2023 Indiana Code › Title 12. Human Services › Article 10. Aging Services › Chapter 10. Community and Home Options to Institutional Care for the Elderly and Disabled Program › 12-10-10-4. "Eligible Individual"

Sec. 4. (a) As used in this chapter, "eligible individual" means an individual who meets the following criteria:
(1) Is a resident of Indiana.
(2) Is:
(A) at least sixty (60) years of age; or
(B) an individual with a disability.
(3) Except as provided in subdivision (5), for an individual who applies initially to the program:
(A) before July 1, 2017, has assets that do not exceed five hundred thousand dollars ($500,000), as determined by the division; and
(B) after June 30, 2017, has assets that do not exceed two hundred fifty thousand dollars ($250,000). In determining assets under this clause, the division shall exclude an additional twenty thousand dollars ($20,000) in countable assets.
(4) Qualifies under criteria developed by the board as having an impairment that places the individual at risk of losing the individual's independence, as described in subsection (b).
(5) An individual who applied initially to the program under IC 12-10-10.5 (expired June 30, 2017) between December 31, 2014, and June 30, 2017, within:
(A) Area 1;
(B) Area 4;
(C) Area 13; or
(D) Area 14;
of the area agencies on aging and had assets that did not exceed two hundred fifty thousand dollars ($250,000). In determining assets under this subdivision, the division shall exclude an additional twenty thousand dollars ($20,000) in countable assets.
(b) For purposes of subsection (a), an individual is at risk of losing the individual's independence if the individual is unable to perform any of the following:
(1) Two (2) or more activities of daily living. The use by or on behalf of the individual of any of the following services or devices does not make the individual ineligible for services under this chapter:
(A) Skilled nursing assistance.
(B) Supervised community and home care services, including skilled nursing supervision.
(C) Adaptive medical equipment and devices.
(D) Adaptive nonmedical equipment and devices.
(2) One (1) activity of daily living if, using the needs based assessment established under section 6.7(1) of this chapter and in accordance with written standards that are established by the division under subsection (g), the area agency on aging determines that addressing the single activity of daily living would significantly reduce the likelihood of the individual's loss of independence and the need for additional services.
(3) An activity that with targeted intervention or assistance with the activity, using the needs based assessment established under section 6.7(1) of this chapter and in accordance with written standards that are established by the division under subsection (g), the area agency on aging determines would significantly reduce the likelihood of the individual's loss of independence and the need for additional services.
(c) Subject to standards established under section 6.7(6) of this chapter, the division shall establish a cost participation schedule for an eligible individual based on the eligible individual's income and countable assets. The cost participation schedule must comply with the following:
(1) Exclude from cost participation an eligible individual whose income and countable assets do not exceed one hundred fifty percent (150%) of the federal income poverty level.
(2) In calculating income and countable assets for an eligible individual, deduct the medical expenses of the following:
(A) The individual.
(B) The spouse of the individual.
(C) The dependent children of the individual.
(3) Exclude twenty thousand dollars ($20,000) of an eligible individual's countable assets from consideration in determining an eligible individual's cost participation.
(d) The division may require annual reverification for eligible individuals who the division determines are likely to experience a material increase in income or assets. An individual shall submit the information requested by the division to carry out the reverification allowed by this subsection.
(e) A case manager from an area agency on aging shall perform the following:
(1) Initial verification of an individual's income and assets.
(2) Annual reverification of an eligible individual's income and assets, as may be required by the division under subsection (d).
(f) The division may not require a family or other person to provide services as a condition of an individual's eligibility for or participation in the program.
(g) The division shall establish written standards setting forth criteria that the area agencies on aging shall use in determining whether an individual who is unable to perform one (1) activity of daily living under subsection (b)(2) or one (1) activity under subsection (b)(3) is eligible for the program.
[Pre-1992 Revision Citation: 4-28-6.1-5.]
As added by P.L.2-1992, SEC.4. Amended by P.L.150-1995, SEC.8; P.L.246-2005, SEC.99; P.L.99-2007, SEC.64; P.L.87-2017, SEC.3; P.L.86-2018, SEC.156.