrictions on providers of telehealth services.
(d) Subject to federal law, the office may not impose any location requirements concerning the originating site or distant site in which a telehealth service is provided to a Medicaid recipient.
(e) A Medicaid recipient waives confidentiality of any medical information discussed with the health care provider that is:
(1) provided during a telehealth visit; and
(2) heard by another individual in the vicinity of the Medicaid recipient during a health care service or consultation.
(f) For purposes of a community mental health center, telehealth services satisfy any face to face meeting requirement between a clinician and consumer.
(g) The office shall implement any part of this section that is approved by the United States Department of Health and Human Services.
(h) The office may adopt rules under IC 4-22-2 necessary to implement and administer this section.
As added by P.L.204-2013, SEC.3. Amended by P.L.150-2017, SEC.1; P.L.85-2021, SEC.3; P.L.207-2021, SEC.8; P.L.109-2022, SEC.2.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-12. "Child"; Reimbursement for Specialized or Nonstandard Wheelchairs; Prior Authorization

Sec. 12. (a) As used in this section, "child" includes any of the following:
(1) An individual who is less than eighteen (18) years of age.
(2) An individual who is at least eighteen (18) years of age and either:
(A) continues to be enrolled in a kindergarten through grade 12 school; or
(B) has a developmental disability.
(b) The office shall reimburse a nursing facility for a specialized or nonstandard wheelchair for a child recipient who resides in a nursing facility at a rate outside the nursing facility's per diem payment for nursing facility services, regardless of whether the child recipient is determined by the office to be rehabilitative.
(c) The office may require prior authorization for reimbursement under this section.
As added by P.L.108-2014, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-13. Coverage for Treatment of Opioid or Alcohol Dependence; Office Requirements; Report Use of Medications to Committee

Sec. 13. (a) The office shall provide coverage for treatment of opioid or alcohol dependence that includes the following:
(1) Counseling services that address the psychological and behavioral aspects of addiction.
(2) When medically indicated, drug treatment involving agents approved by the federal Food and Drug Administration for the:
(A) treatment of opioid or alcohol dependence; or
(B) prevention of relapse to opioids or alcohol after detoxification.
(3) When determined by the treatment plan to be medically necessary, inpatient detoxification in accordance with the most current edition of the American Society of Addiction Medicine Patient Placement Criteria.
(b) The office shall:
(1) develop quality measures to ensure; and
(2) require a managed care organization to report;
compliance with the coverage required under subsection (a).
(c) The office may implement quality capitation withholding of reimbursement to ensure that a managed care organization has provided the coverage required under subsection (a).
(d) The office shall report the clinical use of the medications covered under this section to the mental health Medicaid quality advisory committee established by IC 12-15-35-51. The mental health Medicaid quality advisory committee may make recommendations to the office concerning this section.
As added by P.L.209-2015, SEC.11. Amended by P.L.8-2016, SEC.1; P.L.152-2017, SEC.6; P.L.179-2019, SEC.1.
2023 Indiana Code › Title 12. Human Services › Article 15. Medicaid › Chapter 5. Services Provided › 12-15-5-13.5. Medically Necessary

Sec. 13.5. (a) Services provided to an individual while detained under IC 12-26-5 are medically necessary when provided in accordance with generally accepted clinical care guidelines.
(b) The office shall require managed care organizations to consider services provided to an individual while detained under IC 12-26-5 as medically necessary when provided in accordance with generally accepted clinical care guidelines.
As added by P.L.205-2023, SEC.4.