reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 2 - Eligibility Requirements Other than Need › Section 2-3 - Disability definition and determination

Current through July 10, 2024
Authority: IC 12-15-1-10
Affected: IC 12-13-7-3; IC 12-14-15-1; IC 12-15
Sec. 3.
The definition of disability set forth in
				  42
				  U.S.C. 1382c(a)(3) will be
				  used in making the disability determination of an individual applying for
				  disability benefits.
Transferred from the Division of Family and Children ( 470
					 IAC 9.1-2-3 ) to the Office of the Secretary of Family and Social Services (
					 405 IAC 2-2-3 ) by P.L. 9-1991, SECTION 131, effective January 1,
					 1992.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 2 - Eligibility Requirements Other than Need › Section 2-4 - Payment for examinations and tests

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC
				  12-13-5-1
Sec. 4.
If the office of Medicaid policy and planning (office) makes
				  the individual's disability determination, then the office shall pay for the
				  costs of necessary medical examinations and diagnostic tests required to
				  determine whether the applicable visual or disability requirement is met to
				  qualify for Medicaid to the blind or disabled, subject to the following
				  limitations:
(1) Payment will be made
				only to the medical practitioner upon submission of a completed claim form
				prescribed by the office.
(2)
				Payment for the cost of submitting a report of a previously completed medical
				examination or other record shall not exceed ten dollars ($10).
(3) Payment for an eye examination and
				completion of a report thereon shall not exceed twenty-nine dollars
				($29).
(4) Payment for a physical
				examination or evaluation and completion of a report thereon shall not exceed
				sixty-five dollars ($65). Examination fees include expenses for basic blood
				testing and urinalysis. Fees relating to these tests will not be reimbursed
				separately.
(5) Payment for a
				psychiatric evaluation or testing and completion of a report thereon shall not
				exceed eighty dollars ($80) per hour.
(6) Diagnostic procedures, such as laboratory
				tests, x-rays, and special testing, may be reimbursed only if authorized in
				advance of the procedure by the Medicaid medical review team (MMRT) physician.
				Authorization will only be granted if additional testing is necessary in order
				to:
(A) confirm the diagnosis or to measure
				the severity of the impairment; or
(B) assist in completing the examination.
Payment will not be made for any treatment given to the
				  applicant.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 2.5 - Eligibility for Medicaid under Modified Adjusted Gross Income Standards › Section 2.5-1 - Definitions

Current through July 10, 2024
Authority: IC 12-15-21
Affected: IC 12-15-2; IC 12-15-3
Sec. 1.
For purposes of this rule, the following definitions
				  apply:
(1) "Family size" means the
				number of persons counted as members of an individual's household. In the case
				of determining the family size of a pregnant woman:
(A) the pregnant woman is counted as herself
				plus the number of children she is expected to deliver for her own eligibility
				determination; and
(B) the pregnant
				woman is counted as one (1) person in any other assistance group where she is
				included.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 2.5 - Eligibility for Medicaid under Modified Adjusted Gross Income Standards › Section 2.5-2 - Eligibility under MAGI

Current through July 10, 2024
Authority: IC 12-15-21
Affected: IC 12-15-2; IC 12-15-3
Sec. 2.
(a) The
				eligibility requirements in this rule only apply to the MAGI group defined in
				section 1 of this rule. The office shall continue to apply all other
				eligibility standards as provided in this title to non-MAGI groups.
(b) Notwithstanding any other provision in
				this article, the office shall not apply any asset or resource test or income
				or expense disregards, except for the five percent (5%) income disregard in
				subsection (d), for any individuals in the MAGI eligibility group with the
				highest income standard under which the individual may be determined.
(c) Except as provided in subsection (j), an
				individual's financial eligibility for Medicaid under this section is based on
				the individual's household income as defined in subsection (d). An individual
				whose eligibility is being determined under this section will be eligible for
				Medicaid if the MAGI-based income of the individual's household meets the
				financial threshold requirements in accordance with federal poverty levels
				established by the office under this title.
(d) Except as provided in subdivision (1),
				household income is the sum of the MAGI-based income, as defined in section 1
				of this rule, of the individual and every individual in the individual's
				household, minus the amount equivalent to five (5) percentage points of the
				federal poverty level for the applicable family size as follows:
(1) The MAGI-based income for a tax filer
				will include the income of a claimed child or tax dependent if the child or tax
				dependent will be required to file a tax return under
				26 U.S.C.
				6012(a)(1) for the taxable
				year in which eligibility is being determined.
(2) If the child or tax dependent will not be
				required to file a tax return under
				26 U.S.C.
				6012(a)(1), the income of
				the child or tax dependent will not count in the household income for the
				taxpayer who claims them for the taxable year in which eligibility is being
				determined.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 2.5 - Eligibility for Medicaid under Modified Adjusted Gross Income Standards › Section 2.5-3 - Administrative appeals

Current through July 10, 2024
Authority: IC 12-15-21
Affected: IC 12-15-2; IC 12-15-3; IC 12-15-28
Sec. 3.
An individual may appeal the office's determination of
				  ineligibility under this rule in accordance with the appeal procedures under
				  405 IAC 1.1.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-1.1 - Transfer of property; penalty

Current through July 10, 2024
Authority: IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5; IC 12-15-39.6
Sec. 1.1.
(a) The
				following definitions apply throughout this section:
(1) "Assets" includes all income and
				resources of the applicant or member, and of the applicant's or member's
				spouse, including any income or resources that the applicant or member or the
				applicant's or member's spouse is entitled to receive but does not receive
				because of action by:
(A) the applicant or
				member or the applicant's or member's spouse;
(B) a person, including, but not limited to,
				a court or administrative body with legal authority to act in place of or on
				behalf of the applicant or member or the applicant's or member's spouse;
				or
(C) a person, including, but not
				limited to, a court or administrative body acting at the direction or upon the
				request of the applicant or member or the applicant's or member's spouse.
The term includes assets that an individual is entitled to
				  receive but does not receive because of failure to take action subject to
				  subsection (j).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-1.2 - Annuities

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-15-4
Sec. 1.2.
(a) For
				purposes of this section, "annuity" means a policy, certificate, contract, or
				other arrangement between two (2) or more parties whereby one (1) party pays a
				lump sum of money or other valuable consideration to the other party in return
				for the right to receive payments in the future and shall include any similar
				financial instrument, as may be specified by the Secretary of Health and Human
				Services. An annuity not purchased from an entity described in subsection (b)
				will be considered a transfer for inadequate consideration.
(b) The purchase of an annuity, any
				instrument purporting to be an annuity, or any other arrangement that meets the
				definition of an annuity in subsection (a) shall be considered an uncompensated
				transfer of assets resulting in a penalty under section 1.1 of this rule unless
				the annuity is purchased from one (1) of the following:
(1) An insurance company or another
				commercial company that sells annuities as part of the normal course of
				business.
(2) A nonprofit
				organization qualified under Section 501(c) of the Internal Revenue Code as
				amended.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-2 - Life care contracts

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-13-7-3; IC 12-15
Sec. 2.
(a) An
				applicant who has entered into a life care contract with an institution whereby
				he or she has transferred his or her available assets to the institution in
				exchange for full maintenance and medical care during his or her lifetime in
				that institution is ineligible for Medicaid for the aged, blind, or disabled
				unless the contracting institution can prove to the division by a complete and
				accurate accounting of all funds involved that it is unable to fulfill its
				contract obligations to the applicant.
(b) For purposes of determining an
				individual's eligibility for, or an amount of, benefits under this article,
				when an applicant or member residing in a continuing care retirement community
				or similar life care community collects an entrance fee on admission from such
				individual the fee shall be considered an available resource to the extent
				that:
(1) an individual who has the ability to
				use the entrance fee, or should the contract provide that the entrance fee may
				be used, to pay for care should other resources or income of the individual be
				insufficient to pay for such care;
(2) the individual is eligible for a refund
				of any remaining entrance fee when the individual dies or terminates the
				continuing care retirement community or life care community contract and leaves
				the community; and
(3) the entrance
				fee does not confer an ownership interest in the continuing care retirement
				community or life care community.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-4 - Income of legally responsible relatives; inclusion

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 4.
The countable income of an applicant or member includes
				  income of certain legally responsible relatives in the following
				  situations:
(1) Except as provided in
				subdivision (3), if the applicant or member is under eighteen (18) years of age
				and is living with his or her parent, his or her income includes the income of
				his or her parent.
(2) If the
				applicant or member is living with his or her spouse, his or her income
				includes the income of his or her spouse.
(3) Income of the parent is not included if
				the applicant or member is under eighteen (18) years of age and has been
				approved from home and community based services under an approved waiver, in
				accordance with
				42 U.S.C.A.
				1396n, which specifies the exclusion of
				parental income.
Transferred from the Division of Family and Children (
					 470
					 IAC 9.1-3-6 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 2-3-4 ) by P.L. 9-1991,
					 SECTION
					 131, effective January 1,
					 1992.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-10 - Spend-down eligibility

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 10.
(a) The
				following definitions apply throughout this section:
(1) "County office" means the county office
				of the division of family resources of the family and social services
				administration.
(2) "Incurred
				medical expenses" has the meaning set forth in
				42
				CFR 435.121(f) and
				subsection (e). The term includes expenses incurred by the applicant's or
				recipient's spouse or parent whose income is counted in determining the
				applicant's or recipient's eligibility for Medicaid. The term does not include
				expenses that are subject to payment or have been paid by a third party, except
				expenses paid by the following:
(A) A state
				program.
(B) A local
				program.
(C) Discounts or
				assistance received under the Medicare drug discount card and transitional
				assistance program authorized under
				42
				U.S.C. 1395w-141.
(3) "Spend-down obligation" means the amount
				of any excess monthly income remaining in the eligibility determination in
				section 20(a)(14) of this rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-11 - Loans; inclusion as income

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 11.
(a) A loan
				shall not be considered as income in the month of receipt if the written or
				verbal loan agreement is legally binding under state law and includes the
				following:
(1) the borrower's acknowledgement
				of an obligation to repay; and
(2)
				a timetable and plan for repayment; and
(3) the borrower's express intent to repay
				either by pledging real or personal property or anticipated income.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-12 - Contract sale of real property; calculation as income

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 12.
(a) A
				property agreement is a pledge of security of a property for the payment of a
				debt or the performance of some other obligation within a specified period of
				time. A land contract is a property agreement whereby there is a contract for
				the sale of real estate in which the seller of the real estate retains legal
				title to the real estate until the total contract price is paid by the buyer.
				Pursuant to the Deficit Reduction Act of 2005, land contracts or property
				agreements must meet the following criteria:
(1) The repayment term must be actuarially
				sound in that it cannot be set up in terms that exceed the applicant's/member's
				life expectancy.
(2) Payment must
				be made in equal amounts during the term with no deferral of payment and no
				balloon payment.
(3) The land
				contract or property agreement must prohibit the cancellation of the balance
				upon the death of the lender. If a balance remains upon the death of the
				lender, it must be designated to the estate of the deceased in order to be
				considered valid.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-13 - In-kind support and maintenance; inclusion as income

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 13.
(a) The
				following definitions apply throughout this section:
(1) "In-kind support and maintenance" means
				any food, clothing, or shelter which is received by the applicant or recipient
				and his or her spouse, or by the child applicant or recipient and his or her
				parent(s) because someone else pays for it.
(2) "Shelter" means room, rent, mortgage
				payments, real property taxes, heating fuel, gas, electricity, water, sewerage,
				and garbage collection services.
(3) "Pro rata share of shelter" means the
				average value of monthly shelter costs divided by the number of people in the
				household, regardless of age.
(4)
				"Pro rata share of food" means the average monthly expenses for food divided by
				the number of people in the household, regardless of age.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-14 - Resources, limitations, and exclusions

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-13-7-3
Sec. 14.
(a)
				Individuals eligible under
				405
				IAC 2-1,
				405 IAC
				2-2, and this rule, respectively, are subject to
				resource definitions and exclusions as provided in
				42
				U.S.C. 1382b and at 20 CFR Part 416, Subpart
				L Resources.
(b) Resources
				identified in
				20 CFR
				416.1210 are excluded, and other resources
				that are excluded include the following:
(1)
				The equity value of personal property used to produce food for home consumption
				or used in the production of income.
(2) Income-producing real property if the
				gross income produced from the real property is greater than the expenses of
				ownership.
(3) For an applicant or
				member of Medicaid under the blind category, an amount of his or her resources,
				as specified in an approved plan for achieving self-support, is disregarded for
				a period of time not to exceed twelve (12) months. Such a plan will be approved
				by the office if the plan is in writing and fully documents that the resources
				to be disregarded will be used by the applicant or member in pursuing a bona
				fide activity aimed at achieving self-support.
(4) The home including the shelter where at
				least one (1) of the following individuals resides:
(A) The applicant or member.
(B) The spouse of the applicant or
				member.
(C) The parent or parents
				of the applicant or member.
(D) The
				applicant's or member's biological or adoptive child or children under eighteen
				(18) years of age.
(E) The
				applicant's or member's blind or disabled biological or adoptive child or
				children eighteen (18) years of age or older.
The home also includes the land on which the shelter is
				  located and related outbuildings. The home is exempt until such time as it is
				  verified that none of the persons listed in clauses (A) through (E) intends to
				  reside there.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-15 - Resources; limitations and exclusions

Current through July 10, 2024
Authority: IC 12-15
Affected: IC 12-13-7-3; IC 12-15
Sec. 15.
(a) An
				applicant or recipient is ineligible for medical assistance for any month in
				which the total equity value of all nonexempt personal property exceeds the
				applicable limitation, set forth as follows, on the first day of the month:
(1) One thousand five hundred dollars
				($1,500) for the applicant or recipient, including the amount determined in
				subsection (b), or in addition to the amount determined in subdivision (3), if
				applicable.
(2) Two thousand two
				hundred fifty dollars ($2,250) for the applicant or recipient and his or her
				spouse if the couple is living together, or if the most recent continuous
				period of institutionalization of one (1) member of the couple began prior to
September 30, 1989.
(3) Twelve thousand dollars ($12,000),
				subject to adjustment under Section 1924(g) ofthe Social Security Act, as the
				spousal resource standard provided for in Section 1924(f)(2)(A)(i) of the
				Social Security Act, or a higher amount as determined under:
(A) Section 1924(f)(2)(A)(ii);
(B) Section 1924(f)(2)(A)(iii); or
(C) Section 1924(f)(2)(A)(iv);
of the Social Security Act for a community spouse as defined
				  in Section 1924(h) of the Social Security Act.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-16 - Funeral trusts; consideration

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15; IC 30-2-10
Sec. 16.
A funeral trust established under IC 30-2-10 et seq. which
				  contains a technical defect in the documents required by IC 30-2-10-5 shall be
				  deemed for the purposes of Medicaid eligibility to be valid as of the original
				  date of establishment of the trust if the defect is corrected within twenty
				  (20) days after receipt of notice from the county department of the defect.
Transferred from the Division of Family and Children (
					 470 IAC
					 9.1-3-18 ) to the Office of the Secretary of Family
					 and Social Services ( 405 IAC 2-3-16 ) by P.L. 9-1991, SECTION 131, effective
					 January 1, 1992.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-17 - Income eligibility of institutionalized applicant or member with community spouse; posteligibility

Current through July 10, 2024
Authority: IC 12-15-1-10
Affected: IC 12-15
Sec. 17.
(a) As used
				in this section, "institutionalized spouse" and "community spouse" have the
				meanings set forth in
				42
				U.S.C.A.
				1396r-5(h)(1).
(b) The income eligibility of an
				institutionalized applicant or member with a community spouse shall be
				determined in accordance with
				405 IAC
				2-1.1-5(g).
(c) If an applicant or member is determined
				eligible for Medicaid under subsection (b), posteligibility treatment of income
				to calculate the amount of income to be paid to the institution is determined
				as follows:
(1) Subtract from the applicant's
				or member's gross income determined according to ownership provisions set forth
				in
				42
				U.S.C.A. 1396r-5(b) those
				exclusions required by federal law.
(2) Subtract a spousal allocation equal to
				the community spouse's total income, in accordance with ownership provisions
				set forth in
				42
				U.S.C.A. 1396r-5(b),
				subtracted from the sum of nine hundred eighty-four dollars ($984), plus an
				excess shelter allowance determined under
				42
				U.S.C.A. 1396r-5(d)(4),
				subject to all provisions of
				42
				U.S.C.A. 1396r-5(d), 42
				U.S.C.A. 1396r-5(e), and
				42
				U.S.C.A.
				1396r-5(g).
(3) Subtract an allocation for each dependent
				family member, as defined in subsection (e), equal to one-third (1/3) of the
				amount by which nine hundred eighty-four dollars ($984) exceeds the family
				member's total income, subject to the provisions of
				42
				U.S.C.A. 1396r-5(d), 42
				U.S.C.A. 1396r-5(e), and
				42
				U.S.C.A.
				1396r-5(g).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-18 - Income standards

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 18.
(a) The
				standards used in determining the income eligibility of an applicant or
				recipient under sections 17 and 20 of this rule are as follows:
(1) Individual standard, four hundred seventy
				dollars ($470).
(2) Couple
				standard, seven hundred five dollars ($705).
(3) Nonapplicant or nonrecipient dependent
				child standard, two hundred thirty-five dollars ($235).
(4) Applicant or recipient dependent child
				standard, four hundred seventy dollars ($470).
(5) Essential person standard, two hundred
				thirty-five dollars ($235).
(6) One
				(1) parent standard, four hundred seventy dollars ($470).
(7) Two (2) parent standard, seven hundred
				five dollars ($705).
(8) Stepparent
				standard, two hundred thirty-five dollars ($235).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-19 - Income deemed from parents

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 19.
(a) Except
				as provided in section 4 of this rule, the amount of income of a parent(s) to
				be included as income to an applicant or recipient in section 20 of this rule
				is determined according to the following procedures:
(1) Determine the unearned income of the
				parent(s) which is not excluded by state or federal statute or
				regulation.
(2) If the stepparent
				of the applicant or recipient is living in the home of the applicant or
				recipient and his or her parent, subtract an allocation from the income of the
				parent as determined under subsection (b).
(3) Subtract an allocation to dependent
				children as determined under subsection (b).
(4) Subtract the general income disregard
				specified in section 3 of this rule. The resulting amount is countable unearned
				income.
(5) Determine the earned
				income of the parent(s).
(6)
				Subtract any remaining allocation to dependent children as determined under
				subsection (b).
(7) Subtract any
				remaining amount of the general income disregard.
(8) Subtract the earned income disregard
				specified in section 3 of this rule. The resulting amount is countable earned
				income.
(9) Combine countable
				unearned and countable earned income.
(10) Subtract the appropriate parental income
				standard specified in section 18 of this rule.
(11) The resulting amount is deemed as income
				to the applicant or recipient.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-20 - Income eligibility of applicant or recipient

Current through July 10, 2024
Authority: IC 12-13-5-3; IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 20.
(a) Except
				as provided in section 17 of this rule, an applicant's or recipient's income
				eligibility shall be determined by the following procedures:
(1) Determine the applicant's or recipient's
				unearned income which is not excluded by state or federal statute or
				regulation.
(2) Add to the amount
				determined in subdivision (1) the amount of the spouse's unearned income after
				subtracting any allocation to a dependent child of the spouse as provided in
				subsection (b).
(3) Add to the
				amount determined in subdivision (1) any deemed income from a parent as
				determined under section 19 of this rule.
(4) Subtract the general income disregard
				specified in section 3 of this rule.
(5) Subtract any allocation as determined
				under subsection (b). The resulting amount is countable unearned
				income.
(6) Determine the earned
				income of the applicant or recipient.
(7) Add the spouse's earned income after
				subtracting any remaining allocation to a dependent child from subdivision
				(2).
(8) Subtract any remaining
				general income disregard.
(9)
				Subtract the remaining allocations as determined under subsection
				(b).
(10) Subtract the earned
				income disregard specified in section 3 of this rule. The resulting amount is
				countable earned income.
(11)
				Combine countable unearned and countable earned income.
(12) Subtract the individual income standard
				specified in section 18 of this rule if the applicant or recipient is not
				living with a spouse or is living with a spouse who is receiving assistance to
				families with dependent children.
(13) Subtract the couple income standard
				specified in section 18 of this rule if the applicant or recipient is living
				with a spouse who is not receiving assistance to families with dependent
				children.
(14) If the resulting
				amount in subdivision (12) or (13) is zero dollars ($0) or less than zero
				dollars ($0), the applicant or recipient is eligible for medical assistance. If
				the resulting amount is greater than zero dollars ($0), the applicant or
				recipient is eligible if he or she meets the requirements of section 10 of this
				rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-21 - Posteligibility income calculation

Current through July 10, 2024
Authority: IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5; IC 12-15-7-2
Sec. 21.
Except as provided in section 17 of this rule, the following
				  procedures are used to determine the amount of income to be paid to an
				  institution for an applicant or recipient who has been determined eligible
				  under section 20 of this rule and who is residing in a Title XIX certified
				  hospital, nursing facility, intermediate care facility for the mentally
				  retarded, or public institution:
(1)
				Determine the applicant's or recipient's total income which is not excluded by
				federal statute. Total income includes amounts deducted in the eligibility
				determination under section 20 of this rule.
(2) Subtract the minimum personal needs
				allowance specified in IC 12-15-7-2.
(3) Subtract an amount for increased personal
				needs as allowed under Indiana's approved Medicaid state plan. The increased
				personal needs allowance includes, but is not limited to, court ordered
				guardianship fees paid to an institutionalized applicant or recipient's legal
				guardian, not to exceed thirty-five dollars ($35) per month. Guardianship fees
				include all services and expenses required to perform the duties of a guardian,
				as well as any attorney fees for which the guardian is liable.
(4) Subtract the amount of health insurance
				premiums.
(5) Subtract an amount
				for expenses incurred for necessary medical or remedial care recognized by
				state law but not covered under the state plan, subject to any reasonable
				limits set forth in Indiana's approved Medicaid state plan.
(6) The resulting amount is the amount by
				which the Medicaid payment to the facility shall be reduced.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-22 - Trusts

Current through July 10, 2024
Authority: IC
				  12-13-5-3; IC
				  12-15-1-10
Affected: IC
				  12-15-2-17;
				  IC 12-15-3
Sec. 22.
(a) This
				section:
(1) governs the treatment of trusts
				when determining eligibility of an applicant or member of Medicaid;
				and
(2) applies to trusts
				established by an applicant or member of Medicaid as defined in subsection (e).
As used in this section, "individual" means an applicant or
				  member of Medicaid.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-23 - Savings bonds

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-15-3
Sec. 23.
(a) United
				States Savings Bonds are considered an available resource for Medicaid
				eligibility purposes beginning the first day following the mandatory retention
				period.
(b) The value of the bonds
				shall be determined as follows:
(1) Bonds
				issued at face value shall be valued at face value.
(2) Bonds issued for less than face value
				shall be valued at the purchase price.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-24 - Undue hardship exception for Medicaid eligibility purposes

Current through July 10, 2024
Authority: IC 12-13-7-3; IC 12-15-1-10
Affected: IC 12-15-2-10
Sec. 24.
(a) At the
				time an applicant is notified that they are being denied Medicaid benefits due
				to:
(1) section 1.1 of this rule;
(2) section 22 of this rule; or
(3) both sections 1.1 and 22 of this rule;
				the state shall notify the applicant that a hardship exception to the rules
				exists.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3 - Eligibility Requirements Based on Need; Aged, Blind, and Disabled Program › Section 3-25 - College savings accounts

Current through July 10, 2024
Authority: IC
				  12-13-7-3;
				  IC
				  12-15-1-10
Affected: IC
				  12-15-3-8;
				  IC
				  21-9-2-2;
				  IC
				  21-9-2-11
Sec. 25.
(a) Subject
				to subsection (b) and any applicable federal law, any money deposited in an
				account (as defined in IC 21-92-2 ) 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.
(b) Any money withdrawn from an account
				described in subsection (a) shall be used for eligible educational expenses, as
				determined by
				26 U.S.C.
				529, for the designated
				beneficiary.
(c) Any money
				withdrawn from an account described in subsection (a) that is not used in
				accordance with subsection (b) may be considered one (1) of the following:
(1) An invalid transfer subject to a penalty
				as described in section 1.1 of this rule.
(2) A converted resource countable in the
				month of the withdrawal unless the converted resource is otherwise
				exempt.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.1 - Eligibility Requirements Based on Need; Pregnancy-Related Coverage; Coverage for Children 18 Years of Age and Under (Voided)

Current through July 10, 2024
Voided by P.L. 119-1997, SECTION 6, effective April 9,
				  1997.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.2 - Presumptive Eligibility Services for Pregnant Women › Section 3.2-1 - Definitions

Current through July 10, 2024
Authority: IC 12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 1.
The following definitions apply throughout this rule:
(1) "Ambulatory prenatal care services" means
				outpatient services related to pregnancy, including prenatal services and
				services related to other conditions that may complicate the
				pregnancy.
(2) "Division" means:
(A) the office of the Indiana family and
				social services administration;
or
(B) an
				office that is operated by a contractor of the office to accept Medicaid
				applications.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.2 - Presumptive Eligibility Services for Pregnant Women › Section 3.2-2 - Qualified providers provided with application tools and information

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 2.
The office shall provide each qualified provider with the
				  following:
(1) Access to application
				forms for presumptive eligibility and Medicaid.
(2) Information on how to assist a woman in
				applying for presumptive eligibility and Medicaid.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.2 - Presumptive Eligibility Services for Pregnant Women › Section 3.2-3 - Application; qualified providers to establish presumptive eligibility; presumptive eligibility criteria

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC
				  12-15-2-13
Sec. 3.
(a) An
				application for presumptive eligibility must be made to a qualified
				provider.
(b) A qualified provider
				shall establish presumptive eligibility if the:
(1) woman is pregnant, as evidenced by a
				verifiable pregnancy;
(2) qualified
				provider determines, on the basis of preliminary information provided by the
				woman, that the:
(A) gross family income of
				the woman does not exceed the amount set forth in IC 12-15-2-13;
(B) woman is an Indiana resident;
(C) woman is a United States citizen or a
				qualified alien, as defined in
				8
				U.S.C. 1641, who has resided in the United
				States for at least five (5) years; and
(D) woman is not an inmate of a public
				institution;
(3) woman
				is not currently enrolled in Medicaid; and
(4) woman has not previously been granted
				presumptive eligibility for her current pregnancy.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.2 - Presumptive Eligibility Services for Pregnant Women › Section 3.2-4 - Period of presumptive eligibility

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 4.
(a) The
				period of presumptive eligibility begins on the date the qualified provider
				establishes presumptive eligibility. (b) The period of presumptive eligibility
				ends on the earlier of the:
(1) date the
				division makes a Medicaid eligibility determination with respect to the
				woman;
(2) date the woman's
				pregnancy ends or terminates; or
(3) last day of the month following the month
				during which the qualified provider established presumptive eligibility, if the
				woman has not filed an application for Medicaid by that day.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.2 - Presumptive Eligibility Services for Pregnant Women › Section 3.2-5 - Covered and noncovered services

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 5.
(a)
				Ambulatory prenatal care services are covered by presumptive eligibility.
(b) The following services are not
				covered by presumptive eligibility:
(1)
				Inpatient hospital services.
(2)
				Labor and delivery services.
(3)
				Postpartum care services.
(4)
				Contraception.
(5)
				Sterilization.
(6) Ectopic
				pregnancy services.
(7)
				Abortion.
(8) Abnormal products of
				conception.
(9) Hospice.
(10) Long-term care.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.2 - Presumptive Eligibility Services for Pregnant Women › Section 3.2-6 - Appeal rights

Current through July 10, 2024
Authority: IC
				  12-15-1-10
Affected: IC 12-15-4; IC 12-15-5
Sec. 6.
(a) A
				qualified provider's decision regarding presumptive eligibility is not a
				Medicaid eligibility determination. The notice and appeals rights of Medicaid
				applicants and members set forth in 405 IAC 1.1 do not apply. A woman cannot
				appeal a qualified provider's decision regarding presumptive
				eligibility.
(b) The notice and
				appeal rights of Medicaid applicants and members will apply when the division
				makes a Medicaid eligibility determination with respect to the woman.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.3 - Presumptive Eligibility Determinations by Qualified Hospitals › Section 3.3-1 - Definitions

Current through July 10, 2024
Authority: IC 12-15-2.3-12; IC 12-15-21
Affected: IC 12-15-2; IC 12-15-2.3
Sec. 1.
The following definitions apply throughout this rule:
(1) "Applicant" means an individual who has
				been determined presumptively eligible for Medicaid and has submitted an
				application.
(2) "Application"
				means an Indiana application for health coverage.
(3) "Presumptive eligibility period" means
				the period that begins on the day on which a qualified hospital makes a
				presumptive eligibility determination and ends on the earlier of the following:
(A) In the case of an applicant, the day that
				a decision is made on the application.
(B) In the case of a presumptively eligible
				individual, the last day of the month following the month in which a qualified
				hospital determined the individual to be presumptively eligible.
(C) In the case of an individual eligible
				under
				405 IAC
				10-4-1(a), the periods, as
				applicable, in accordance with
				405 IAC 10-4-11(c)
				 through
				405 IAC
				10-4-11(e).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.3 - Presumptive Eligibility Determinations by Qualified Hospitals › Section 3.3-2 - Presumptive eligibility determinations

Current through July 10, 2024
Authority: IC
				  12-15-2.3-12; IC
				  12-15-21
Affected: IC 12-15-2; IC 12-15-2.3
Sec. 2.
The office shall provide reimbursement for covered services
				  during the presumptive eligibility period to an individual who is determined by
				  a qualified hospital, on the basis of preliminary information, to be
				  presumptively eligible.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.3 - Presumptive Eligibility Determinations by Qualified Hospitals › Section 3.3-3 - Presumptive eligibility performance standards and sanctions

Current through July 10, 2024
Authority: IC
				  12-15-2.3-12; IC
				  12-15-21
Affected: IC 12-15-2.3
Sec. 3.
(a) A
				qualified hospital shall meet the following performance standards with regard
				to an applicant's application during the following time periods in order to
				make presumptive eligibility determinations:
(1) Between the effective date of this rule
				and December 31, 2015, as follows:
(A) Eighty
				percent (80%) of presumptively eligible individuals from a qualified hospital
				shall complete and submit an application before the end of the presumptive
				eligibility period.
(B)
				Seventy-five percent (75%) of applications submitted for applicants will be
				sufficiently complete.
(C) Ninety
				percent (90%) of the applicants who complete and submit an application shall be
				determined eligible for a Medicaid program.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.3 - Presumptive Eligibility Determinations by Qualified Hospitals › Section 3.3-4 - Administrative appeals

Current through July 10, 2024
Authority: IC 12-15-2.3-12; IC 12-15-21
Affected: IC 4-21.5-3
Sec. 4.
(a) A
				qualified hospital may appeal the office's revocation of its presumptive
				eligibility status under the provisions of 405 IAC 1-1.4.
(b) The following actions are not sanctions
				and are not appealable:
(1) The office's
				decision to issue a warning to a qualified hospital and to require a corrective
				action plan.
(2) The office's
				decision not to exercise its discretion to lift a hospital's request for
				reinstatement under section 3(e) of this rule.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.4 - Presumptive Eligibility Determinations by Other Qualified Providers › Section 3.4-1 - Definitions

Current through July 10, 2024
Authority: IC 12-15-2.3-12; IC 12-15-21
Affected: IC 12-15-2; IC 12-15-2.3
Sec. 1.
The following definitions apply throughout this rule:
(1) "Applicant" means an individual who has
				been determined presumptively eligible for Medicaid and has submitted an
				application.
(2) "Application"
				means an Indiana application for health coverage.
(3) "Presumptive eligibility period" means
				the period that begins on the day on which a qualified provider makes a
				presumptive eligibility determination and ends on the earlier of the following:
(A) In the case of an applicant, the day that
				a decision is made on the application.
(B) In the case of a presumptively eligible
				individual, the last day of the month following the month in which a qualified
				provider determined the individual to be presumptively eligible.
(C) In the case of an individual eligible
				under
				405 IAC
				10-4-1(a), the periods, as
				applicable, in accordance with
				405 IAC 10-4-11(c)
				 through
				405 IAC
				10-4-11(e).
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.4 - Presumptive Eligibility Determinations by Other Qualified Providers › Section 3.4-2 - Presumptive eligibility determinations

Current through July 10, 2024
Authority: IC
				  12-15-2.3-12; IC
				  12-15-21
Affected: IC 12-15-2; IC 12-15-2.3
Sec. 2.
The office shall provide reimbursement for covered services
				  during the presumptive eligibility period to an individual who is determined by
				  a qualified provider, on the basis of preliminary information, to be
				  presumptively eligible.
Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 3.4 - Presumptive Eligibility Determinations by Other Qualified Providers › Section 3.4-3 - Presumptive eligibility performance standards and sanctions

Current through July 10, 2024
Authority: IC
				  12-15-2.3-12; IC
				  12-15-21
Affected: IC 12-15-2.3
Sec. 3.
(a) A
				qualified provider shall meet the following performance standards with regard
				to an applicant's application during the following time periods in order to
				make presumptive eligibility determinations:
(1) Between the effective date of this rule
				and December 31, 2016, the following:
(A)
				Eighty percent (80%) of presumptively eligible individuals from a qualified
				provider shall complete and submit an application before the end of the
				presumptive eligibility period.
(B)
				Seventy-five percent (75%) of applications submitted for an applicant will be
				sufficiently complete.
(C) Ninety
				percent (90%) of the applicants who complete and submit an application shall be
				determined eligible for a Medicaid program.