Indiana Health Coverage Program Policy Manual Chapter 1200 GENERAL PROGRAM INFORMATION Sections 1200.00.00 – 1215.00

1200.00.00 GENERAL PROGRAM INFORMATION ......................................................................... 1 1215.00.00 MEDICAL ASSISTANCE .............................................................................................. 1 1215.05.00 LEGAL BASIS ......................................................................................................... 1 1215.10.00 PROGRAM OVERVIEW .......................................................................................... 1 1215.15.00 ELIGIBILITY CRITERIA ............................................................................................. 1

1

1200.00.00 GENERAL PROGRAM INFORMATION This chapter presents general information about the Indiana Health Coverage Programs (IHCP). 1215.00.00 MEDICAL ASSISTANCE Medicaid is a federal and state funded program which pays for the medical care of people who meet specific categorical non-financial, income, and resource requirements. Individuals can be eligible for full, limited, or emergency Medicaid coverage depending on the category under which they qualify. 1215.05.00 LEGAL BASIS The Medicaid program is established under Title XIX of the Social Security Act. Federal regulations in Title 42 of the Code of Federal Regulations (CFR) provide further legal authority. The Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services is the federal agency which has administrative responsibility for the Medicaid program. 1215.10.00 PROGRAM OVERVIEW Medicaid became effective in Indiana on January 1, 1970. The Medicaid program covers a wide range of medical care and services for eligible individuals. 1215.15.00 ELIGIBILITY CRITERIA The determination of eligibility for Medical Assistance is based upon financial and non-financial requirements. The Medicaid program is comprised of numerous categories of assistance. Each category has additional specific criteria which must be met for eligibility to exist. These requirements are discussed in Chapter 1600.

Indiana Health Coverage Program Policy Manual Chapter 1400 ADMINISTRATIVE POLICY Sections 1400.00.00 – 1055.05.00

Contents 1400.00.00 ADMINISTRATIVE POLICY ........................................................................................ 2

1405.00.00 FAMILY AND SOCIAL SERVICES ADMINISTRATION ................................................... 2 1405.05.00 DIVISION OF FAMILY RESOURCES ........................................................................ 3 1405.15.00 DIVISION OF MENTAL HEALTH AND ADDICTION .................................................. 3 1405.20.00 DIVISION OF AGING ............................................................................................ 3 1405.25.00 DIVISION OF DISABILITY, AGING AND REHABILITATIVE SERVICES (DDARS)............ 3 1405.30.00 OFFICE OF MEDICAID POLICY AND PLANNING (OMPP) ........................................ 3 1405.35.00 RESERVED ........................................................................................................ 3 1405.40.00 THE OFFICE OF EARLY CHILDHOOD AND OUT-OF-SCHOOL LEARNING (OECOSL) .... 3 1410.00.00 PERSONNEL STANDARDS ........................................................................................ 4 1410.10.00 MERIT PERSONNEL FOR ELIGIBILITY CASE PROCESSING ....................................... 4 1410.15.00 USE OF OTHER STAFF .......................................................................................... 4

1410.20.00 SUFFICIENT STAFF ............................................................................................... 5 1415.00.00 OUTREACH ......................................................................................................... 5 1420.00.00 INQUIRIES FOR INFORMATION ............................................................................ 5 1420.05.00 PRINTED MATERIAL ............................................................................................. 6 1420.10.00 MANUALS AND PROGRAM DIRECTIVES ................................................................ 6 1425.00.00 CONFIDENTIALITY .................................................................................................... 6 1425.05.00 ACCESS AND USE OF CONFIDENTIAL INFORMATION ............................................ 7 1425.10.00 RELEASE OF CONFIDENTIAL INFORMATION ......................................................... 7 1425.10.05 RELEASE OF CONFIDENTIAL INFORMATION TO THE INDIVIDUAL ......................... 7 1425.10.10 RELEASE OF INFORMATION TO THIRD PARTIES .................................................... 7 1425.10.10.05 RELEASE OF CONFIDENTIAL INFORMATION WITHOUT CONSENT .................... 7

1425.10.10.20 ISSUANCE OF SUBPOENA ............................................................................... 8

1

1425.10.15 RELEASE OF MEDICAID NUMBERS TO PROVIDERS (MED) ............................ 8

1425.10.15.05 RETROACTIVE OR EMERGENCY SERVICES ....................................................... 9 1425.10.15.10 VALIDATION OF CORRECT MEDICAID NUMBER (MED) .................................... 9 1430.00.00 PROTECTED CASES .............................................................................................. 9 1432.00.00 ADA/REHABILITATION ACT POLICY ......................................................................... 10 1432.05.00 LEGAL BASIS OF THE ADA/REHABILITATION POLICY ............................................ 10 1432.05.05 ACCOMMODATIONS FOR THE ADA/REHABILITATION ACT .................................. 10 1432.10.00 ADA COORDINATOR ........................................................................................... 11 1435.00.00 NON-DISCRIMINATION ....................................................................................... 11 1435.05.00 NON-DISCRIMINATION INFORMATION ............................................................... 11

1440.00.00 COMPLAINTS ......................................................................................................... 11 1440.10.00 APPLICANT/RECIPIENT COMPLAINTS RECEIVED BY DFR ...................................... 12 1440.15.00 COMPLAINTS RECEIVED FROM THIRD PARTIES BY DFR ....................................... 12 1440.20.00 COMPLAINTS OF DISCRIMINATION ..................................................................... 12 1440.20.05 THE DFR AND DISCRIMINATION COMPLAINTS .................................................... 15 1440.20.10 THE FAMILY INDEPENDENCE SECTION AND DISCRIMINATION COMPLAINTS ....... 17 1445.00.00 MANDATORY REPORTING OF CHILD ABUSE OR NEGLECT ....................................... 18 1450.00.00 CASE RECORD MAINTENANCE ............................................................................... 18 1450.10.00 CONTENT OF CASE FILE ...................................................................................... 19 1450.15.00 RETENTION OF CASE RECORDS ........................................................................... 19 1450.20.00 RETENTION OF DOCUMENTS WITHIN THE CASE FILE .......................................... 20

1450.20.05 RETENTION OF DOCUMENTS WITHIN THE CASE FILE .......................................... 21 1455.00.00 DESTRUCTION OF CASE MATERIAL ........................................................................ 21 1455.05.00 REMOVAL OF EXTRANEOUS MATERIAL FROM CASE RECORDS ............................ 21

2

1400.00.00 ADMINISTRATIVE POLICY This chapter presents administrative policy, including: Family and Social Services Administration (Section 1405) Personnel Standards (Section 1410) Outreach (Section 1415) Inquiries for Information (Section 1420) Confidentiality (Section 1425) Protected Cases (Section 1430) ADA/Rehabilitation Act Policy (Section 1432) Non-Discrimination (Section 1435) Complaints (Section 1440) Mandatory Reporting of Child Abuse or Neglect (Section 1445) Case Record Management (Section 1450) Destruction of Case Material (Section 1455) 1405.00.00 FAMILY AND SOCIAL SERVICES ADMINISTRATION The Family and Social Services Administration (FSSA) is the agency of the state responsible for social service and financial assistance programs. The administration includes the following six major service divisions: The Division of Family Resources (DFR) – includes Medical Review Team (MRT) The Division of Mental Health and Addiction (DMHA) The Division of Aging The Disability, Aging and Rehabilitative Services (DDARS) The Office of Medicaid Policy and Planning (OMPP) FSSA Operations – includes Medical Review Team (MRT) The Office of Early Childhood and Out-of-School Learning (OECOSL)

3

FSSA is steadfast in our mission to break the cycle of poverty by providing Hoosiers with the healthcare, social services, and support necessary to achieve lasting economic independence. Through thoughtfully designed and fiscally sustainable programs, we equip individuals and families with the resources and opportunities they need to build stability, reclaim dignity, and secure long-term success. FSSA strives to be a high-performing, integrated agency that efficiently utilizes its resources to provide consistent, reliable services while ensuring responsible stewardship of state and federal funding. 1405.05.00 DIVISION OF FAMILY RESOURCES The Division of Family Resources (DFR) has the responsibility for administering the Medicaid Eligibility Process at the regional and county levels. The Division includes the Medical Review Team. 1405.15.00 DIVISION OF MENTAL HEALTH AND ADDICTION The Division of Mental Health and Addiction (DMHA) is responsible for mental health needs, addiction services, and operation of the state psychiatric hospitals. 1405.20.00 DIVISION OF AGING The Division of Aging was created as Indiana’s State Unit on Aging in accordance with the Older Americans Act (OAA) and falls directly under the Family and Social Services Administration. By Indiana statute, the division is granted the legal authority to establish and monitor programs that serve the needs of Indiana seniors. 1405.25.00 DIVISION OF DISABILITY, AGING AND REHABILITATIVE SERVICES (DDARS) The Division of Disability, Aging and Rehabilitative Services (DDARS) administers social service programs providing continuous lifelong support for citizens in need of disability and rehabilitative supports in the State of Indiana. 1405.30.00 OFFICE OF MEDICAID POLICY AND PLANNING (OMPP) The Office of Medicaid Policy and Planning (OMPP) is responsible for administering Medicaid programs, supporting the local DFR offices and assisting in compliance with federal regulations and the state plan. 1405.35.00 RESERVED 1405.40.00 THE OFFICE OF EARLY CHILDHOOD AND OUT-OF-SCHOOL LEARNING (OECOSL)

4

The Office of Early Childhood and Out-of-School Learning oversees early childcare, education and out-of-school-time programs. 1410.00.00 PERSONNEL STANDARDS Certain personnel standards must be followed in the administration of the Medicaid program. The following sections discuss these requirements. 1410.10.00 MERIT PERSONNEL FOR ELIGIBILITY CASE PROCESSING DFR personnel employed by FSSA used in the determination of eligibility and calculation of benefits are to be stated with merit staff employed by the Division. Functions of the eligibility staff include but are not limited to interviewing, evaluating, information gathering, and establishing eligibility and benefit levels. 1410.15.00 USE OF OTHER STAFF The DFR is encouraged to use volunteers in activities such as prescreening, assisting applicants in completing the application, and securing needed verification.

5

1410.20.00 SUFFICIENT STAFF The DFR should employ sufficient staff to perform eligibility and benefit issuance functions accurately and process fair and timely in accordance with the standards set forth in this manual. 1415.00.00 OUTREACH Outreach is intended to promote education and public awareness of assistance programs as well as increases access to services. Outreach includes: Providing program information Providing referrals to other agencies Training community organizations that provide program information to the public to promote assistance programs Eliminating the social and geographic barriers to participation Encouraging continued participation by AGs. 1420.00.00 INQUIRIES FOR INFORMATION An inquiry is a request for information regarding the eligibility requirements for assistance. Individuals inquiring about assistance are to be given information in written form and orally, as appropriate, regarding eligibility requirements, scope of the program, coverage, and the rights and responsibilities of applicants/recipients.1 Responses to inquiries regarding eligibility should be general. Information regarding agency procedures, income and resource standards, and program requirements may be provided. In no event should individually requesting information be told that they are eligible or ineligible unless that individual has filed an application and an official determination has been made. A worker who makes an eligibility statement without receiving an application and/or completing a thorough investigation of an individual's or family's situation puts the agency at risk of providing benefits to ineligible people and denies the client the right to proper notice which is required by federal law. The notice establishes and supports the client's right to appeal. Verbal communication without written notification serves to interfere with the client's rights.

6

1420.05.00 PRINTED MATERIAL Written information such as brochures, pamphlets, or other material in paper and electronic form that describes basic financial and non-financial eligibility criteria, the application process, and participant rights and responsibilities, is to be made available. This written information should be distributed at local offices and shall be made available to other local agencies upon request. The written information explaining the rules and procedures governing the appeal and hearing process is to be made available by the DFR to each applicant/recipient and to any other interested person.2

1420.10.00 DIRECTIVES The Indiana Health Coverage Program Policy Manual (IHCPPM) and supplemental instructions used in the determination of eligibility shall be accessible via the internet at DFR for examination by members of the public on regular workdays during regular office hours.3 1425.00.00 CONFIDENTIALITY All information obtained by the DFR and maintained in the case record about an applicant/recipient and their circumstances is confidential. Information obtained by DFR from participants or individuals, whether or not they are currently participating, is also considered confidential. Workers who access the agency's records pertaining to their family and friends are violating the client's right to confidentiality and the agency's security agreement. Violators will be subject to appropriate disciplinary action. Once it is determined that a caseworker is related to or has a personal relationship with the client, that case must be assigned to a worker in another office, within the same Region, who has no familial or personal relationship to any of the individuals in the case. A relative, close friend or co-worker may not perform any of the interview or eligibility functions needed to support the case. These types of cases should be transferred to another local office within the same Region, to process and/or to complete the interview.

7

1425.05.00 ACCESS AND USE OF CONFIDENTIAL INFORMATION Access and use of confidential information are to be restricted to those DFR staff members with direct responsibility for establishing eligibility, authorizing benefit levels, and providing services for the individual or family for whom the information was obtained. Confidential information may also be shared with DFR staff who have responsibility for administration and oversight of the programs for which the confidential information was secured. Under no circumstances may a list of names and addresses of applicants/recipients be released for commercial or political purposes.4 1425.10.00 RELEASE OF CONFIDENTIAL INFORMATION Sections 1425.10.05 through 1425.10.15 describe circumstances in which confidential information may be released. 1425.10.05 RELEASE OF CONFIDENTIAL INFORMATION TO THE INDIVIDUAL Upon request of an applicant/recipient and/or their authorized representative for the examination of their case record, all case information pertaining to that individual is to be made available.5 Individuals who request copies of case material may be charged a fee per page (not to exceed the actual cost of copying) by the local DFR office. When a hearing has been requested, federal regulations6 mandate that the claimant, or their representative, will have adequate opportunity to examine the contents of their case file and all documents and records to be used by the agency at the hearing at a reasonable time before the date of the hearing as well as during the hearing. 1425.10.10 RELEASE OF INFORMATION TO THIRD PARTIES Unless permitted in one of the following sections, the release of agency information requires a statement signed by the applicant/recipient, authorizing the local office to release the information to the requesting agency or individual.7 This written authorization must specify the scope of information the Local Office is authorized to release, the specific agency or individual to whom the information is to be released, and the period of time for which information is to be released. The AUTHORIZATION FOR DISCLOSURE OF PERSONAL AND HEALTH INFORMATION form (State Form 54621) should be used to ensure all the needed information is provided and that the parties are aware of their rights and responsibilities under the agreement. Authorizations should be preserved in the case file. 1425.10.10.05 RELEASE OF CONFIDENTIAL INFORMATION WITHOUT CONSENT Confidential information may be released without the applicant's/recipient's permission for purposes directly connected with the following scenarios.

8

The administration of SNAP, TANF, Children and Family Services, IMPACT, Child Support, Medicaid, Title XX, and federal Supplemental Security Income (SSI) programs (such purposes include establishing eligibility, determining the amount of assistance, and providing services) Any investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of any of the above programs Any audit or similar activity (such as a review of expenditure reports or a financial review) conducted in connection with any of the above programs by any governmental entity which is authorized by law to conduct such audit or activity. 1425.10.10.20 ISSUANCE OF SUBPOENA In the event of the issuance of a subpoena for the case record or for a local office representative to testify concerning an applicant/recipient, the attorney for the FSSA is to be immediately informed of this fact. The attorney should make a determination of the appropriateness of releasing the information and, where appropriate, bring to the court's attention the statute and regulation regarding confidentiality. When information is to be made available to any person under compulsory legal process, the DFR should make reasonable efforts to furnish prior notice to the client regarding the release. 1425.10.15 RELEASE OF MEDICAID NUMBERS TO PROVIDERS (MED) Medicaid providers are encouraged to ask all recipients who request medical services to show a valid Hoosier Health Card (Medicaid Card) at the time the service is rendered. The provision of the Hoosier Health Card facilitates the payment authorization process.

9

1425.10.15.05 RETROACTIVE OR EMERGENCY SERVICES Providers who render services during periods immediately prior to the determination of Medicaid eligibility or to persons in emergency situations may experience difficulty in billing the Medicaid program as they may never have the opportunity to see a valid Hoosier Health Card. When verification is needed from the DFR, the provider must submit a written request to obtain a valid Medicaid Recipient I.D. number. Medicaid Recipient I.D. numbers are not to be given over the telephone. The written request from the provider must include the following information: Recipient's name Recipient's Social Security number Recipient's address Recipient's date of birth The service was given. Once the DFR has verified that the patient is (or was on the date of service) an eligible Medicaid recipient, a written response is to be given to the provider identifying the recipient's name, Medicaid recipient I.D. number, and third-party liability information, where applicable. The DFR must include the recipient's name exactly as it appears on the Medicaid enrollment/eligibility file. Since the Medicaid contractor must have the above elements for processing provider claims, the DFR must take care in providing accurate information. The DFR should also provide written information to the provider when the individual for whom a Medicaid Recipient I.D. number is requested is found to be ineligible for Medicaid currently or at the time the service was rendered. 1425.10.15.10 VALIDATION OF CORRECT MEDICAID NUMBER (MED) Occasionally a Medicaid provider may view the card but miscopy the Medicaid recipient I.D. number. In these instances, the provider should make every effort to obtain the correct number from the recipient. If such efforts are unsuccessful, the provider may write to DFR requesting the correct number. The DFR should ask the provider to include in the written request the name of the recipient and the erroneous Medicaid recipient I.D. number. The procedures outlined here and in the preceding subsection must be applied consistently to all Medicaid providers. 1430.00.00 PROTECTED CASES

10

No longer applicable. 1432.00.00 ADA/REHABILITATION ACT POLICY The purpose of Section 504 of the Rehabilitation Act of 1973 (Section 504) and Title II of the Americans with Disabilities Act (ADA) is to protect disabled individuals and individuals who have a relationship or association with a disabled person from discrimination based upon the disability in participation of or obtaining benefits and services which they are otherwise qualified to receive. Section 508 of the Rehabilitation Act of 1973 (Section 508) requires agencies to provide employees and members of the public access to information comparable to the access available to others. DFR does not discriminate against individuals with disabilities, as defined by Section 504, Section 508, the ADA, and other relevant laws. 1432.05.00 LEGAL BASIS OF THE ADA/REHABILITATION POLICY The legal basis for prohibition against discrimination of disabled individuals is Section 504 and the ADA. As a recipient of federal funds under the Medicaid program, DFR is subject to Section 504 and its implementing regulation promulgated by the U.S. Department of Health and Human Services, 45 C.F.R. Part 84. As a state agency providing social services, DFR is subject to the ADA and implementing regulations promulgated by the U.S. Department of Justice, 28 CFR Part 35. 1432.05.05 ACCOMMODATIONS FOR THE ADA/REHABILITATION ACT It is DFR’s policy to provide reasonable accommodation by furnishing individuals with disabilities appropriate auxiliary aid and services where necessary to afford those individuals an equal opportunity to participate in and enjoy the benefits of DFR’s programs and services for which they are otherwise qualified to receive. This includes providing information in accessible formats like braille, large print, and digital navigable formats. DFR provides primary consideration to the accommodation requests of individuals with disabilities; however, requests which fundamentally alter the nature of a service, the programs, or create undue financial or administrative burden upon DFR are addressed by the ADA Coordinator to ensure to the maximum extent possible individuals with disabilities who meet the essential eligibility requirements for the receipt of such DFR services have access to participate in and enjoy the benefit of DFR’s programs and services.

11

1432.10.00 ADA COORDINATOR FSSA has an ADA Coordinator who helps ensure compliance with Section 504, Section 508, the ADA, and other relevant laws. The ADA Coordinator oversees training, advice, and guidance regarding Section 504, Section 508, the ADA, and other relevant laws along with other members of FSSA. DFR staff and contractors, supporting field operations, who have questions or inquiries regarding compliance with Section 504, Section 508, the ADA, or other relevant laws should contact their DFR Regional Manager. DFR staff and contractors working in Central Office who have questions or inquiries regarding compliance with Section 504, Section 508, the ADA, or other relevant laws should contact their supervisor. Both the DFR Regional Managers and Central Office supervisors will then work with the ADA Coordinator to address and resolve any questions and/or inquiries. The ADA Coordinator can be contacted at ADA@fssa.in.gov. 1435.00.00 NON-DISCRIMINATION Individuals will not be discriminated against for reasons of age, race, ethnicity, sex, disability, religious creed, national origin, marital status, veteran status, primary language, or political beliefs in any aspect of program administration including, but not limited to: The acceptance of and responsiveness to a request for assistance The eligibility determination The issuance of Medicaid cards or benefits Fair hearing procedure Any other service offered by DFR. 1435.05.00 NON-DISCRIMINATION INFORMATION In accordance with federal law and U.S. Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of age, race, ethnicity, veteran status, primary language, national origin, sex, age, or disability. If you believe that you have been discriminated against and wish to file a complaint, you may do so by following the instructions below. In order to inform all individuals of their protection against discrimination and to ensure agency compliance with civil rights laws and policies, DFR publicizes the procedures for filing state and federal complaints in order to inform individuals of nondiscrimination compliance. Information regarding the complaint system and an explanation of the procedure must be provided to all individuals immediately upon request. 1440.00.00 COMPLAINTS

12

An applicant/recipient, or a person acting in their behalf, may register any dissatisfaction they may have regarding DFR action or inaction relative to their entitlement to benefits as well as any mistreatment by agency staff. Complaints may be made to the DFR in person, by telephone or by letter. Some complaints may be directed to the FSSA or other officials of federal or state government. Complaints directed to other governmental offices are normally referred to the DFR for investigation and reply. All complaints are to be given prompt, courteous, and thorough attention by DFR staff. 1440.10.00 APPLICANT/RECIPIENT COMPLAINTS RECEIVED BY DFR Upon receipt of a complaint from an applicant/recipient, the DFR is to take immediate steps to address the problem, including any or all the following: Review the situation to determine whether the action taken was in accord with federal and state law and regulation. (If an error occurs, adjusting action is to be taken immediately.) Promptly interview, telephone, or write the complainant to interpret appropriate aspects of the program. Provide the complainant with appropriate program leaflets. Advise the complainant of other programs and community resources that may be able to meet their needs; and advise complainants of their appeal rights and help them to understand the appeal and hearing process. See IHCPPM 4205.00.00 – 4205.10.00 regarding appeal rights. 1440.15.00 COMPLAINTS RECEIVED FROM THIRD PARTIES BY DFR When the DFR receives a complaint or inquiry on behalf of the applicant/recipient from an individual other than the applicant/recipient, specific information about the applicant/recipient cannot be released without their signed consent. See IHCPPM 1425.00.00 – 1425.10.10.20 regarding confidentiality. If such inquiry is received without an authorization for release of information, the DFR is to provide general information relative to the nature of the complaint. The complainant should be advised of the confidentiality of case records and of the necessity of obtaining the applicant's or the recipient's signed consent should the general information not be sufficient. 1440.20.00 COMPLAINTS OF DISCRIMINATION Federal civil rights laws make it illegal to discriminate against someone who has filed a complaint or has engaged in other Equal Employment Opportunity (EEO) or civil rights activity. Examples of Discrimination: Discrimination can occur in many ways. The actions below are examples of discrimination and non-compliance with civil rights requirements when the action is

13

motivated by or results from a policy that has a disproportionately adverse impact on a person or group of people who belong to one of the protected classes, including: Denial of an individual or household of any service or benefits provided under the program for which the individual or household is otherwise eligible. An example is not providing a translator or other foreign language assistance to a household with limited English proficiency. Failure of DFR staff to provide the same quality, quantity or manner of service or benefits to all. Segregation or separate treatment of individuals in any manner related to the application for or receipt of program benefits (An example is having separate facilities or separate procedures based on race or another protected status and having noticeably better office space in one part of town versus another where populations include a greater percentage of those with protected status). Use of criteria or methods of administration that have the effect of defeating or impairing the objectives of any program (An example is imposing additional eligibility criteria on certain individuals). Selection of sites for offices that exclude or discourage individuals from accessing the benefits of the program, such as offices that are not ADA compliant, are not located on fixed transportation routes, or may be inaccessible to populations that are served. Adverse treatment such as rude, unprofessional, and unresponsive behavior directed at any individual with a protected status. Evidence of Discrimination Evidence of discrimination is established when all the following conditions are met: A complainant shows that they have been adversely affected by a program decision. The adverse action is related to a protected condition; and The person against whom the action was taken is a member of the protected class. Timeframes for Client to File a Formal Complaint: The complaint must be filed no later than 180 days from the date of the alleged discrimination or when the complainant became aware of the action. If circumstances warrant, the Division of Family Resources may extend the filing time.

HOW TO FILE A DISCRIMINATION COMPLAINT

14

Program applicants or program recipients who feel that they have been discriminated against can file a complaint to the following: In-person: Your local DFR office can receive the complaint Mail: Complaints may be mailed to: Division of Family Resources 402 W. Washington Street, Room W392 Indianapolis, IN 46204 To the attention of: Medicaid Civil Rights Phone: Call (317) 233-0826 Email: MedicaidCivilRights@fssa.IN.gov You may also choose to send your complaint to the Health and Human Services Office of Civil Rights (HHS OCR) by the methods listed below. This may be done along with sending your concern to the state by the methods listed above, or you may choose to send to only the state or only the HHS OCR office. The investigations will be separate. Mail: Complaints may be mailed to:

Centralized Case Management Operations U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F HHH Bldg. Washington, D.C. 20201 Email: OCRComplaint@hhs.gov Use the OCR Complaint Portal: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf Phone: You may also call the regional HHS OCR office at (800) 368-1019.

TDD: (800) 537-7697

15

Complaint Format: People who feel they have been discriminated against may file a written or verbal complaint. Anyone contacted about a complaint should make every effort to obtain the following information from the complainant: Name, address, telephone number or other means of contacting the complainant Name and location of office where the alleged discrimination took place Nature of the incident that led to the complaint Protected status (i.e., age, race, ethnicity, sex, disability, religious creed, national origin, marital status, veteran status, primary language, or political beliefs) that the complainant believes was violated Names and contact information of the individuals who have knowledge of the discriminatory action Date of the alleged discriminatory action. 1440.20.05 THE DFR AND DISCRIMINATION COMPLAINTS The DFR's and OMPP’s responsibilities related to handling complaints of discrimination are listed below. Civil Rights complaints are to be forwarded to the appropriate Regional Manager (RM) who will initiate the investigation. Complaints may be forwarded to the RM via telephone or the regional mailbox (email). The RM will notify the Medicaid Civil Rights inbox (MedicaidCivilRights@fssa.IN.gov) so that tracking of the complaint may begin. Tracking will include, at a minimum, date complaint was received by the RM; nature of complaint; disposition of complaint; date final response provided to the client. The tracking of civil rights complaints will be managed by the Medicaid Policy section. Any conflicts of interest will be reported and resolved before the investigation moves forward. The RM will designate a manager in their region to address the complaint. This will include at a minimum: contacting client; reviewing case information or other documentation; rectifying any errors in case processing, etc.; completing a report for DFR records; completing a letter that summarizes the findings and responds to the client’s complaint. The RM will maintain oversight of this process.

16

If the complaint alleges discrimination by a specific worker or refers to one incident (and there is no allegation of or reason to believe that there is a policy or practice in the office that may be discriminatory), refer the complaint to the appropriate DFR State Eligibility Manager and Regional Manager. All complaints must be resolved within ninety (90) calendar days of when the complaint is filed, but an investigation will be initiated upon receipt of the complaint. A letter to the complainant will be drafted with a summary of the findings and actions taken by DFR and/or Medicaid. The letter will include information regarding the right to appeal to the Civil Rights Review Board, which is also stated below. DFR will review the draft of the decision letter prepared by the local DFR office after the investigation is completed and determine if the investigation was thorough and whether appropriate action was taken. If an investigation was not conducted, review the DFR's written report to determine if the reason(s) for not conducting an investigation are acceptable. DFR will mail a copy of the final decision letter to the complainant and forward a copy of the letter to the Medicaid Civil Rights inbox (MedicaidCivilRights@fssa.IN.gov). DFR will follow up on all findings where corrective actions were needed to ensure that the corrective actions have been taken and that problems are not recurring. DFR and OMPP will review discrimination complaint logs to determine if there are any patterns of complaints that may require training or other corrective actions either statewide or in particular project areas. DFR will analyze participation data to determine if there are areas where any protected classes appear to be underrepresented and take corrective action (such as outreach) as needed. DFR will ensure that state agency staff understand and receive annual training on civil rights requirements. APPEAL OF CIVIL RIGHTS COMPLAINT FINDINGS If a complainant disagrees with the findings and actions they can appeal to the Civil Rights Review Board through the following methods, which will be outlined in the letter they receive from DFR. Mail Appeal Request To: Division of Family Resources

17

402 W. Washington Street, Room W392 Indianapolis, IN 46204 To the attention of: Medicaid Civil Rights Appeal Email Appeal Request To: MedicaidCivilRights@fssa.IN.gov The Civil Rights Review Board will be made up of at least one designee from DFR, Medicaid, the Office of Healthy Opportunities, and the Office of General Counsel. Any conflicts of interest will be reported and resolved before the appeal moves forward. The Civil Rights Review Board will obtain and review the investigation record from DFR to make a determination. Once they have obtained and reviewed all of the necessary information, the Civil Rights Review Board will draft a letter that summarizes the findings and responds to the appeal. The letter will be mailed to the complainant, and forwarded to the Medicaid Civil Rights inbox (MedicaidCivilRights@fssa.IN.gov), within sixty (60) days of receiving the appeal, summarizing the Board’s decision and any actions that may be taken as a result. 1440.20.10 THE FAMILY INDEPENDENCE SECTION AND DISCRIMINATION COMPLAINTS The Family Independence Section’s responsibilities in resolving complaints of discrimination are described below. Complaint has been received. Attempt to get as much information as possible as described in Section 1440.20.00 under 'Complaint Format'. If the complaint alleges discrimination by a specific worker or refers to one incident (and there is no allegation of or reason to believe that there is a policy or practice in the office that may be discriminatory), refer the complainant to the appropriate DFR State Eligibility Manager and Regional Manager within one day after receiving receipt. If the complaint alleges widespread discrimination or discriminatory practices in the local office, arrange to have someone from Family Independence Section go to the local office to investigate the allegation. The investigation would be conducted in a manner similar to the procedures described in Section 1440.20.05, but more emphasis would be put on contacting other applicants and recipients of the same protected class as the complainant to see if they had experienced similar treatment. These cases would also be handled in the same timeframes described under local office procedures. Acknowledge receipt of the complaint to the complainant in writing within five days after receipt.

18

Review the draft of the decision letter prepared by the local DFR office or Family Independence Section staff after the investigation is completed. Determine if the investigation was thorough and whether appropriate action was taken. If all of the information is complete and the decision is in keeping with stated findings, forward the report to the appropriate federal regional office. Instruct the DFR to forward a copy of the final decision letter to the complainant. If an investigation was not conducted, review the DFR's written report to determine if the reason(s) for not conducting an investigation are acceptable. Follow up on all findings of 'probable non-compliance' to ensure that corrective actions have been taken and that problems are not recurring. Review discrimination complaint logs to determine if there are any patterns of complaints that may require training or other corrective actions either statewide or in particular project areas. Analyze participation data to determine if there are areas where any protected classes appear to be underrepresented and take corrective action (such as outreach) as needed. Ensure that state agency staff and the DFR understand and receive annual training on civil rights requirements. 1445.00.00 MANDATORY REPORTING OF CHILD ABUSE OR NEGLECT Indiana law requires any individual who has reason to believe that a child is a victim of child abuse or neglect to make a report. A person who knowingly fails to make such a report commits a Class B misdemeanor. Reports are to be made by contacting the local Department of Child Services or law enforcement agency. Each local DFR office should have an established policy which addresses how staff are to report suspected child abuse and neglect. Each worker should be aware of this policy and be encouraged to make appropriate reports. 1450.00.00 CASE RECORD MAINTENANCE The worker is responsible for the maintenance of a complete and accurate case record. Case records serve the following purposes: Provides historical information to substantiate DFR action Provides essential information about the individual’s current situation to reflect their need for assistance

19

Helps to ensure continuity of service by the DFR and/or proper referral to other needed resources Prevents needless repetition of fact gathering Provides material for research and statistical purpose Provides material by which agency policies, practices, and standards of performance can be substantiated and evaluated Serves as the basis for the state's payment to or on behalf of an AG 1450.10.00 CONTENT OF CASE FILE The electronic copy eligibility case file must contain all signed application forms necessary to support the eligibility determination, collateral sources of verification, and correspondence. There is no mandatory requirement as to how material is to be arranged in the eligibility case files. However, it is important that the method adopted by the DFR, or worker, be understood and consistently used.

Information in the file(s) should be consistent with information entered into the Eligibility System. At a minimum, case records must contain the following information: Current and previous Self-Sufficiency plans Copies of referral forms to service providers and/or other organizations. Copies of appointment notices or documentation of appointments if scheduling was done manually; and Contracted service providers are also to maintain case files in accordance with their contracts. Case notes should be kept on comment screens to document the specific barriers participants face and their resolution; contacts between participant, DFR, and contracted service provider; and any other pertinent information. 1450.15.00 RETENTION OF CASE RECORDS Hard or electronic copy case records are not to be taken from the DFR except for official use by employees or for use by proper authority upon court order. Receipts should be made and

20

acknowledged in such cases and proper follow-up should be made to ensure the return of the case records to the file. 1450.20.00 RETENTION OF DOCUMENTS WITHIN THE CASE FILE Most case records are to be maintained for three years. The three-year period starts at different times for different documents. The following is the list of documents that must be retained for the entire life of the case and three years following the date on which the eligibility or claims collection case was discontinued. Application Interview guide Combined application form used for application actions Medical information Absent parent information Assignment of rights forms Court records Legal agreements Records establishing overpaid benefits and/or fraud Social Security Numbers Birth and death records Citizenship records. Other case file records must be retained for a three-year period beginning with the effective date of the action it supports. Those records include but are not limited to: Budget forms Income and expense records used to support the eligibility determination and benefit calculation Notices Hearing decisions Benefit issuance records not related to overpaid or underpaid benefits.

21

Inactive case records may also be preserved during the life of the individual so long as they may be needed for repayments on existing claims. 1450.20.05 RETENTION OF DOCUMENTS WITHIN THE CASE FILE Records of a deceased recipient may be retained as long as necessary for filing claims for recovery against the estate. 1455.00.00 DESTRUCTION OF CASE MATERIAL All case file materials must be maintained for review and audit purposes in accordance with the retention guidelines presented previously. Before destroying case file records, it is important to ensure that the record has lost relevance for all the programs in which the case members participated. When case records have been inactive for three years, a request for record destruction must be submitted to the Archives Division, Commission on Public Records, with a representative sample of three cases for the year. Upon approval, the other inactive case records may be destroyed. 1455.05.00 REMOVAL OF EXTRANEOUS MATERIAL FROM CASE RECORDS The periodic removal of extraneous material from the case record assists in case management. All material which supports the current eligibility determination must be retained. Examples of material to be retained are: Applications Medical information Medical expense information Child support information Assignments Agreements Overpayment information.

22

1 42 CFR 435.905 2 42 CFR 435.905 3 42 CFR 435.905 4 IC 12-14-22-8 5 470 IAC 2.1-3-1 6 42 CFR 431.242 7 42 CFR 431.306

Indiana Health Coverage Program Policy Manual Chapter 1600 CATEGORIES OF ASSISTANCE Sections 1600.00.00 – 1621.00.00

Contents 1600.00.00 CATEGORIES OF ASSISTANCE ...................................................................... 2

1600.05.00 MEDICAID ELIGIBILITY CATEGORIES SUMMARY ..................................... 2 1610.00.00 MEDICAL ASSISTANCE FOR THE AGED, BLIND & DISABLED (MED 1, MED 4) . 2

1610.02.00 SSI ELIGIBLE INDIVIDUALS (MED 1) ........................................................ 3

1610.05.00 AGED INDIVIDUALS (MED 1) .................................................................. 4 1610.10.00 BLIND INDIVIDUALS (MED 1) ................................................................. 4 1610.20.00 DISABLED INDIVIDUALS (MED 1) ........................................................... 4 1610.25.00 RCAP ELIGIBLE INDIVIDUALS (MED 1) .................................................... 5 1610.26.00 EMPLOYEES WITH DISABILITIES (MED 1) ............................................... 5

1610.30.00 QUALIFIED MEDICARE BENEFICIARY (MED 4) ........................................ 5 1610.35.00 SPECIFIED LOW-INCOME MEDICARE BENEFICIARY (MED 4) ................... 6 1610.40.00 QUALIFIED DISABLED WORKER (MED 4) ................................................ 6 1610.45.00 QUALIFIED INDIVIDUALS (MED 4) .......................................................... 6 1610.45.10 MEDICARE BUY-IN PROGRAM BENEFITS ...................................................... 6 1610.46.00 APPLYING THE SIL (SPECIAL INCOME LEVEL) BUDGET FOR MEMBERS RESIDING IN FACILITIES ...................................................................... 9 1610.47.00 APPLYING THE SIL (SPECIAL INCOME LEVEL) BUDGET FOR HCBS WAIVERS.... 9 1610.50.00 PREGNANT HOOSIER WHOSE INCOME INCREASES .............................. 10 1620.00.00 HOOSIER HEALTHWISE (MED 3) ................................................................ 10

1620.05.00 LOW INCOME PARENTS / CARETAKERS ............................................... 11 1620.05.15 TRANSITIONAL MEDICAL ASSISTANCE ................................................. 12

1620.35.00 RESERVED ........................................................................................... 12 1620.35.05 NATIVE AMRICAN/ALASKA NATIVE HIP (MED 3) .................................. 12 1620.36.00 HIP STATE PLAN PLUS (MED 3) ............................................................ 12 1620.37.00 HIP BASIC-STATE PLAN (MED 3) .......................................................... 13 1620.38.00 HIP STATE PLAN PLUS WITH CO-PAYS (MED 3) .................................... 13 1620.39.00 HIP REGULAR PLAN PLUS (MED 3) ....................................................... 13 1620.39.05 HIP REGULAR BASIC (MED 3) ............................................................... 14 1620.40.00 CHILDREN IN PSYCHIATRIC FACILITIES (MED 3) .................................... 14 1620.45.00 REFUGEE MEDICAL ASSISTANCE (MED 2) ............................................ 14 1620.50.00 PREGNANT HOOSIERS - FULL COVERAGE (MED 3) ............................... 15

1620.60.00 CHILDREN UNDER AGE 1 (MED 3) ....................................................... 16

1

1620.65.00 CHILDREN AGE 1 - 5 (MED 3) ............................................................... 16

1620.70.00 CHILDREN AGE 6 - 18 (MED 3) ............................................................. 17 1620.71.00 CHILDREN AGE 1 - 19 (MED 3) ............................................................. 17 1620.72.00 CHILDREN'S HEALTH PLAN (MED 3) ..................................................... 17 1620.73.00 FOSTER CARE INDEPENDENCE ............................................................. 18 1620.74.00 FORMER FOSTER CHILDREN UP TO AGE 26 ......................................... 18

1620.75.00 NEWBORNS ........................................................................................ 18 1620.80.00 FAMILY PLANNING SERVICES ............................................................... 18 1621.00.00 BREAST AND CERVICAL CANCER TREATMENT SERVICES ...................... 19 1622.00.00 HCC (HOOSIER CARE CONNECT) .................................................................... 20

1623.00.00 590 PROGRAM .............................................................................................. 20

1624.00.00 INDIANA PATHWAYS FOR AGING (PATHWAYS) .............................................. 21

2 1600.00.00 CATEGORIES OF ASSISTANCE This chapter of the manual provides information regarding the Medicaid and Hoosier Healthwise program. It also defines each specific Medicaid category under which a person/family can qualify. Additionally, it explains the scope of coverage offered under each category. The Medicaid program has categorical eligibility requirements which must be met in order to receive assistance. These requirements are discussed in detail in Chapter 2400 - Non-Financial Eligibility Requirements. The main sections in this chapter include: • Categories of Assistance (Section 1600). • Medical Assistance for the Aged, Blind, & Disabled (Section 1605). • Hoosier Healthwise (Section 1610). 1600.05.00 MEDICAID ELIGIBILITY CATEGORIES SUMMARY There are 35 categories under which individuals may be eligible for Medicaid coverage. The method used to determine income eligibility (Modified Adjusted Gross Income MAGI/non- MAGI), the type of coverage (traditional fee-for-service or managed care), and the scope of the benefits provided all vary based on the category under which individuals are eligible. (See Chapters 3200 and 3400 for an explanation of MAGI methodology.) The following table lists all of the Medicaid coverage categories, eligibility criteria for each category, the type of benefit package provided, and whether MAGI methods are applied to determine income eligibility. Indiana Medicaid Hierarchy 05052025.p 1610.00.00 MEDICAL ASSISTANCE FOR THE AGED, BLIND & DISABLED (MED 1, MED 4) Medicaid coverage is available to individuals who are aged, blind, or disabled. The scope of coverage varies depending upon the specific category under which an individual qualifies. The categories and scope of coverage are explained in the following sections. As of April 2015, individuals eligible in MED 1 categories who are not in an institution or on a waiver and who are not eligible for Medicare will be enrolled in Hoosier Care Connect (HCC), a coordinated health care program. Hoosier Care Connect members will have to select a managed care entity (MCE) that will help coordinate care with the members’ providers. Care coordination is individualized based on a member’s assessed level of need determined through a health screening. Individuals in MED 1 who are eligible for Medicare and those who reside in institutions or are on a HCBS Waiver will receive Traditional fee-for-service coverage.

3

1610.02.00 SSI ELIGIBLE INDIVIDUALS (MED 1) This category is identified in the eligibility system as MASI.

To be eligible for MASI Medicaid, an individual must be determined to be disabled by the Social Security Administration. When determined SSI disabled and receiving SSI payments, the proper category of assistance is MASI. MASI is based on categorical eligibility and does not have a budget or redetermination. It is a full coverage category with no cost sharing and is at the top of the Medicaid hierarchy, therefore, it should not be replaced with any other category of medical coverage.

MASI should be given only based on information received via SDX Interface from the Social Security Administration. The SDX Payment Information page displays the detailed payment status codes for MASI budgeting. The "Payment status code" indicates if an individual is receiving any dollar amount (SSI benefits) and the "Medicaid Eligibility Code" indicates if the SSI applicant is eligible for Federally administered Medicaid coverage (MASI).

There are several codes received from SSA via SDX interface, however only one will form SSI.

Please see below for detailed information:

This population receives SSI payments: • Federally administered Medicaid coverage should be continued regardless of payment status code (1619(b) participants) • This population may or may not be receiving SSI payments: • Goldberg/Kelly payment continuation • Eligible for Medicaid (N24 Payment Status Only) • Eligible for Medicaid (1634 States Only) • All the remaining listed codes are not eligible for MASI budgeting: • REFUSED TO ASSIGN RIGHTS TO TPL • DEEMING WAIVED, CHILD UNDER A STATE HOME CARE PLAN • REFERRED TO THE STATE FOR MEDICAID DETERMINATION DUE TO ENTITLEMENT OR INCREASE IN DAC BENEFITS UNDER T2 • ELIGIBLE UNDER STATE DETERMINATION (OBSOLETE) • TITLE VIII SPECIAL VETERANS BENEFIT RECEIPIENT • INELIGIBLE PER STATE DETERMINATION (OBSOLETE) • DRUG ADDICITON AND/OR ALCOHOLISM (OBSOLETE) • MEDICAID QUALIFYING TRUST MAY EXIST • REFERRED TO STATE FOR DETERMINATION (1634 STATES) - FEDERAL DETERMINATION NOT POSSIBLE • STATE DETERMINATION - NOT SSA RESPONSIBILITY

4

• WIDOW(ER) - 1634 STATES If the worker questions whether MASI is the correct category, they should contact Helpdesk/PAL rather than open MASI without the correct SSA determination.

If a person has deemed SSI eligibility but is not receiving payments because another SSA benefit amount is more than the maximum SSI amount (such as disabled adult children members), these members should be determined for MED 1 eligibility under normal income and resource rules.

The maximum SSI payment amount should be entered into as SSI income, and any excess above that amount should be entered as Social Security income. This will cause the income to be properly counted in the budget for all programs. This would apply to some widow/ers (see 2414.10.20) and Disabled Adult Children (see 2414.10.10). 1610.05.00 AGED INDIVIDUALS (MED 1) This category is identified in IEDSS as MA A.

To be eligible in this category, an individual must be age 65 or older.1 A person is categorically eligible for MA A beginning with the month they turn 65.

The full range of Medicaid covered services is available to recipients in the MA A category except for aliens who are eligible for emergency services only. 1610.10.00 BLIND INDIVIDUALS (MED 1) This category is identified in IEDSS as MA B.

To be eligible in this category an individual must meet the definition of blindness set forth in State regulation. The definition is the same as that of the SSI program.2

The full range of Medicaid covered services is available to recipients in the MA B category, except for aliens who are eligible for emergency services only. 1610.20.00 DISABLED INDIVIDUALS (MED 1) This category is identified in IEDSS as MA D.

To be eligible under this category, individuals must be substantially impaired as set forth in the definition of disability in State law.3

The full range of Medicaid covered services is available to receipts in the MA D category except for aliens who are eligible for emergency services only.

5

1610.25.00 RCAP ELIGIBLE INDIVIDUALS (MED 1) This category is identified in IEDSS as MA R.

To be eligible for Residential Care Assistance Program-related Medicaid, an individual must:

• Be approved for Room and Board Assistance (RBA). • Be aged, blind, or disabled. The aged, blind, and disabled requirements for RCAP- related Medicaid are the same as those for RCAP.4 • The full range of Medicaid covered services is available to recipients in the MA R category. 1610.26.00 EMPLOYEES WITH DISABILITIES (MED 1) MEDWorks – Medicaid for Employees with Disabilities – consists of two categories identified in IEDSS as MADW and MADI.

A federal law known as the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIA) added two new optional Medicaid categories designed to remove barriers to employment for persons with disabilities by providing access to health care. Effective July 1, 2002, Indiana’s Medicaid Program was expanded to cover these categories with the enactment of P.L. 287-2001.

MADW is the basic MEDWorks category for individuals who meet the Medicaid definition of disability without regard to the person’s employment. MADI is the medically improved category for persons who lose eligibility in the basic category because of an improvement in their medical condition which although is not a medical recovery, is improved to the extent that the Disability definition for the basic category is no longer met.5

To be eligible, individuals must be aged 16-64. Depending on their income, some MEDWorks members must pay premiums. All members pay the regular Medicaid co-payments. 1610.30.00 QUALIFIED MEDICARE BENEFICIARY (MED 4) This category is identified in IEDSS as MA L. To be eligible in this category an individual must be entitled to Medicare Part A.6 There is no other blindness or disability requirement for the QMB category. Medicaid coverage under QMB is limited to payment of the following:7

• The monthly premium for Medicare Part B • The monthly premium for Premium Hospital Insurance under Medicare Part A for individuals not entitled to free Part A • Medicare Parts A and B deductibles and co-insurance.

6

An individual can be simultaneously eligible for QMB and any other full coverage MA. 1610.35.00 SPECIFIED LOW-INCOME MEDICARE BENEFICIARY (MED 4) This category is identified in IEDSS as MA J.

To be eligible in this category, an individual must be entitled to Medicare Part A.8 There is no other blindness or disability requirement for the Specified Low-Income Medicare Beneficiary (SLMB) category.

Medicaid coverage under SLMB is limited to payment of the Medicare Part B premium.9

An individual can be simultaneously eligible for SLMB and any other full coverage MA category. 1610.40.00 QUALIFIED DISABLED WORKER (MED 4) This category is identified in IEDSS as MA G.

To be eligible in this category, an individual must have lost or will lose premium-free Medicare Part A coverage due to his employment status.10

Medicaid coverage under this category is limited to payment of the monthly premium for Medicare Part A.11

An individual is not eligible under this category if they are eligible for Medicaid under any other category. 1610.45.00 QUALIFIED INDIVIDUALS (MED 4) This category is identified in IEDSS as MA I.

To be eligible in this category, an individual must be entitled to Medicare Part A.12 There is a cap amount for QIs each year.

MA I pay the Medicare Part B premium.13

An individual eligible under any other Medicaid category cannot be eligible as a QI.

1610.45.10 MEDICARE BUY-IN PROGRAM BENEFITS

Table 1. Medicare Savings Program Aid Categories

7

Aid Category in IED Benefit Name/Package Minimum Federal Income Limit Indiana’s Income Limit (more generous in most cases) Income Disregard Benefit Can Co- Exist with Full Medicaid category (Full Dual)? Comments MA L Qualified Medicare Beneficiary, QMB 100% FPL 150% FPL $20 general income disregard, $65 + ½ earned income disregard (example: earns $1,065 from a job, we deduct $65 and ½ of the income, and count only $500 of the earned income)

Pays Part A & B premiums, coinsurance, and deductibles Yes MA L/QMB can be open along with full Medicaid or can be open alone (partial dual). MA J Specified Low- Income Medicare Beneficiary, SLMB 120% FPL 170% FPL $20 general income disregard, $65 + ½ earned income disregard (example: earns $1,065 from a job, we deduct Pays Part B premiums only Yes MA J/SMLB can be open along with full Medicaid or can be open alone (partial dual).

8

$65 and ½ of the income, and count only $500 of the earned income) MA I Qualified Individual, QI 135% FPL 185% FPL Note: SSA COLA increases go into effect Jan. 1 of each year; we ignore the increase in Social Security income until new FPL amounts go into effect in March 1 of each year. Pays Part B premiums only No All MA I/QI members are partial duals only MA G Qualified Disabled & Working Individuals, QDWI 200% FPL 200% FPL Note: SSA COLA increases go into effect Jan. 1 of each year; we ignore the increase in Social Security income until new FPL amounts go into Pays Part A premiums only No All MA G/QDWI members are partial duals only

9

effect in March 1 of each year.

1610.46.00 APPLYING THE SIL (SPECIAL INCOME LEVEL) BUDGET FOR MEMBERS RESIDING IN FACILITIES For the correct Medicaid budget to be applied, it is important to select the correct facility type on the Facility Details screen in the eligibility system (if applicable). If it is unclear what type of facility an individual resides in, it must be verified. This can be completed by contacting the individual, authorized representative or facility.

The selections below will build the SIL budget in the eligibility system:

• Developmentally Disabled or Developmental Disability • Nursing Facility/Long Term Care • Hospital • Psychiatric Hospital • CRF/DD Developmentally Disabled

If a member has an approved HCBS waiver, the SIL budget will automatically be applied. For more information regarding the SIL, see IHCPPM 3010.20.15 and 3315.00.00. 1610.47.00 APPLYING THE SIL (SPECIAL INCOME LEVEL) BUDGET FOR HCBS WAIVERS The Eligibility System will automatically update the HCBS waiver status, workers are unable to make these updates. The waiver status is received from the approving waiver State agency. Not all HCBS waiver interfaces will form the SIL budget. The SIL budget will form in the Eligiblity System when the interface displays:

• Active • Pend for Aid and Eligibility • Pend for Other Information

The SIL budget will not form in the eligibility system when the interface displays:

• Targeted • Terminated from Waiver • Denied

10

1610.50.00 PREGNANT HOOSIER WHOSE INCOME INCREASES When a pregnant individual receives an increase in income, their Medicaid eligibility must continue without change.14 They shall remain eligible in the same category regardless of an income increase. If a pregnant individual is enrolled in another mandatory category (i.e., MASI) or covered under a waiver, they can remain in that category as long as they meet eligibility requirements. Pregnant Individuals who lose eligibility from a mandatory category should transition to MAMA or MAGP through the end of their post-partum period.

The income that the member has when they report the pregnancy determines if the member will go into MAMA or MAGP. Once the pregnancy coverage is open the category will not change until after the post-partum period ends with the exceptions of voluntary withdrawal, death, or moved out of state. 15

Exception: If a member’s Medicaid is set to close for a reported change other than death, moving out of Indiana, or voluntary withdrawal; but before the effective date of the closure DFR discovers that the person is pregnant; eligibility should be re-evaluated for a potential rescission of the closure.

Note: Effective 4/1/22, members eligible for full coverage Medicaid/CHIP while pregnant receive continuous post-partum coverage for 12 months beginning the last day of pregnancy through the end of the month in which the 12-month period ends.16 1620.00.00 HOOSIER HEALTHWISE (MED 3) Medical coverage is available to certain parents/caretakers, infants, and children, former foster children ages 18 to 26 who were enrolled in Medicaid (any state) on their 18th birthday, and pregnant women under the Hoosier Healthwise Program. Additionally, medical coverage under the Healthy Indiana Plan (HIP) is available to adults between ages 19 and 64, effective February 1, 2015.

Hoosier Healthwise is funded by Title XIX-Medicaid and by the Children’s Health Insurance Program-Title XXI and is composed of three benefit packages. Coverage under these packages is generally comprehensive, with a few exceptions, which are noted below. The packages are as follows:

• Package A (Standard Plan) provides comprehensive healthcare coverage to some eligible parents and other caretaker adults, infants and children, former foster children ages 18 to 26 who were enrolled in Medicaid (any state) on their 18th birthday, and pregnant women. There are no premiums or co-payments for children under age 18. IEDSS category codes under this package are MA F, MAGP, MA X, MA Y, MA Z, MA 2, MA 9, and MA 15.

11

• Children who are wards of the State, children in the Adoption Assistance Program, foster children and former foster children (MA 4, MA 8, MA 15) may opt out of Traditional Medicaid FFS and voluntarily enroll in Hoosier Care Connect, a coordinated care program (see 1610.00.00 for a description of the Hoosier Care Connect program).

HIP is funded through a Section 1115 demonstration waiver with the CMS, Indiana’s existing cigarette tax revenues, and from a Hospital Assessment Fee. HIP coverage is available to adults aged between 19 and 64 years, who do not have Medicare, have income equal to or less than 133% of the FPL, and are not eligible for any other Medicaid category excluding low-Income parents/caretakers and transitional Medical Assistance.

Under HIP, a person will qualify for either State Plan Benefits or Regular Plan Benefits. Within each plan exists Plus and Basic. Please, refer to IHCPPM 3500.00 to see the difference in benefits and cost sharing between HIP Plus and HIP Basic.

To receive coverage under either HIP State Plan Plus (MASP) or HIP Regular Plan Plus (MARP), a person must make financial contributions towards a Personal Wellness and Responsibility (POWER) account that is based on their income and the FPL percentage range that the member falls in, but can be no less than $1 per month, regardless of a person’s income.

To receive coverage under either HIP State Plan Basic (MASB) or HIP Regular Plan Basic (MARB), the income standard is 100% of the FPL.

• HIP State Plan Plus (MASP) benefits, refer to 3520.10.00 • HIP State Plan Basic (MASB) benefits, refer to 3520.15.00 • HIP Regular Plan Plus (MARP) benefits refer to 3520.25.00. • HIP Regular Plan Basic (MARB) benefits, refer to 3520.30.00

A woman who is a member of any HIP category who becomes pregnant will be moved into the MAMA category unless income increases at the same time. If this happens, she should go into MAGP. 1620.05.00 LOW INCOME PARENTS / CARETAKERS This category is identified in the eligibility system as MAGF.

The category consists of parents and caretaker relatives of dependents less than 18 years of age and is reserved for members who do not qualify for HIP coverage due to Medicare, a waiver or refugee status. A parent includes biological, adopted, and stepparent.

For the definition of a caretaker relative, please refer to IHCPPM 2420.00.00. This category also consists of low-income parent and caretaker refugees for the first twelve months after arriving in the United States.

12

For more information regarding MAGF coverage, see IndianaMedicaid.com or refer members to call the information number on the back of their Medicaid Card. 1620.05.15 TRANSITIONAL MEDICAL ASSISTANCE This category is identified in IEDSS as MA F. Although MA F is considered Hoosier Healthwise, MA F is not considered a MED 3 category. Nor is it considered MED 2. Refer to IHCPPM Chapter 3800 for more specific information on MA F.

Up to 12 months of full medical coverage under the Transitional Medical Assistance (TMA) category is available to parents/caretaker relatives who have been discontinued from or are denied Medicaid because of the earnings of a caretaker relative who was eligible for and received Medicaid, with the Low-Income Parent/Caretaker (LIPCT) designation, in Indiana in three of the preceding six months. TMA is also available to certain dependents. Refer to Chapter 3800.

To qualify for TMA, the AG must be ineligible for Medicaid for being over 133% FPL (plus the 5% disregard) for one of the following reasons:17

• New or increased earnings of a parent or caretaker relative who is participating • member of the AG • New or increased earnings of a MA sanctioned parent or caretaker relative who is • a non-participant due to a sanction • The effective date of TMA corresponds to the date of discontinuance or the date on which the AG first becomes ineligible, whichever is earlier.18 1620.35.00 RESERVED 1620.35.05 NATIVE AMRICAN/ALASKA NATIVE HIP (MED 3) Native Americans and Alaska Natives who qualify for HIP will automatically be placed into HIP State Plan. Additionally, Native American and Alaskan Native HIP members will not be required to make any financial contributions to a POWER Account or make any required co-pays.

If a Native American and Alaska Native chooses to be covered by fee-for-service, rather than managed care, the person will then have eligibility under the MANA category. 1620.36.00 HIP STATE PLAN PLUS (MED 3) This category is identified in IEDSS as MASP.

13

To be eligible in this category an adult must be at least 19 years of age and less than 65 years of age and have income equal to or less than 133% of the FPL, unless the person qualifies for TMA.

The upper age limit is waived for Low-Income Parent/Caretakers. A potential member may not be enrolled in or eligible for enrollment in the federal Medicare program. Eligible participants include:

• Low Income parents and caretaker relatives • TMA eligible individuals; or • Individuals that qualify as medically frail.19

HIP Plus State Plan requires the participant to pay a monthly POWER Account contribution (PAC) and only has co-payments on non-emergency use of the hospital emergency department. MASP members, who are American Indian/Alaska Natives, are not required to make a financial contribution to a POWER Account. 1620.37.00 HIP BASIC-STATE PLAN (MED 3) This category is identified in IEDSS as MASB.

To be eligible in this category an adult must be at least 19 years of age and less than 65 years of age (upper age limit is waived for low-income parent/caretakers). They must have income at or below 100% FPL. They will be enrolled in HIP Basic State Plan if they fail to make financial contributions toward a POWER account and fall into one of the following groups:

• Low-income parents and caretaker relatives • Individuals that qualify as medically frail.20 1620.38.00 HIP STATE PLAN PLUS WITH CO-PAYS (MED 3) This category is identified in IEDSS as MAPC.

• To be eligible in this category an adult must have been eligible under MASP, while being determined medically frail, having income between 100% FPL and 133% FPL, and failing to make ongoing financial contributions to a POWER account. • If an MAPC member’s income decreases to below 100% FPL, they will be moved into the State Plan Basic category. 1620.39.00 HIP REGULAR PLAN PLUS (MED 3) This category is identified in IEDSS as MARP.

14

To be eligible in this category an adult must be at least 19 years of age and less than 65 years of age. A potential member may not be enrolled in or eligible for enrollment in the federal Medicare program or be eligible for any other Medicaid category.21 The income standard is 133% FPL. HIP Regular Plus requires the participant to pay a monthly POWER Account contribution (PAC) and only has co-payments on non-emergency use of the hospital emergency department. 1620.39.05 HIP REGULAR BASIC (MED 3) This category is identified in IEDSS as MARB.

To be eligible in this category an adult must be at least 19 years of age and less than 65 years of age with income at or below 100% FPL and will be enrolled in HIP Basic after failing to make financial contributions to a POWER account. A potential member may not be enrolled in or eligible for enrollment in the federal Medicare program or be eligible under any other Medicaid category.22 The HIP Basic benefit package applies co-payments to services. The “HIP Basic” Plan maintains essential benefits, but incorporates reduced benefit coverage, has a more limited pharmacy benefit, does not include dental, and does not include vision benefits. 1620.40.00 CHILDREN IN PSYCHIATRIC FACILITIES (MED 3) This category is identified in IEDSS as MA O.

To be eligible in this category a child must be under age 21, an inpatient of a Medicaid certified psychiatric facility, and meet MAGF eligibility requirements (except the age 18 limitations) as if they were living at home.23 A recipient who is approved for MA O prior to his 21st birthday remains eligible until age 22 as long as he remains in the psychiatric facility. 1620.45.00 REFUGEE MEDICAL ASSISTANCE (MED 2) This category is identified in IEDSS (Indiana Eligibility Determination Services System) as MA Q (Refugee Medical Assistance (RMA) 1st 12 months for individuals entering the U.S prior to 5/5/25 or 1st 4 months for members entering the U.S on or after 5/5/25. 24 Individuals receiving or eligible to receive Refugee Cash Assistance (RCA) are eligible for Medicaid under these categories. This is the category of last resort, after all other categories have been explored.

A MA Q (Refugee Medical Assistance (RMA) 1st 4-12 months (prior to 05/05/25 or 1st 4 months on or after 05/05/25) in the U.S) AG that becomes ineligible for assistance due solely to new or increased earnings may receive continued Medicaid until the end of the four/12-month period. In cases where a member of the AG obtains private medical coverage, it is imperative to answer Third Party Liability questions located in IEDSS (Indiana Eligibility Determination Services System) under Non-financial questions and properly update information on the Third-Party Liability Detail

15

Screen. A refugee may not receive Medicaid under this provision once his initial four/twelve- month eligibility period ends.

Low-income Parent/Caretaker refugees who are within their first 12 months (4-months on or after 5/5/25) of entry in the country will be placed into MAGF (Parent or Caretaker Relative, not eligible for HIP) instead of MA Q (Refugee Medical Assistance (RMA). These members will remain in MAGF up to twelve months depending on their entry date into the U.S. At the end of the eligibility period, the State Eligibility system will explore all other eligible categories for the member, including HIP. 1620.50.00 PREGNANT HOOSIERS - FULL COVERAGE (MED 3) These categories are identified in IEDSS as MAMA and MAGP. To be eligible for these categories pregnant individuals must have an attestation of pregnancy and have income less than or equal to 208% of the Federal Poverty Level, with the 5% MAGI disregard included if needed to pass.25 There are no resource eligibility requirements for these categories.

If a pregnant individual receiving coverage under either of these two categories receives an increase in income which causes their countable income to exceed the standard, they remain eligible for pregnancy-related coverage through the end of the 12 months postpartum period, as explained in Section 1610.50.00.24 The 12-month postpartum period is available to an individual who meets one of the following criteria:

• Applies for Medical Assistance while pregnant and is eligible on the date pregnancy ends (by birth or other means). • Applies for Medical Assistance while pregnant and is eligible on the date pregnancy ends (by birth or other means) and/or was both pregnant and financially eligible in the month of application or one of the three retro months prior to the application. • Applies for Medicaid after the child is born (or the pregnancy is terminated by other means) and was both pregnant and financially eligible in the month of application or one of the three retro months prior to the application Month. For a pregnant individual who was eligible and enrolled on the date their pregnancy ends, the agency must provide coverage described through the last day of the month in which the 12-month postpartum period ends. 25

16

Example 1: • Retro Month 1 – Individual was pregnant but over the income limit for MAGP • Retro Month 2 – individual was pregnant but over the income limit for MAGP • Retro Month 3 – individual was pregnant, and pregnancy ended, and they were under the income limit for MAGP Application month – individual was over the income limit for MAGP. In this case, the individual should be found eligible for retro month 3 and ongoing, as the increase in income should be disregarded until the postpartum period ends.

Example 2: • Retro Month 1 – individual was pregnant but over the income limit for MAGP • Retro Month 2 – individual was pregnant but over the income limit for MAGP • Retro Month 3 – individual was pregnant, and pregnancy ended, and they were still over the income limit for MAGP • Application month – individual was under the income limit for MAGP but fails income test for all other categories In this case, the individual is not eligible for coverage, since she was not eligible for any retro month or the month that pregnancy ended, so income cannot be disregarded for their postpartum period.

Example 3: • Retro Month 1 – individual was pregnant but over the income limit for MAGP • Retro Month 2 – individual was pregnant and under the income limit for MAGP • Retro Month 3 – individual was pregnant, and pregnancy ended, but they were over the income limit for MAGP • Application month – individual was over the income limit for MAGP In this case, the individual should be found eligible for Retro month 2 and ongoing, as the increase in income should be disregarded until the postpartum period ends. 1620.60.00 CHILDREN UNDER AGE 1 (MED 3) This category is identified in IEDSS as MA Y.

To be eligible in this category a child must be under the age of one.26

The income standard for this category is less than or equal to 208% of the Federal Poverty Level and there are no resource requirements. 1620.65.00 CHILDREN AGE 1 - 5 (MED 3) This category is identified in IEDSS as MA Z.

17

To be eligible in this category a child must be at least one year of age, but not six years old.

Income standards are based on 141% of the Federal Poverty Level and there are no resource requirements.27

1620.70.00 CHILDREN AGE 6 - 18 (MED 3) This category is identified in IEDSS as MA 2.

To be eligible in this category a child must be at least age six (6), but under age nineteen (19).28

The income standard is based on 106% of the Federal Poverty Level and there are no resource requirements. 1620.71.00 CHILDREN AGE 1 - 19 (MED 3) This category is identified in IEDSS as MA 9. This category is an eligibility expansion effective July 1, 1998. It is funded under the federal "Children's Health Insurance Program" (CHIP) enacted in the Balanced Budget Act of 1997. To be eligible in this category:

• A child must be aged 1 through age 5 with income between 141% - 158% of the federal poverty level; or • Age 6 through 18 with income between 106% - 158% of the federal poverty level, and not eligible in any other Medicaid category.

There are no resource requirements. 1620.72.00 CHILDREN'S HEALTH PLAN (MED 3) This category of Hoosier Healthwise is designated as MA 10 on IEDSS.

Effective January 1, 2000, comprehensive medical coverage, under an eligibility expansion funded through the federal Children's Health Insurance Program (CHIP), is available to Indiana children under the age of 19.29 Under this category, also known as Package C, the income limit was 200% of the federal poverty guidelines at implementation and increased to 250% of the federal poverty guidelines, as of October 1, 2008. (Refer to IHCPPM Section 3010.30.00.)

There are no resource requirements. Coverage is provided only to children who are ineligible for all other categories of Hoosier Healthwise. MA 10 is, therefore, last in the IEDSS Medical

18

Hierarchy. Please note, however, that a child who fails MA 9, but who would be eligible for MA D or MA B, could receive MA 10, if otherwise eligible. (Refer to IHCPPM Section 2035.30.10).

Unlike the other Hoosier Healthwise categories, MA 10 has cost-sharing requirements. There are premiums that must be paid as a condition of enrollment and ongoing eligibility, and there are co-payments for some services.

Retroactive coverage is not available under this category. Coverage begins with the month of application. (Refer to IHCPPM Section 2035.60.00.) 1620.73.00 FOSTER CARE INDEPENDENCE Note: Effective 1/1/23, Former foster care children enrolled in Medicaid (any state) on their 18th birthday will transition to MA 15 (Refer to 1620.74.00 and 2035.30.25). 1620.74.00 FORMER FOSTER CHILDREN UP TO AGE 26 This category is identified in IEDSS as MA 15.

To be eligible under this category, an individual must have been in foster care and enrolled in Medicaid (any state) on his/her 18th birthday and must be 18 through 26 years old.30

There are no income standards or resource requirements for this eligibility group. 1620.75.00 NEWBORNS This category is identified in IEDSS as MA X.

MA X is based on deemed eligibility and does not have a budget or redetermination. It is a full coverage category with no cost sharing and is at the top of the Medicaid hierarchy, therefore, it should not be replaced with any other category of medical coverage.

The only exception to this is if a newborn is approved for the MA D category. If an ongoing MA X child is approved for MA D, the category change will be effective the following month.

A child born to an individual who was receiving (and eligible for) Traditional Medicaid, HIP, or any Hoosier Healthwise benefit package except Package C (MA 10), at the time of the child's birth, is deemed automatically eligible for Medicaid in the Newborn category. Coverage in this category continues for 12 months from birth. Refer to Sections 2225.10 and 2428.00. 1620.80.00 FAMILY PLANNING SERVICES

19

This category is identified in IEDSS as MA E.

Individuals may be eligible under this category when family planning services are requested. There is no age requirement. Income standards are based on 141% of the Federal Poverty Level and there are no resource requirements. 1621.00.00 BREAST AND CERVICAL CANCER TREATMENT SERVICES Breast and Cervical Cancer Treatment Program (ISDH): In Indiana, the Breast and Cervical Cancer Treatment program (BCCP) is administered by the State Department of Health. To be eligible, an individual must be screened and found to need treatment for breast or cervical cancer by the BCCP and have income equal to or less than 200% of the Federal Poverty Level (FPL). The Indiana Breast and Cervical Cancer Program provides access to breast and cervical cancer screenings, diagnostic testing, and treatment for underserved and underinsured women who qualify for services and meet all other Medicaid requirements. Eligibility includes:

• Indiana resident • Uninsured or underinsured • Insured with unmet deductible • 30 - 49 years of age (for office visit, clinical breast exam, and Pap smear) • 50 - 64 years of age (for office visit, clinical breast exam, Pap smear, and mammogram) • 65 years of age and older if not enrolled in Medicare Part B • At or below 200% of the FPL

BCCP Option 3 (MA 12): Alternatively, an individual can receive full Medicaid benefits and coverage for treatment under the BCCP Option 3 program, which is identified as the Medicaid category MA 12. To be eligible, an applicant must be diagnosed with breast or cervical cancer and referred to FSSA through ISDH, and meet the following criteria:

• Indiana resident • At least 18 years old but not over 64 years old • Has income at or below 200% of the FPL • Is not eligible for Medicaid under any other category and is not enrolled in Medicare • Is uninsured or underinsured (cancer treatment not covered).

The effective date of coverage is based on dates of application and diagnosis. Example 1: Application received 5/15/2020 with a diagnosis date of 4/15/2020. Effective date of coverage should be 4/1/2020.

Example 2: Application received 5/15/2020 with a diagnosis date of 12/15/2019. The effective date of coverage should be 2/1/2020. (It cannot go beyond 90 days prior to application month.) For information on screening through BCCP and referrals for BCCP Option 3, see the ISDH website at: https://www.in.gov/health/cdpc/cancer/early-detection/

20

1622.00.00 HCC (HOOSIER CARE CONNECT) HCC is a managed care program for Medicaid members that are on a MED 1 category, under 60 years of age and are not:

• On Medicare • In an institution • On an approved HCBS waiver

HCC provides additional services including:

• Medication Therapy Management • Health Care Coordination • Access to a 24-hour Nurse Helpline

For HCC members that turn 60, they will be rolled into the Pathways program (see IHCPPM 1624.00.00).

HCC information is not stored in the eligibility system and DFR will not have visibility to HCC assignments. If a member has a question about the HCC, they can contact their MCE (managed care entity) listed on their insurance card or by calling member services at 866-963-7383. 1623.00.00 590 PROGRAM The 590 Program provides coverage for certain healthcare services provided to Indiana Health Coverage Programs (IHCP) members ages 21 through 64 who are residents of state-owned psychiatric facilities. These facilities operate under the direction of the Indiana Family and Social Services Administration (FSSA), the Division of Mental Health and Addiction (DMHA) or the Indiana Department of Health (IDOH). Individuals who are or are incarcerated are not eligible for the 590 Program.

590 is not stored in the eligibility system, it is displayed in MMIS and is available in the Portal.

If an ongoing Medicaid member is reported as residing in a SOF (State Operated Facility) and is intended to reside in the facility for 30 or more days, the facility details screen should be updated, and the case will be suspended. When the facility reports the members release from the facility, the Medicaid should be unsuspended.

During the time that an individual is in the 590/SOF facility, an AR (authorized representative) form is not required for the facility to act on the members behalf. 31 Upon release from the facility, a signed AR form is required.

21

1624.00.00 INDIANA PATHWAYS FOR AGING (PATHWAYS) Indiana PathWays for Aging, also referred to as “PathWays,” is a managed care program for Medicaid members who are:

• 60 years of age and older, and • Receiving Medicaid in an aged, blind or disabled category (Including MEDWorks and MASI).

Members enrolled in PathWays include those who:

• May or may not be enrolled in or eligible for Medicare, • May or may not be receiving LTSS (long-term support services) including those who are: • Residing in a nursing or long-term care facility, or • Receiving services under an approved PathWays waiver (formerly called the Aged and Disabled waiver). • Receiving BPHC services in a MED 1 category

Medicaid members that are not eligible for PathWays include:

• Those under 60 • HIP members of any age • Hoosier Healthwise Members of any age • Individuals who are only partial benefit dually eligible (QMB-only, SMLB-only, QI, or QDWI) • MAGF members who are not in the PathWays waiver • DDRS waiver recipients, including: o FSW (Family Support Waiver) o CIH (Community Integration and Habilitation Waiver) • TBI (Traumatic Brain Injury) Waiver recipients • TBI out-of-state placements • Residents of State Operated Facilities (SOF) • Program of All Inclusive Care for the Elderly (PACE) members • RCAP (Room and Board) members • Breast and Cervical cancer members on MA12 • I/DD residents in intermediate care facilities (ICF) • ESO (Emergency Services Only) members

Certain populations will not be placed into the PathWays program and will remain in Fee-for- Service (FFS). These members are not required to participate in the PathWays program but have the option to Opt-in.

22

• Individuals who are already receiving hospice upon being eligible for PathWays, • Individuals participating in self-directed Medicaid services, and • American Indians and Alaskan Natives (AI/AN). For more information refer to 2402.15.15.20.

PathWays information is not stored in the eligibility system and DFR will not have visibility to PathWays assignments. If there are questions regarding the PathWays program, the member or their authorized representative can contact the MCE (managed care entity) on their insurance card.

If the MCE is unable to resolve the issue/concern, then direct the member/AR to:

PathWays Phone Numbers Pathways Member Support Services (MSS) Support for eligible Medicaid members, age 60 or older who are enrolled in PathWays for Aging, with navigating the various options and care transitions associated with managed care, long term care and waiver services. Pathways Member Support Services Helpline: 877-738-3511 Indiana PathWays for Aging (Enrollment Broker): Assists members with initial plan selections and plan changes, including just cause requests Indiana Pathways for Aging Indiana PathWays for Aging Helpline: 87-PATHWAY-4 (877-284-9294)

1 42 CFR 435.520 2 42 CFR 435.530 3 42 CFR 435.540 4 IC 12-10-6-1 5 IC 12-15-41; Social Security Act (SSA) 1902(a)(10)(ii)(XV); SSA 1902(a)(10)(ii)(XVI) 6 SSA 1902(a)(10)(E) 7 SSA 1905(p)(3) 8 SSA 1902(a)(10)(E) 9 42 CFR 431.625(d) 10 SSA 1902(a)(10)(E) 11 SSA 1905(p)(3)(A)(i) 12 SSA 1902(a)(10)(E) 13 SSA 1905(p)(3) 14 SSA 1902(e)(6)

23

15 SSA 1902(e)(16) 16 SSA 1902(e)(16) 17 405 IAC 10-4-5 18 405 IAC 10-4-1 19 405 IAC 10-4-3 20 405 IAC 10-4-3 21 405 IAC 10-4-1 22 405 IAC 10-4-1 23 42 CFR 435.222 24 45 CFR 400.211 and 90 FR 13370 25 42 CFR 435.831(1); 42 CFR 435.603 25 42 CFR §435.170 26 42 CFR 435.222 27 42 CFR 435.222 28 42 CFR 435.222 29 IC 12-17.6-3-2 30 SSA 1902(a)(10)(A)(i)(IX) 31 I.C. 29-3-3-5

Indiana Health Coverage Program Policy Manual Chapter 1800 APPLICATION REGISTRATION Sections 1800.00.00 – 10835.15.00

Contents 1800.00.00 APPLICATION REGISTRATION ......................................................................... 1 1805.00.00 REQUEST FOR AN APPLICATION ..................................................................... 1 1810.00.00 REQUEST FOR AN INDEPENDENT RESOURCE ASSESSMENT (MED 1) ............... 2 1815.00.00 INFORMED CHOICE ........................................................................................ 3 1820.00.00 INITIAL CONTACT PERSON ............................................................................. 3 1825.00.00 APPLICATION REGISTRATION PROCESS .......................................................... 4 1825.05.00 COMPLETION OF THE APPLICATION................................................................ 4 1825.05.05 RECEIPT OF AN APPLICATION ......................................................................... 5

1825.05.15 INDIVIDUAL CLEARANCE ................................................................................. 5 1825.10.00 PERSON WHO SIGNS THE APPLICATION .......................................................... 7 1825.10.05 ALIAS .............................................................................................................. 7 1825.15.00 DATE OF THE APPLICATION ................................................................................. 8 1835.00.00 SCHEDULING THE INTERVIEW (MED 1, 2, 4) ................................................... 8 1835.05.10 APPLICANT INTERVIEW (MED 1, MED 2, MED 4) ............................................. 9 1835.15.00 DENYING AN APPLICATION WHEN THERE IS NO INTERVIEW ........................... 9

1

1800.00.00 APPLICATION REGISTRATION This chapter contains the application registration processes. It includes: • Request for an Application (Section 1805) • Request for an Independent Resource Assessment (MED 1) (Section 1810) • Informed Choice (Section 1815.00.00) • Initial Contact Person (Section 1820) • Completion of the Application (Section 1825.05.00)

• Receipt of an Application (Section 1825.05.00) • Individual Clearance (Section 1825.05.15)

• Individual Clearance (Section 1825.05.15) • Person who Signs the Application (Section 1825.10.00) • Alias (Section 1825.10.05) • Date of the Application (Section 1825.15.00) • Scheduling the Interview (MED 1, 2, 4) (Section 1835.00.00) • Applicant Interview (MED 1, MED 2, MED 4) (Section 1835.05.10). 1805.00.00 REQUEST FOR AN APPLICATION The Indiana Application for Health Coverage must be accessible to clients at all times during which the office is open. It will also be provided in an on-line version during open office hours and when the office is closed. All reception staff, eligibility workers and those answering telephone calls must inform clients that an application will be accepted when the name and address is completed, and the form is signed. No other requirements or limitations can be placed on the client's right to file an application for Health Coverage. For the Healthy Indiana Plan (HIP), please refer to Chapter 3500. Individuals may request assistance in person, by mail, by telephone, or online. If requested, the individual will be referred to our application portal on the FSSA website or may be given or mailed an Indiana Application for Health Coverage. When an application form is provided, assistance in completing the application is to be offered.1 Applications will also be received through electronic account transfer from the Federal Marketplace.2

2

Program information must be provided electronically, in print, and orally to all applicants and other authorized individuals who request it, such as parents of dependent children, authorized representatives, certain power-of-attorneys, and legal guardians. Information that must be provided includes:3

• Eligibility requirements • Available Medicaid services • The rights and responsibilities of applicants and beneficiaries. Such information must be provided to applicants and beneficiaries in plain language and in a manner that is accessible and timely to: • Individuals who are limited English proficient through the provision of language services at no cost to the individual (the language line is 877-261-6608; and • Individuals living with disabilities through the provision of auxiliary aids and services at no cost to the individual in accordance with the Americans with Disabilities Act and section 504 of the Rehabilitation Act. Individuals may also receive help with the health coverage application through a Certified Indiana Navigator including Enrollment Center staff.4, 5 The individual requesting assistance should be encouraged to file an application the same day the DFR is contacted. The individual is to be informed that prompt filing is important as the date of entitlement is affected by the date the signed application is received by the DFR or the Federal Marketplace. An individual has the right to apply and the right to have the determination of eligibility made without discrimination because of race, color, sex, age, disability, religion, national origin, marital status, or political belief. An application must be provided without question or delay to any individual requesting assistance without regard to apparent ineligibility.6 1810.00.00 REQUEST FOR AN INDEPENDENT RESOURCE ASSESSMENT (MED 1) An aged, blind, or disabled individual who becomes institutionalized on or after September 30, 1989, and whose spouse is living in the community, is entitled to a resource assessment without filing a Medicaid application. The request for an independent assessment can be made by either spouse or his representative. An Independent Resource Assessment should be requested when a spouse enters a long-term care facility and anticipates that he may have to apply for Medicaid at a later date. The assessment establishes the total value of the couple's nonexempt resources on the exact date of admission to the facility so that the "spousal share" can be calculated. The spousal share, or one-

3

half of a couple's combined resources, is a critical element in the Medicaid eligibility determination as it represents the amount of resources, not to exceed the current limit listed in Section 3005.10.00(MED 1), which can be protected for the community spouse when the institutionalized spouse applies for Medicaid. Refer to Section 2635.10.10.05 which explains the resource assessment determination and the procedures to follow. The spousal share is determined off-line by the caseworker using the State Form 45919 (R/11- 96)/FI 2060 and entered on the Resource Assessment page. If a data entry error or mathematical error is discovered, the Manager can access the Resource Assessment page and correct the spousal share. The determination cannot be appealed until a Medicaid application is filed. An Independent Resource Assessment should never be conducted in conjunction with an application. It should only be completed when there is no Indiana Application for Health Coverage. When an Indiana Application for Health Coverage is made for an individual residing in long term care and that individual has a spouse in the community, Register Application Page should be completed just as it is for any other applicant. The resource assessment will then be done on-line during the application entry process. If an Independent Resource Assessment was completed prior to an Indiana Application for Health Coverage, the spousal share will be displayed on the Resource Assessment page. 1815.00.00 INFORMED CHOICE The Eligibility System is designed around the outreach concept of "informed choice" which provides clients the option to apply for any or all programs (FS, TANF, MA) of assistance in one interview. The household should be informed that each program has specific eligibility requirements that do not apply to the other programs, and that loss of benefits under one program does not always mean that other program benefits will also be lost. It is the obligation of the DFR to provide the individual with sufficient objective information to allow the individual to make an informed choice. Additional programs may be selected by the client during the subsequent interview with the caseworker or at any time the client desires but will require an application to be completed. 1820.00.00 INITIAL CONTACT PERSON The agency must accept an application from the applicant, an adult who is in the applicant's household, or family, an authorized representative, or if the applicant is a minor or incapacitated, or someone acting responsibly for the applicant. The individual who makes the initial request for assistance is referred to as the Initial Contact Person (ICP) for the application. The ICP completes the application registration process and signs the Indiana Application for Health Coverage. The ICP may or may not be seeking assistance for

4

himself and may or may not be the interviewee during the application interview, if applicable. Refer to Section 2005.05.10 which explains who may be interviewed, if required. The worker must inform the ICP that information about Rights and Responsibilities are included as an attachment to the Application. If an interview is required, please, refer to IHCPPM 2005.05.10. 1825.00.00 APPLICATION REGISTRATION PROCESS Application registration begins the application process for individuals requesting assistance. The purpose of application registration is to: • Gather basic demographic information on the individual(s) for application completion • Perform individual clearance, statewide clearance, prior contact checks and address inquiries through the Eligibility System • Initiate tracking of applications through the Eligibility System. 1825.05.00 COMPLETION OF THE APPLICATION The application process is initiated when either the Initial Contact Person (ICP) requests assistance from the DFR to complete the Indiana Application for Health Coverage or actually submits a complete Indiana Application for Health Coverage with the DFR through the FSSA Benefits Portal (https://www.ifcem.com/CitizenPortal/application.do). The ICP must be given an opportunity to review the information that was recorded and must be given a copy of the information. This application is then signed by the ICP. The application can be printed in either English or Spanish. The ICP may also elect to take a printed application form from the FSSA Benefits Portal to complete outside the office or the form may be mailed to an individual or family identified by the ICP by having the application printed through the FSSA Benefits Portal. The ICP should be advised that the completed application should be mailed to the FSSA Document Center, brought to the DFR, or faxed to 1-888-436-9199. An Indiana Application for Health Coverage is considered valid when, at minimum, a name, address, and signature are provided. Individuals without a fixed address (homeless) may use the address of the DFR when applying, if the individual has no other reliable address where she can receive mail. Once the application has been signed, the recorded information supplied by the ICP is not to be changed nor is information to be added. The date of application is the date on which a signed application is received by the DFR.

5

1825.05.05 RECEIPT OF AN APPLICATION When a valid application is received electronically, through the mail, by fax, over the phone, or is hand delivered, the date of receipt of the application will be recorded. Inquiry into the Eligibility System will be performed to determine the active, inactive, pending, or unknown status of the individual. Refer to Section 1825.05.15 for information regarding individual clearance. When an invalid application (missing name, address and/or signature) is received through the mail, the screener does not record its receipt. The form is returned to sender with instructions for proper completion. Further, if an outdated application form such as the old FI 2400 or HHW application is received by the DFR, such application should be considered acceptable as long as it meets minimum requirements according to IHCPPM 1825.05.00. However, the individual who submitted the application should be contacted about utilizing the FSSA Benefits Portal to obtain the correct application in the future. 1825.05.15 INDIVIDUAL CLEARANCE It is imperative to check the client’s name and address via the Eligibility system in order to identify whether the client has any previous history documented in the Eligibility system. The check must be performed prior to the clearance process for each and every individual residing at the household address using both name and SSN. The screener must resolve any clearance problems before application registration processing continues. Failure to match someone correctly may lead to multiple records and duplicate benefits. If the worker does not find a name match in the Eligibility System and no name or SSN match is found, the worker should start Application Registration in the Eligibility System. Demographic information on all household members should be entered as it appears on the application. If the caseworker does find an exact match for any individual on the application, proceed as follows: • Worker will start Application Registration in the Eligibility System. • Demographic information on all household members will be entered as it appears on the application. • The screener will need to review the display that is shown to ensure that all information was entered correctly. For an exact match, the screener can place an “X” in the select column and hit <ENTER>. The next individual will be displayed, and the same process is repeated until all individuals have been cleared.

6

If the demographic data as known to Eligibility System is different from that provided by the ICP, proceed as follows: • Worker will start Application Registration in the Eligibility System. • Demographic information for each individual in the household should be entered exactly as it appears on the inquiry screen and that information will be displayed as it was found in Eligibility System. • At this time, this information should be examined to ensure an exact match. If it is not an exact match, the PF17 key will allow the screener to return to the previous screen. The information that was incorrect will then need to be corrected so it is an exact match to the screen that first showed the individual match. If it is an exact match, the screener can place an “X” in the select column and hit <ENTER>. The system will allow the individual to PASS. • Once the individual has been allowed to PASS, do not change information for any individuals until reaching the Eligibility System screen reflecting the relationships of all household members or the Eligibility System screen showing the individuals living at the case address. Types of changes that may occur on these screens include: o Spelling of individual’s name o Date of birth o Sex code o Ethnic code o Social Security Number (SSN) If it is discovered that someone’s verified SSN has been entered for another individual, the following guidelines should be observed. NOTE: Do not simply key over the name/DOB/sex/race fields to attach the SSN to the correct individual. This will tangle their data under one RID. Follow this procedure: • If the SSN is found for an individual in an open case, check the SSN verification in case file and if necessary, re-verify the SSN. • If the SSN is found for an individual in a closed case, you may temporarily enter the individual into the case being processed, adding his demographic data. Clearance will run for this individual and the information must match. To correct the SSN in either situation above, blank out the incorrect SSN and press ENTER. This will free the SSN to be entered for the verified SSN owner. The correct SSN may then be added to the blank field. In the second scenario, the individual may then be deleted. If both workers verify the SSN to be correct, the problem must be resolved with the Social Security Administration. If an individual appears on the Eligibility System with multiple SSN’s, contact the Help Desk so the situation can be corrected.

7

When ICP cannot provide sufficient information for the screener to make a “match” without doubt that the match is correct, the worker should start Application Registration without entering the questionable individual(s). For all individuals for whom a definite match cannot be made, proceed as follows: • A memo should be attached by the screener to the Indiana Application for Health Coverage alerting the caseworker that the individual(s) should be added and pass clearance. • An entry should also be made in Running Record Comments. The ICP must be encouraged by the screen to obtain the missing demographic information by the scheduled interview. If any individual is found to be active in an existing Eligibility System case, refer to Section 1825.05.05 for instructions on how to proceed. If the address given by the ICP matches an address known to the Eligibility System as active, refer to Section 1825.05.05 for instructions on how to proceed. 1825.10.00 PERSON WHO SIGNS THE APPLICATION Anyone can sign the Indiana Application for Health Coverage. The person signing the application is required to swear or affirm that the information he provides on the application is true and correct to the best of his knowledge or belief. Once the application is signed, the recorded information supplied by the ICP is not to be changed, nor is information to be added. The agency must require that all initial applications be signed under penalty of perjury. Electronic, including telephonically recorded, signatures and handwritten signatures transmitted via any other electronic transmission must be accepted. 1825.10.05 ALIAS The individual's legal name is to be used on the application in most cases. If the individual has an alias or has used other names in the past, it is important to establish which name the individual uses most frequently when doing business. The individual's most commonly used name is the name under which the case is to be established.

8

1825.15.00 DATE OF THE APPLICATION The date of application for Medicaid is determined as explained below. IMPORTANT: The original date of application must always be honored and is never to be altered.7 If duplicate applications are received for an applicant, the earliest application date must be maintained and used to determine the proper effective date of coverage. Notification of denial as a duplicate application must be sent to the applicant for any duplicate application submitted. The date of application is the date a signed application is received by DFR.8 Any application received after 4:30pm EST, or on a non-business day, should be dated as received on the next business day. For example: • When the application is mailed into the DFR, the local DFR office must ensure that the actual date of receipt is stamped on the application. The stamped date is the application date. • When an application is completed over the phone, the received date is the date it was completed. • When the application is completed on-line or is faxed to the DFR, the received date of the application will be the actual date the application was completed on-line or received via fax, subject to business day rules as stated above. • When an application is received from the SSA interface or Federal Marketplace, the date of application is always the date the DFR receives the application. The time rule does not apply. Duplicate applications are processed per the rules listed above. 1835.00.00 SCHEDULING THE INTERVIEW (MED 1, 2, 4) After the inquiry and Application Registration processes have been completed, an interactive interview must be scheduled for the applicant whose eligibility is being determined under a non- MAGI category. If the interview is not held on the same day that the application is received, an appointment must be scheduled. The system will generate an appointment notice to the client if an appointment is scheduled at least seven business days in advance for initial applications, five business days for general appointments, six business days for redeterminations, and ten days for IMPACT appointments.

9

If an appointment is scheduled sooner, a manual notice must be prepared and given to applicant. This can be accomplished by screen printing CSAS. The initial interview may be held on the same day that the application is received or as soon as possible. The initial interview should be scheduled to give sufficient time to determine eligibility and provide benefits within the timeliness standards. All individuals must be informed of the conditions under which an out of office interview may be conducted. 1835.05.10 APPLICANT INTERVIEW (MED 1, MED 2, MED 4) To determine initial eligibility there must be an interview with the applicant or with someone acting responsibly for the applicant. Refer to Sections 2005.00.00 and 2005.05.10. The interview may take place in the DFR or on the telephone. The worker must be assured that it is not a hardship on the applicant to come to the office. Interviews cannot be required for someone whose eligibility is being determined under MED 3 or by an LIS/MSP application from Social Security, unless the applicant is also being considered potentially eligible under MED 1, 2, or 4. 1835.15.00 DENYING AN APPLICATION WHEN THERE IS NO INTERVIEW If an individual whose eligibility is being determined under a non-MAGI category does not keep an appointment for an interview within 30 days of the application date, the worker must then take action to deny the application on the 30th day. The application should not be closed until the 30th day for failure to keep an appointment. If the 30th day falls on a non-business day, the denial action must be taken on the next business day to be timely. An entry should be made in Running Record Comments to explain the denial situation. An applicant may voluntarily withdraw the application at any time.

1 42 CFR §435.908 2 42 CFR §435.907

10

3 42 CFR §435.905 4 IC 27-19-2-12 5 IC 27-19-2-3 6 42 CFR §435.906 7 405 IAC 2-1-3 8 405 IAC 2-1-3

Indiana Health Coverage Program Policy Manual Chapter 2000 Application Processing Sections 2000.00.00 – 2050.20.00

Contents 2000.00.00 APPLICATION PROCESSING ................................................................................ 2 2005.00.00 THE INTERVIEW (MED 1, MED 2, MED 4) ............................................................ 2 2005.05.00 COOPERATION WITH THE ELIGIBILITY INTERVIEW AND RESCHEDULING (MED 1, 2, MED 4) .................................................................................................................................... 3 2005.05.10 WHO CAN BE INTERVIEWED ................................................................................. 3 2005.05.15 WHEN AN INTERVIEW IS REQUIRED ...................................................................... 6 2005.10.00 AUTHORIZED REPRESENTATIVES ........................................................................... 6 2015.00.00 RESPONSIBILITIES OF THE APPLICANT/RECIPIENT .................................................. 8 2015.05.00 PROVIDE PROOF OF INFORMATION ..................................................................... 9 2015.10.00 UNDERGO MEDICAL EXAMINATION (MED 1) ....................................................... 9 2015.15.00 COOPERATE IN TREATMENT PLAN (MED 1) ......................................................... 9 2015.20.00 REPORT CHANGES IN CIRCUMSTANCES .............................................................. 10 2020.00.00 APPLICATION TIME STANDARDS ............................................................................ 10 2020.15.00 APPLICATION TIME STANDARDS (MED) .............................................................. 10 2020.20.00 APPLICATION PROCESSING DELAY ...................................................................... 10 2020.20.10 EXCEPTIONS TO APPLICATION TIME STANDARDS ................................................ 11 2025.00.00 VERIFICATION ........................................................................................................ 11 2025.05.00 VERIFICATION REQUIREMENTS ........................................................................... 11 2025.05.05 VERIFICATION OF QUESTIONABLE INFORMATION ............................................... 12 2025.05.10 COLLATERAL CONTACTS ..................................................................................... 14 2025.10.00 RESPONSIBILITY FOR OBTAINING VERIFICATION ................................................. 14 2025.10.05 CLIENT ATTESTATION AND WRITTEN STATEMENTS……………………………………………14 2025.15.00 REQUESTS FOR INFORMATION ........................................................................... 16 2025.20.00 TIME STANDARDS FOR PROVIDING INFORMATION ............................................. 17

2030.00.00 PROVIDING INFORMATION TO THE APPLICANT/RECIPIENT OR PARENT OF APPLICANT/RECIPIENT ............................................................................................................... 17 2030.10.00 PROVIDING INFORMATION TO APPLICANTS ........................................................ 18 2035.00.00 DETERMINATION OF INITIAL ELIGIBILITY ................................................................ 19 2035.10.00 REASONABLE COMPATIBILITY OF INCOME............................................................ 19 2035.15.00 PRE-ADMISSION SCREENING IS PENDING (MED 1) .............................................. 20 2035.20.00 HOME AND COMMUNITY-BASED SERVICE WAIVERS (MED 1) ............................. 20 2035.30.00 DETERMINATION OF MEDICAL CATEGORY (MED) ............................................... 21 2035.30.05 DETERMINATION OF MA 9 CATEGORY (MED 3) .................................................. 22 2035.30.10 DETERMINATION OF MA 10 CATEGORY (MED 3) ................................................ 22 2035.30.15 DETERMINATION OF MEDWorks CATEGORY ....................................................... 23 2035.30.20 DETERMINATION OF MA 14 CATEGORY (MED 3) ................................................ 23 2035.30.25 DETERMINATION OF MA 15 CATEGORY (MED 3) ................................................ 23 2035.30.30 DETERMINATION OF MA E (MED 3) .................................................................... 24 2035.31.00 DESIGNATION OF THE PACKAGE C PREMIUM PAYER ........................................... 24 2035.32.00 ENROLLMENT PROCESS FOR MA 10 .................................................................... 24 2035.33.00 DESIGNATION OF MED WORKS PREMIUM PAYER ENROLLMENT PROCESS .......... 25 2035.35.00 DETERMINATION OF INELIGIBILITY ..................................................................... 26 2035.40.00 AUTHORIZATION ................................................................................................ 26 2035.40.05 AUTHORIZING WHEN CITIZENSHIP OR IMMIGRATION STATUS IS NOT VERIFIED .26 2035.60.00 EFFECTIVE DATE (MED 1, 2, 3) ............................................................................... 27 2035.65.00 EFFECTIVE DATE OF QMB MEDICAID (MED 4) ..................................................... 28 2035.70.00 EFFECTIVE DATE OF QDW MEDICAID (MED 4) .................................................... 28 2035.75.00 EFFECTIVE DATE OF SLMB MEDICAID (MED 4) .................................................... 28 2035.80.00 EFFECTIVE DATE OF QI MEDICAID (MED 4) ......................................................... 28 2040.00.00 REAPPLICATIONS .................................................................................................. 28 2050.00.00 MSP APPLICATIONS FROM SSA LIS DATA FILE (MED 4) ........................................... 29 2050.05.00 THE MSP APPLICATION DATE (MED 4) ................................................................ 29 2050.10.00 INITIAL SYSTEM PROCESSING OF LIS/MSP APPLICATION (MED 4) ........................ 30 2050.20.00 VERIFICATION AND ELIGIBILITY DETERMINATION (MED 4) .................................. 30

2

2000.00.00 APPLICATION PROCESSING

At the end of the application registration process, client scheduling should take place to schedule an interactive interview. The policies in this chapter pertain to the processing of new applications after the application registration and interviewing scheduling processes have occurred. The Federal Health Insurance Marketplace and the State Medicaid Agency will be coordinated in their eligibility determinations of individuals that follow the application process through the Marketplace or the DFR. The following sections are contained in this chapter:

• The Interview (Section 2005) • Responsibilities of the Applicant/Recipient (Section 2015) • Application Time Standards (Section 2020) • Verification (Section 2025) • Concluding the Interview/Providing Information (Section 2030) • Determination of Initial Eligibility (Section 2035) • Reapplications (Section 2040) • MSP Applications from SSA LIS Data File (MED 4) (Section 2050) 2005.00.00 THE INTERVIEW (MED 1, MED 2, MED 4) This section does not apply to the following applicants who are exempt from the personal interview requirement. Applicants for MAGI coverage (any MED 3 category) LIS/MSP applicants sent electronically to the eligibility system via data exchange from SSA SSI recipients MASI recipients adding a buy in category An interactive interview is required for all other individuals who apply, including a paper application for QMB/SLMB/QI/QDW coverage.1 It may not be known at the application point whether the applicant will have eligibility determined under a MED 3 category or another applicable category. Once it is known that MED 3 is not applicable, an interview appointment notice must be sent to the applicant and any authorized representative. Refer to IHCPPM 2005.05.10. The interviewee being considered for MED 1 or MED 4 coverage may choose to be evaluated for either or both categories during the interview. Applicants who fail to keep the initial interview for MED 1 must be assessed to determine if they qualify for coverage under a MAGI category

3

before an application is denied. Such applicants (unless a LIS/MSP application was sent from SSA) should not be selected for QMB/SLMB/QDW/QI coverage if the personal interview was not completed before the application expired. Category changes: A data gathering interview must also take place for a category change in the following circumstances: A limited coverage category (Emergency Services Only, Family Planning Only, or QMB/SLMB/QI/QDW) changing to a MED 1 category A MAGI category (HIP, HHW) which disregards resources changing to a category which requires a thorough review of all applicable resources (MED 1, MED 4) MASI coverage based on receipt of SSI changing to another MED 1 category due to loss of SSI status or to the circumstances described in IHCPPM 2414.10.20 for widow/ers and Disabled Adult Children. The only exception is for a member who was interviewed for a MED 1 category but was dual processed (conditionally authorized in HIP pending a disability decision). If such a member completed the MA D personal interview within the past 90 days, a new interview is not required, and a pending verification request may be sent for updated resource amounts and any other changes. 2005.05.00 COOPERATION WITH THE ELIGIBILITY INTERVIEW AND RESCHEDULING (MED 1, 2, MED 4)

An application is to be denied if an individual does not cooperate with the interview requirement. Refusal is determined when the AG can cooperate but clearly demonstrates a refusal to be interviewed. Applications are to be denied on the 30th day (or next business day when the 30th day is a non-business day) when the applicant has failed to keep scheduled appointments or to reschedule an appointment by the 30th day.

If there is any question as to whether the household has merely failed to cooperate, as opposed to refused to cooperate, the household should not be denied, and the agency should aid complete the interview requirement.2 If the individual contacts the DFR to reschedule, the interview should be rescheduled as soon as possible to stay within processing time frames. A copy of written notices to reschedule should be kept in the case record. Appointments scheduled by phone should be documented in Running Record Comments.

2005.05.10 WHO CAN BE INTERVIEWED

4

In addition to who can be interviewed for an applicant/recipient, this section may also be applied towards who DFR can discuss missing and needed verifications to determine Medicaid eligibility for an applicant/recipient. An applicant or authorized representative may be the interviewee and can conduct all business related to the application process. The initial contact person (ICP) who makes the initial request for assistance cannot be interviewed or request an interview be rescheduled unless they are the designated Authorized Representative, or the applicant or member is also present and gives one- time permission.

For Authorized Representatives, the Authorized Representative for Health Coverage, State Form 55366 must be used to authorize someone to apply on behalf of an AG and must be filed in the case record.

Alternatively, the prospective authorized representative and the applicant/member may call DFR and jointly agree to the authorized representative relationship over the phone.3 Any individual other than the parent of an applicant/recipient under age 18 must be authorized verbally or in writing by the applicant unless medical documentation (such as a doctor’s statement) is presented showing that the applicant is medically unable to provide such authorization (Refer to IHCPPM Section 2005.10.00).

For a spouse of an applicant/recipient to be interviewed, the spouse must either be an authorized representative for the applicant/recipient or be given verbal permission by the applicant/recipient to be interviewed on behalf of the applicant/recipient. Verbal permission can occur in person or over the phone. If it is done over the phone, DFR must ensure that the applicant/recipient giving the verbal permission is in fact the applicant/recipient by asking that person to verify a few things about themselves including but not limited to last four digits of SSN, date-of-birth, address, case number, and RID number. An applicant/recipient may also give verbal authorization to someone other than a spouse. Someone who is merely given verbal permission is not an authorized representative and is not authorized to speak with the DFR about the applicant/recipient’s case beyond that occurrence. Despite the availability of an authorized representative, the DFR may require personal contact with the applicant if such contact is necessary to determine eligibility under any program.

Note: If an applicant/recipient fails to cooperate with the Authorized Representative or third party, then the worker must reach out to the applicant/recipient.

The authorized representative must be familiar with the AG situation to represent them properly. The worker will determine if the authorized representative is representing the AG

5

appropriately. If the applicant/recipient fails to cooperate with the Authorized Representative, and the Authorized Representative is unable to obtain the required verifications needed to complete an eligibility determination, then contact should be made with the applicant/recipient to obtain verifications. Authorized representatives assume responsibility for the accuracy of the information provided. AGs who utilize an authorized representative are subject to the same disqualification penalties and possible prosecution as AGs representing themselves.

Unless there is a valid Authorized Representative form, employees of nursing facilities may not be interviewed on behalf of a resident in their facility unless the client is medically incapable of being interviewed and there is no one else to act on the client's behalf. A doctor’s statement verifying incapacitation is required in these instances.

Legal guardians and powers of attorney may apply for assistance on behalf of the applicant and must present the appropriate documents verifying their status to be interviewed. A power of attorney document must be general enough to encompass applying for assistance. If it is specific to only a certain activity, it does not suffice for application purposes and a POA crafted for the sole purpose of applying for Medicaid is not acceptable. POA invalidates upon the death of a member, and case records are unavailable unless an approved AR form is on file.4

Note: After a member passes away, the authorized representative form remains valid under the condition the POA or AR being designated on the form signed while the member was living. The chief of social services (or his/her designee) of any institution under the control of the Family and Social Services Administration may apply for assistance on behalf of patients in the institution and be interviewed. The social services staff person may apply for assistance for an individual who will remain in the facility or for whom plans are in process of moving to an alternative placement and be interviewed. The most common usage of this procedure will occur with state institutions under the supervision of the Division of Mental Health. When an application is received for a deceased applicant, the application must be processed, and an eligibility determination completed. If an interview is required, then the data gathering interview can only be completed with a verified Authorized Representative or Court appointed Personal Representative. The interview cannot be completed if a valid AR or Court appointed Personal Representative Form is not in the file nor can any information be released to an interested party that is not a verified AR or Court appointed Personal Representative.5 An interested party that has information specific to the applicant’s situation can provide required verifications including the death certificate, but the interested party’s ability to intervene begins and ends with providing documentation or verification. Each situation must be evaluated to determine, if necessary, information to complete the eligibility determination can be obtained.

6

Any application processing questions for this scenario should be sent to the Central Office Policy Unit for clarification. 2005.05.15 WHEN AN INTERVIEW IS REQUIRED

When a member applies for a non-MAGI category (MED 1, MED 2 or MED4), then a data gathering interview must be completed. The only exceptions to this are: LIS/MSP applications sent electronically to the eligibility system via data exchange from SSA SSI recipients SSI recipients that are adding a Medicare buy in category, such as MA L. If a member is ongoing in a MAGI category but requests a non-MAGI category, then a data gathering interview is required. This includes: Members that turn 65 Members that state that they are disabled and request to pursue a disability category Members ongoing in a HIP category that receive disability approval through SSA Members in a limited coverage category (Emergency Services Only, Family Planning or QMB/SLMB/QI/QDW) changing to a MED 1 category Paper QMB application. The only exception is for a member who was interviewed for a MED 1 category but was dual processed (conditionally authorized in HIP pending a disability decision). If such a member completed the MA D personal interview within the past 90 days, a new interview is not required, and a pending verification request may be sent for updated resource amounts and any other changes.6 2005.10.00 AUTHORIZED REPRESENTATIVES

An authorized representative is a designated individual or organization acting on the client’s behalf to assist with application and renewal services. The agency permits applicants and beneficiaries to designate an individual or organization to act responsibly on their behalf in assisting with the individual's application and renewal of eligibility and other ongoing communications with the agency. There are no restrictions on who can serve as an authorized representative including navigators, or individuals working for an enrollment center, if the member permits. Any individual working for the authorized agency may serve as the “qualified authorized representative”, regardless of which associate signs designated form.

7

An authorized representative may be appointed at the time of application, renewal or any other times designated by the applicant or beneficiary. Likewise, a court order establishing legal guardianship, or a power of attorney should be recognized and documented as written consent by the applicant or beneficiary for lawful representation. Applicants and beneficiaries may authorize their representatives to: • Sign an application on the applicant's behalf • Complete and submit a renewal form • Receive copies of the applicant or beneficiary's notices and other communications from the agency • Act on behalf of the applicant or beneficiary in all other matters with the agency.

Authorized representatives must agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant or beneficiary provided by the agency. The authorization will remain valid until the applicant or beneficiary modifies the agreement or notifies the agency that the representative is no longer authorized to act on his or her behalf. Similarly, the authorized representative may inform the agency that he or she no longer representing the client, or there is a change in the legal authority upon which the individual or organization's authority was based. Notification should include the applicant or authorized representative's signature as appropriate.

For authorized representative agreements which are not based on an existing legal authority, the official AUTHORIZED REPRESENTATIVE FOR HEALTH COVERAGE (State Form 55366) form must be signed by both the member and the authorized representative. Alternate forms or letters will not be accepted. Authorized representative agreements can be accepted via mail, fax, submission via the benefits portal, agreement on the telephone, or may be dropped off at a local DFR office. See below for more information on telephonic AR agreements and electronic signatures. Authorized Representative relationships agreed to over the telephone A verbal authorization is acceptable from the member for any Authorized Representative (AR). A three-way call will need to be completed between the member and AR to obtain and confirm the specific AR details. The information must be entered on the Authorized Representative or Legal Guardian Detail page during the call. After the AR information is entered into the eligibility system and the applicant and AR agree on the terms of authorization, it will remain in the system as an authentic and verified agreement unless/until the AR or applicant/recipient withdraws the authorization. AR details must be documented in case notes.

8

One-time call permissions One-time only verbal authorizations are for that specific moment in time. AR should not be added to eligibility system and should only have access to information authorized by member. When a member is on the telephone, he or she may provide verbal authorization for anyone to act as the authorized representative for that individual call only. Subsequent phone calls will again require member’s verbal permission for information to be shared. Electronic signatures Electronic signatures for authorized representative agreements will only be accepted if it is completed with DocuSign, Adobe Acrobat, ESIGN, SignNow, UETA or other such official software which provides supporting verification that it was electronically signed by the applicant/member, such as a digital certificate issued by a certificate authority. If the name is added in a script font in word-processing software such as Microsoft Word, this is not allowable. Electronic signatures submitted via email, faxed directly to the DFR office (rather than to the Document Center at 1- 888-436-9199) or sent by other non-secured formats will not be accepted; however, if sent through the portal, mailed or faxed to the Document Center, or dropped off at the DFR local office, this is allowable. Any questions about the validity of the electronic signature should be submitted to PAL for review. The authorized representative must be familiar with the AG situation to represent them properly. The worker will determine if the authorized representative is representing the AG appropriately. If the applicant/recipient is failing to cooperate with the Authorized Representative, and the Authorized Representative is unable to obtain the required verifications needed to complete an eligibility determination, then contact should be made with the applicant/recipient to obtain verifications.

Authorized representatives assume responsibility for the accuracy of the information provided. AGs who utilize an authorized representative are subject to the same disqualification penalties and possible prosecution as AGs representing themselves. Note: If a member passes away, the authorized representative form remains valid, under the condition the POA or the AR being designated on the form signed while the member was living. 2015.00.00 RESPONSIBILITIES OF THE APPLICANT/RECIPIENT

The DFR must advise each applicant/recipient of his rights and responsibilities as indicated in the following sections.

9

Each applicant will receive this information as part of the submitted application. When an application is completed over the phone, the Rights & Responsibilities must be read orally to the person completing the phone application. (An audio recording of the Rights and Responsibilities is acceptable.) This is only during the application process, not during a data gathering and/or redetermination interview. 2015.05.00 PROVIDE PROOF OF INFORMATION

The applicant/recipient must consent to the release of any information necessary to determine his initial and continuing eligibility for assistance.1 They must supply required documents and records and must assist the DFR in obtaining verifications1, including proof of incapacity. Failure or refusal by an applicant to provide the DFR with information or verification of information required to determine eligibility will render the AG ineligible for assistance.1 If the individual is doing all that they can to cooperate in verifying the information, but are unable to do so, the DFR must assist the AG in verifying the information. See 2025.10.00 for special circumstances requiring additional flexibility When neither the worker nor the individual can secure the necessary documentation, the individual's written statement may be accepted as sufficient documentation using the guidelines in 2025.10.05. If there is a question as to whether a submission or statement is sufficient, send to PAL for review before taking adverse action on the case.

2015.10.00 UNDERGO MEDICAL EXAMINATION (MED 1)

A blind or disabled applicant or incapacitated recipient must undergo a medical examination necessary to establish categorical eligibility for MA.7

A blind, disabled, or incapacitated recipient must undergo subsequent medical examinations, if required, to establish continuing eligibility.8

2015.15.00 COOPERATE IN TREATMENT PLAN (MED 1) The blind or disabled recipient must cooperate in any treatment plan which has been recommended by the examining physician and approved for payment by the Medicaid program's Prior Authorization Process. The goal of such treatment must be full or partial alleviation of his visual impairment, incapacity, or disability.9

Failure to cooperate in such plan without good cause will render the recipient ineligible for assistance.10 "Good cause" includes, but is not limited to:

10

• The treatment is contrary to the applicant's religious beliefs • Previous surgery of the same type recommended was unsuccessful • The recommended treatment is very risky because of its magnitude or unusual nature • Amputation of a major limb is involved.11 2015.20.00 REPORT CHANGES IN CIRCUMSTANCES The applicant/recipient must report any changes in circumstances affecting Medicaid eligibility to the DFR within 10 days of the date on which the change occurred or became known to the recipient.12

AGs will be advised at the point of application in the Rights & Responsibilities of their responsibility to report changes. This provision is applicable at any time after submission of the application, regardless of whether it has been approved or not. 2020.00.00 APPLICATION TIME STANDARDS

Due to federal requirements, applications must be processed within specific time standards. The time allowed varies depending on whether the applicant is alleging a disability. The time standard is counted beginning with the day following the date of application and ending with the date on which the eligibility notice is mailed. Time standards for application processing as required by the individual programs are explained in the following sections. 2020.15.00 APPLICATION TIME STANDARDS (MED)

The DFR must determine eligibility within federally prescribed time standards and must so inform each applicant both verbally and in writing at time of application. Notification to applicant may also be electronic. These time standards include the following:13 • 45 days for all MA categories except the Disabled categories (MA D and MADW), which is 90 days. 14

• The time standard covers the period from the date of application to the date the eligibility notice is mailed.15 The DFR must not utilize the time standard as a waiting period before granting MA. Additionally, the fact that a case is going to pend beyond the time standard cannot be used as the basis for denying the application.16

2020.20.00 APPLICATION PROCESSING DELAY

11

Delay exists when an application is not processed within the federally prescribed time standards. The worker is to determine the reason for delay and whether the delay was caused by the AG or the DFR by using the information in the following sections. 2020.20.10 EXCEPTIONS TO APPLICATION TIME STANDARDS Every effort must be made by the DFR to process all applications within the time standards. If an application pends beyond the time standard, the reason must be clearly documented in the case notes. Reasons are as follows:

• Awaiting documentation of life insurance cash value from life insurance company. • Awaiting medical or visual information from the examining physician. • Receipt of hearing decision .

2025.00.00 VERIFICATION To determine eligibility for assistance, the DFR is required to verify information to support the eligibility determination process such as: • Non-financial factors of eligibility • Resources • Income • Claimed expenses.

These factors will vary by program. For factors which may impact eligibility, unless otherwise specified in this Manual. The use of client statement should be used only as a last resort. 1

2025.05.00 VERIFICATION REQUIREMENTS

The DFR must have adequate information on which to base case eligibility decisions. Therefore, at least one source of verification must be obtained for each eligibility factor. Verification is the use of third-party information or documentation to establish the accuracy of statements on the application as well as statements obtained during the interactive interview.

12

Verifications must be reasonable and limited to those that are necessary to ensure an accurate eligibility determination. For example, financial and demographic information is required only for those individuals living in the home who are members of the AG (as participants or non- participants). Therefore, when dealing with a household made up of AG members and excluded persons, the worker may not require the AG, as a condition of eligibility, to provide information and verify the circumstances of the non-AG members. (See Chapter 3200 for information concerning AG membership as a participant or non-participant and exclusion from AG membership). Verifications may be secured by one of the following methods: • Electronically (if an interface or data exchange is available) • Telephone contact with individual to clarify provided verifications or items not requiring hard copy verification (such as tax relationships or pregnancy status) • Collateral contacts (see 2025.05.10) • Written (hard copy) documentary evidence, including verifications received by fax or other electronic devices where the authenticity of the source of the verification along with the verification itself can be validated • As a last resort, some items may be verified via client statement (refer to IHCPPM 2025.10.05 for the policy on acceptable client attestation/written statements) Case notes must contain all telephone or personal contacts and documentary evidence used as verification. At a minimum, the following must be recorded: • The eligibility factors verified • The name of the contact person • The date of the contact; and • The information obtained from the contact.

This entry in Case Notes should be in sufficient detail to support the determination of eligibility or ineligibility.

2025.05.05 VERIFICATION OF QUESTIONABLE INFORMATION

All eligibility factors that are questionable must be verified prior to the approval of the AG. To be considered questionable, the information on the application must be inconsistent with:

13

• Statements made by the applicant • Information on previous applications • Information available to the worker.

When determining if the information is questionable, the worker will base the decision on the circumstances of the AG. Further verifications may be necessary if any of the following situations occur:

• A report of expenses that exceed income. • The AG reports no income and/or no assets, yet is managing financial affairs • Information has been received that there are individuals not included on the application reside with the applicant/recipient and, therefore, the composition of the AG is questionable.

Questionable information alone does not serve as a basis for a denial or termination of the case. When unclear information is received from a third party or from the AG, clarification and verification of the AG’s circumstances must be pursued. A written request, which clearly advises the AG of the verification needed and actions needed to clarify the circumstances must be sent. The notice must advise the AG it has 13 days to respond and clarify its circumstances and that failure to respond will result in denial/closure. If the AG does not respond to the written notice or does respond but refuses to provide sufficient information to clarify the circumstances, adverse action is taken to terminate the case. A new application is required if the AG wishes to continue to receive benefits. Refer to IHCPPM 1610.50.00 for pregnancy-related change processing.

If the AG responds and provides sufficient information, the reported information must be acted upon.

Benefits for one category cannot be terminated solely because benefits under another category are terminated.

Note: All written and attested statements must include a signature, date, and give specific monetary/frequency terms of actual/anticipated projections of income and or resources when applicable (Refer to 2025.05.00 and 2025.10.05). For example: My husband earns $500/month, or I have $50.00 in cash on hand. This information will need to be provided for applicants/household members. The worker must document the reason for the signed statement.

14

If there is question as to whether a submission or statement is sufficient, send to PAL for review before taking an adverse action on the case. 2025.05.10 COLLATERAL CONTACTS

There are some institutions such as banks, insurance companies, and medical institutions which will not release information without the written consent of the individual. If information from such sources is essential to the determination of eligibility, and the individual does not or cannot provide the necessary information and refuses to sign a release form, eligibility cannot be established, and consequently the application must be denied.

When contacting collateral contacts, disclosure of information should be limited to that which is necessary to obtain the information being sought. Disclosure that the AG has applied for or is receiving Medicaid should not occur.

2025.10.00 RESPONSIBILITY FOR OBTAINING VERIFICATION

The applicant or authorized representative has the responsibility for providing adequate data to substantiate the request for assistance. The applicant or authorized representative is not required to present evidence in person at the DFR. The evidence may be supplied in person, through the mail, by facsimile or other electronic devices as listed in IHCPPM 2025.05.00. Some information may be obtained electronically through interfaces or other databases as specified in the State’s Verification Plan.

Assistance in Obtaining Verifications: If it is difficult or impossible for the individual or authorized representative to obtain the evidence in a timely manner or the AG has presented insufficient documentation, the worker must help. This assistance includes collateral contacts, faxing the signed Authorization for Release of Financial Information (State Form 3234/ FI 0014) or the Life Insurance Verification (State Form 4478/FI 0775) to the financial institution or sending the signed Request for Earnings Information (State Form 54092/DFR 0065) to the employer.

Good judgment is required on the part of workers when determining what, if any, verifications can be furnished by the applicant or authorized representative. The worker should accept any reasonable evidence and will be primarily concerned with how adequately the evidence proves the statements on the application. When neither the worker nor the applicant/recipient can secure the necessary documentation, the applicant/recipient's written statement may be acceptable information, except for certain eligibility factors (Refer to 2025.10.05).

15

If the applicant or authorized representative is refusing to provide documentation that is in the sole possession of applicant or authorized representative, or that can only be created or provided by the applicant or authorized representative, see IHCPPM 2015.05.00 Note: This does not apply when an applicant/recipient is failing to cooperate with the Authorized Representative or third party in securing required documentation. In these cases, the worker must reach out to the applicant/recipient to determine whether the applicant/recipient has attempted to cooperate with obtaining verifications and needs assistance. An Authorized Representative’s statement that they cannot obtain the verifications from their client cannot stand in for the required documentation. Special Circumstances Requiring Flexibility17: In cases where the applicant/recipient is a victim of domestic violence, it is important to understand the barriers that can exist in the process of obtaining verifications where the abusing party may be in possession of the needed documentation and any attempt to obtain said documentation would pose a threat to the applicant/recipient. Similarly, members who are homeless or have experienced a natural disaster should be allowed to self-attest when documentation does not exist at the time of application or renewal or is not reasonably available to them. Because members who are in treatment for Substance Abuse Disorder (SUD) are at very high risk for relapse if they lose their medical coverage, workers should be especially sensitive to the challenges these members face in obtaining documentation and make every effort to work with the member and accept client attestation when it is the best available information.

Self-attestations must be made in the form of a written statement as outlined in 2025.10.05. If there is a question as to whether a submission or statement is sufficient, send to PAL for review before taking adverse action on the case. 2025.10.05 Client Attestation and Written Statements When all reasonable attempts have been made but neither the worker nor the applicant/recipient can secure the necessary documentation, the applicant/recipient's signed statement is to be acceptable information. The signed statement will serve as documentation of why DFR took action and is protected against future audits. The document could also be used for possible investigations if the attestation is later found to be questionable. Client Attestation cannot be used for any or all the following:

16

• Citizenship status • Social Security number • Valid exception to applying for SSN (i.e., when client’s stated SSN is not verified by data match, or when proof of application or for SSN is not provided for an applicant/member who is not a newborn). • Legal documentation that includes but limited to trusts, wills, court orders, contracts and any referenced schedules, exhibits, or attachments to these documents. • Disability status • Waiver approvals • For assets held by an open financial institution, a written attestation may only be accepted if the applicant/member has attempted to gather the documentation but was unable to; and the applicant/member has signed the Authorization for Release of Financial Information (State Form 3234/ FI 0014) or Life Insurance Verification (State Form 4478/FI 0775) and returned the form to DFR, but the institution has not responded to DFR by the deadline

A written statement must be submitted to the DFR detailing what steps were taken to gather the required documents. The statement must include the applicant or member’s best estimate of the information that was requested (for example, an estimate of income received or when the income ended). The statement must be dated and signed by the applicant/recipient or authorized representative. All written and attested statements must include a signature, date, and give specific monetary/frequency terms of actual/anticipated projections of income and or resources when applicable. For example: My husband earns $500/month, or I have $50.00 in cash on hand. This information will need to be provided for applicants/household members. The worker must document the reason for the signed statement.

Examples of satisfactory written attestation:

Name: Janet Jones DOB: 01/01/1980 Address: 123 Main Street, Indianapolis, IN

I lost my job with ABC Company on March 1st of this year. I asked them to fill out a form or give me a letter about my job but they are not responding. Their phone number is 317-555- 1212.

My last pay from ABC Company was March 15th. I was paid every two weeks, and the check was for 60 hours at $10.00 an hour, for a total of $600 before taxes.

This is information is complete and correct to the best of my knowledge.

Signature

Date

17

Name: Michael Miller DOB: 01/01/1980 Address: 123 Main Street, Indianapolis, IN

I do not have the 2014 Honda Civic anymore and I don’t have any paperwork on it. It broke down and was towed away by the city around August of 2022.

This is information is complete and correct to the best of my knowledge.

Signature

Date Note: This does not apply when an applicant/recipient is failing to cooperate with the Authorized Representative or third party in securing required documentation. In these cases, the worker must reach out to the applicant/recipient to determine whether the applicant/recipient has attempted to cooperate with obtaining verifications and needs assistance. An Authorized Representative’s statement that they cannot obtain the verifications from their client cannot stand in for the required documentation. If there is a question as to whether a submission or statement is sufficient, send to PAL for review before taking an adverse action on the case. 2025.15.00 REQUESTS FOR INFORMATION If the worker requires information or verification from the individual, he must provide the individual with the following: • A written list of specific information required to complete the application process • The date the information is due. • Information on the consequences of not returning additional information by the due date.18

18

When asked to release information necessary to process an application, the date and the name of the person or organization from which information is being requested must be listed on the release form prior to requesting the client's signature. This policy applies to the Authorization for Release of Information Form, or any of the other forms such as the FI-0014 and FI-0065 used to document the client's authorization for the release of confidential information. All these forms must show the date signed by the client and may not be honored if more than 90 days old. The client may also revoke this authorization at any time prior to the expiration of the release. The worker must provide the verification checklist for all AGs within the household.

The individual is responsible for providing as much of the required information as possible and must be informed that time extensions can be requested. However, any delay may affect potential benefits. The worker must assist the individual when the individual is unable to act wholly on his own or when the individual requests assistance obtaining information. When additional information or verifications are required, the individual must be informed of the above specifications. IEDSS will not automatically generate this notice. If there is electronic data available from the federal data services hub or other electronic resources, the worker must first use the available electronic data before requesting additional information from the individual.

2025.20.00 TIME STANDARDS FOR PROVIDING INFORMATION

If it is determined at the interview or at any time during the application process that additional information or verification is required, the AG must be notified and given 13 calendar days to comply with the request. For all, the verification due date is 13 calendar days from the date the pending verification checklist is provided. If the verification due date falls on a holiday or weekend, the deadline for the requested information is the next working day. 2030.00.00 PROVIDING INFORMATION TO THE APPLICANT/RECIPIENT OR PARENT OF APPLICANT/RECIPIENT

Applicants will receive Rights & Responsibilities when submitting a Medicaid application, and annually at each successful redetermination. If at any time an applicant or member or their Authorized Representative requests that the Rights & Responsibilities be mailed to them, or read to them, the worker should do so at the time of such request.

19

The following are helpful items that the worker should be prepared to verbally explain to each Medicaid interviewee if they ask for this information. At a minimum, workers should conclude an interview by informing the interviewee of the next steps to be taken by both the applicant/member and the DFR. • That the AG will receive written notices stating the actions that must be taken to stay eligible. (If the AG cannot comply, the client should call before the deadline to explain the reason.) • All eligibility factors pertaining to the Medicaid categories which have been chosen • That there is an Appeals and Hearings process available • The applicant's Rights & Responsibilities are outlined within the Indiana Application for Health Coverage and can be mailed again if requested • The fact that the application will be processed for the category with the most benefits that the individual may be eligible to receive • The applicant's freedom of choice as to the type and number of categories under which he applies, including the QMB category for applicants entitled to Medicare Part A • The applicable timeline standards to determine eligibility for the application • That if the AG disagrees with any action taken by the DFR, it may request a fair hearing • That the AG's SSNs will be matched against the records of other agencies to detect unreported income and resources • The fact that the individual may withdraw their application at any time during the application process or request that his assistance be discontinued. 2030.10.00 PROVIDING INFORMATION TO APPLICANTS

The following information must be provided: • If an applicant is approved, a Hoosier Health Card will be sent to each enrollee within two weeks after the approval is authorized. This is a plastic identification card expected to be retained throughout the person's eligibility for Hoosier Healthwise or traditional Medicaid in Indiana. If a person is discontinued and reapplies, the same card can once again be used if the person is re-enrolled. Coverage under traditional Medicaid and all benefit packages of Hoosier Healthwise except Package C, may be retroactive up to three months prior to the month of application if all requirements are met. Coverage under Package C can begin no earlier than the month of application. Also, coverage under MA L cannot begin any month earlier than the month of application. • Coverage under the premium-free packages will be explored first and if the person wishes coverage under Package C, payment of the premium is required. • Annual redeterminations of eligibility are required for all enrolled persons.

20

• If determined to be eligible for Medicaid, the person will be able to select a Medicaid provider(s) of his choice or19, if he is in a managed care category, he must select a health plan. • Discuss the medical assignment and explain that the free service of paternity establishment is not available for children who are found eligible under Package C. • Discuss the premium requirements of MEDWorks for disabled applicants who are working.

2035.00.00 DETERMINATION OF INITIAL ELIGIBILITY This section discusses policy for:

• Disposition: The initial determination of eligibility or ineligibility. • Date of entitlement: The initial date of eligibility for assistance.

Refer to Chapter 2200.00.00 for determination of on-going eligibility, redeterminations, and certification periods. 2035.10.00 REASONABLE COMPATIBILITY OF INCOME

Reasonable compatibility standards will be used to address situations where an applicant/recipient’s self-attested information and electronic sources of information are inconsistent.20

Self-Attested Income Income Obtained from the Work Number or other electronic sources Worker Action Below the Standard Below the standard Use the reported income. No further proof is needed. Below the standard Above the standard Refer to the Reasonable Compatibility section below. Above the standard Below or above the standard Use the reported income. No further proof is needed. Note: below is applicable at any time, including application, redetermination, reported change, etc. • If an individual attests to income below the Medicaid or S-CHIP applicable income standard and if electronic data on income is unavailable, further documentation will be required from the applicant.

21

• If an individual attests to income above the Medicaid or S-CHIP applicable income standard and the electronic data indicates income below the applicable income threshold, the individual is determined ineligible with no additional information sought. The individual is screened for eligibility for other insurance affordability programs. • If an individual attests to income below the Medicaid or S-CHIP applicable income standard and the electronic data indicates income above the applicable standard, documentation will be required from the applicant to resolve. In this situation, the worker needs to send a Pending Verifications for Applicants/Recipients (DFR Form 2032) to the client to verify the income before the case is closed/denied. • If the difference between what an individual attests to and the electronic data results in a different category or cost-sharing amount, documentation will be required from the applicant to resolve.

Note: Local Office must investigate and request documentation (send DFR Form 2032) when information retrieved from an electronic data source directly conflicts with member/applicant’s attestation and results in a benefit change.21 Refer to Chapter 3000 for the applicable income and resource standards for everyone. 2035.15.00 PRE-ADMISSION SCREENING IS PENDING (MED 1)

When pre-admission screening (PAS) is pending on an individual who has entered a nursing facility, ICF/IID or CRF/DD, it is to be assumed that the individual will be approved, absent evidence to the contrary. A "yes” should be entered on the drop-down menu for Pre-Admission Screening field on the Facility Details page in the Eligibility system. The date is either the date the screening was initiated, if known, or the date the individual entered the facility.

The DFR will not receive a copy of the Form 450B (Physician Certification for Long Term Care Services) when the level of care determination is made. DFR should arrange a procedure with Medicaid facilities so that the facilities will notify the caseworker if a level of care is denied. When a denial is received by the worker, the information on Facility -Details page must be updated accordingly. 2035.20.00 HOME AND COMMUNITY-BASED SERVICE WAIVERS (MED 1)

Parental income and resources are not considered when determining the Medicaid eligibility of individuals less than 18 years of age who are being considered for Home and Community-Based Services (HCBS). Parents should be asked early in the interview if they want retroactive Medicaid coverage for the child. If retroactive coverage prior to the waiver effective date is requested, the parents must provide verification of their income and resources. Generally, most parents do not

22

want retroactive coverage for the child prior to the waiver and are resistant about being asked any questions about themselves. If the parents do not want the retroactive coverage, they are not required to provide information about their own finances for those retroactive months. As each screen is completed, the questions will relate to the situation of the child only, if retroactive coverage is not desired. 2035.30.00 DETERMINATION OF MEDICAL CATEGORY (MED)

In the absence of a stated preference by the applicant22, Eligibility System will determine the category according to the hierarchy listed below. A brief description of the categories can be found in Chapter 1600. The hierarchy is designed so that the applicant is first considered under the category which provides the most comprehensive scope of coverage in the most expeditious manner. If the client states an intention to apply for the Aged, Blind, or Disabled category, the preferred category can be entered by the worker on Program Request Summary screen. However, a person who is eligible in a mandatory category cannot choose to be in an optional category. Therefore, individuals who are working and eligible in the Disabled category cannot choose to be in MEDWorks. Additionally, applicants do not have the option to choose the MA 10 category when eligible under another category. An individual who is eligible for MADW (not MADI) can choose to be enrolled under MA D. Workers must ensure that the applicant is in fact eligible for MA D. For example, if the applicant’s gross earned income minus impairment-related work expenses is more than the SGA limit, MA D cannot be approved. Refer to Sections 1620.72.00 and 2035.30.10 regarding MA10 determinations, and to Section 2035.30.05 which explains the special considerations for MA 9, children aged 1 – 19.

• MA SI SSI Recipient – full coverage, HCC or FFS • MA X Newborn – HHW Package A, full coverage • MA Y Children under age one - HHW Package A, full coverage. • MA Z Children aged one through five - HHW Package A, full coverage • MA 2 Children aged 6 through 18 - HHW Package A, full coverage • MAGF Parent/Caretaker and Refugee Parent/Caretaker -FFS, full coverage • MA F Transitional Medical Assistance (TMA) - HHW Package A, full coverage • MAMA Pregnant women – HIP Maternity, full coverage • MAGP Pregnant women - HHW Package A, full coverage • MA O Children aged 19-21 residing in inpatient psychiatric facilities – full coverage, FFS • MA 15 Former Foster Care ages 18 through 25 – full coverage, HCC or FFS • MA 9 Children aged one through 18 - HHW Package A, full coverage • MA R RCAP related - full coverage, HCC or FFS

23

• MA A Aged - full coverage, HCC or FFS • MA B Blind - full coverage, FFS • MA D Disabled – full coverage, HCC or FFS • MADW MEDWorks, Basic category – Medicaid for Employees with Disabilities; full coverage, HCC or FFS • MADI MEDWorks, medically improved category – Medicaid for Employees with Disabilities - full coverage, HCC or FFS • MA Q Refugee Medical Assistance (RMA) - full coverage, FFS • MA L Qualified Medicare Beneficiary (QMB) - limited coverage • MA J Specified Low-Income Medicare Beneficiary (SLMB) – limited coverage • MA I Qualified Individual (QI) – limited coverage • MA G Qualified Disabled Working (QDW) - limited coverage • MA10 Children birth through 18; HHW Package C, comprehensive coverage, some services subject to limits • MA E Family Planning Services for Women and Men – limited coverage, FFS. 2035.30.05 DETERMINATION OF MA 9 CATEGORY (MED 3) This category, established effective July 1, 1998, includes 141% - 158% of the Federal Poverty Level, and children aged 6 through 18 with income between 106% - 158% of the poverty level.23 The MA 9 income standards are listed in Section 3010.30.15. MA 9 is positioned in the hierarchy after MA 2 and before MA B and MA D. However, if a blind or disabled child is determined eligible for MA B or MA D, without a spend-down, she/he will be authorized in one of those categories not MA 9.

New applicants will be considered first in MA 9 without being required to go through the medical determination process with the MMRT. If they fail MA 9 eligibility, then they will be considered under MA B or MA D. Recipients who are eligible in the MA B or MA D categories without a spend-down, but who meet the MA 9 financial requirements will remain in MA B or MA D.

Recipient children in MA B or MA D who are in Medicaid certified facilities and who have liabilities will remain in those categories.

A child who meets the MA 9 requirements but would also be eligible for MA B or MA D with a spend-down, will be approved in MA 9.

2035.30.10 DETERMINATION OF MA 10 CATEGORY (MED 3)

24

This category, established effective January 1, 2000, includes children aging from birth through the age of 18, who are not eligible in any other medical category. MA 10 is Benefit Package C of Hoosier Healthwise. The income standards were set at 200% of the federal poverty guidelines until October 1, 2008, when they were increased under an MA 10 expansion to 250% of the federal poverty guidelines. The standards are listed in Sections 3010.30.20 and 3010.30.25. Information on budgeting under the expansion is found at Section 3460.15.05.

MA 10 is positioned at the bottom of the medical hierarchy due to the requirement that eligibility be pursued under the other categories first. However, the same provision as in MA 9, that is applied to children who would be eligible in the Blind and Disabled categories is applicable to MA 10. Refer to the previous section, 2035.30.05.

2035.30.15 DETERMINATION OF MEDWorks CATEGORY

A disabled individual will be considered under all applicable categories according to the hierarchy. If the individual’s gross earnings, minus Impairment-Related Work Expenses (IRWE) exceed the Substantial Gainful Activity amount specified in Section 3046.00.00, or their total countable income or resources exceed the MA D limits listed in Chapter 3000, they will then be considered for eligibility in MEDWorks. MADW is considered first.

An applicant for Medicaid cannot be approved initially in MADI.

If the Medical Review Team or the Social Security Administration determines that an MADW recipient is no longer disabled due to a medical improvement in his condition, MRT will determine whether the improvement does not constitute a full medical recovery. If there is not a full medical recovery, such individual will be determined for MADI categorical eligibility. 2035.30.20 DETERMINATION OF MA 14 CATEGORY (MED 3)

Note: Effective 1/1/23, Former foster care children enrolled in Medicaid (any state) on their 18th birthday will transition to MA 15 (Refer to 1620.74.00 and 2035.30.25). 2035.30.25 DETERMINATION OF MA 15 CATEGORY (MED 3)

This category includes individuals who were in Foster Care and enrolled in Medicaid (any state) upon attaining age 18 and who are less than 26 years of age. This category is open to former foster care individuals who are Indiana residents and are not enrolled in another category of Medicaid. There is no income or asset test, and annual

25

redeterminations are not required. Members who meet eligibility requirements and are receiving benefits in another full coverage category, can continue to receive Medicaid under existing category, but a new applicant or a person who is not currently passing in another category, can go directly to MA 15 (if eligible) without requiring an eligibility determination for any other category. Note: The category of MA 14 for former foster children from states other than Indiana, which included an income test and covered individuals aged 18 – 21, will be phased out as of January 1, 2023, and eligible individuals will instead be covered under MA 15 rules.

2035.30.30 DETERMINATION OF MA E (MED 3)

A person must request that he or she wishes to receive family planning services for an eligibility determination under this category. Services under this category are limited to those related to family planning. Pregnant women who deliver or whose pregnancy is terminated will automatically be considered for MA E if not eligible for another category.

2035.31.00 DESIGNATION OF THE PACKAGE C PREMIUM PAYER

When an Indiana Application for Health Coverage is filed, the person signing the application understands that if the child is eligible for Package C, there will be a premium due before the child can be enrolled. The premium payer is assigned according to the following default logic: mother, father, non-parent caretaker. The caseworker may override the system designation of payer in the following circumstances: • The mother is living in the home and the system has designated her, but it is the father (also in the home) who wants to be the payer. • The child is a ward of the DCS and is placed with someone other than the parents. (If the ward is placed with a parent, the parent will be designated premium payer.) • The child has a legal guardian and is placed with the parent. In this situation, it will be necessary to determine which of these individuals is financially and legally responsible for the child and enter that person as premium payer. 2035.32.00 ENROLLMENT PROCESS FOR MA 10

Once eligibility is established, a conditional approval for MA 10 is to be authorized. This means that the children meet all eligibility requirements of MA 10 except for payment of the first premium(s).

26

The first premium month is the month after authorization. The months of application and months through the month of authorization are premium-free. The children will be enrolled when the premium has been paid. When processing the MA 10 application, the DFR worker must complete an off-line calculation to determine if the child would be eligible for retro Medicaid coverage in another category. Refer to Chapter 3405.00.00 on how to process retro benefits for a MAGI case.

It is not necessary to request retro income unless there is a significant change in income, however income should be entered for each retro month. If the child is found to be eligible for retro coverage, then the worker should open the category for those retro months and fully document what was completed in the case notes. The billing process allows for an overdue billing, which gives the payer a subsequent opportunity to pay the premium before the application will be closed. If a payment is not received by the final due date, the conditional approval will be system denied. Once the first premium has been paid and MA 10 is authorized, coverage can only be discontinued for non-payment at renewal.24 Outstanding premiums must be paid by renewal month. If the premium payments are not received by renewal month, benefits will be terminated. If the individual is discontinued for nonpayment of premiums, that individual will need to submit a new application. Individuals who reapply are not required to pay the previously owed premiums.

Note: For MAGI applications, if the applicant does not state/verify the income was different in the retro months, the verified income for the application month must be copied/entered for each retro month to avoid incorrectly determining eligibility for those months based on zero income.

2035.33.00 DESIGNATION OF MED WORKS PREMIUM PAYER ENROLLMENT PROCESS

MADW/I premium payer is set in the following default order: • Applicant/recipient aged 18 and older • Mother of applicant/recipient under age 18 • Father of applicant/recipient under age 18

The caseworker can change the payer of a child under age 18 from mother to father as requested by the parent. In the case of a married couple when both are applicants/recipients of

27

MEDWorks, each spouse will be designated as his or her own premium payer. However, the premium will be a ‘couple premium’, meaning one premium is assigned to both spouses. Both will be enrolled when the one premium is paid, and both will be denied if the premium is not paid. One billing statement will be sent to the couple. Applicants who pass all eligibility requirements and based on income are required to pay a premium to be enrolled will be conditionally approved until the premium is paid. The first premium month is the month following the month of authorization. All prior months in which the individual is eligible are premium-free.

2035.35.00 DETERMINATION OF INELIGIBILITY

An AG is to be denied if just one eligibility requirement fails to be met causing the AG to be ineligible. However, if, during the eligibility study the worker verifies that other requirements are not met; all reasons for denial must be entered on the Eligibility Determination Results page 2035.40.00 AUTHORIZATION An AG must be authorized when all required eligibility information is documented, and the determination of eligibility is complete. Please note the exception in section 2035.40.05. In all other instances, AGs are to be authorized whenever the eligibility determination is complete. Authorization of an AG is not to be delayed while awaiting completion of the eligibility determination for other AGs in the case.

Before authorizing an AG, the worker should carefully review all data and the case eligibility results for accuracy. This involves reviewing every retroactive month as well as the recurring month. 2035.40.05 AUTHORIZING WHEN CITIZENSHIP OR IMMIGRATION STATUS IS NOT VERIFIED If a person would be determined otherwise eligible for Medicaid under any category due to meeting all verification requirements of Medicaid, except for the verification of either citizenship or qualified immigration status, then the person must be determined eligible for Medicaid. Please refer to IHCPPM 2402.20.00 for individuals declaring to be immigrants.

Persons who do not have citizenship or qualified immigration status verified promptly by the DFR through an electronic match or by other means but can otherwise be determined eligible are given 95 days from intake date to provide proof of citizenship or qualified immigration status. The system will automatically generate a notice of Reasonable Opportunity if electronic interface verification for citizenship fails. Additionally, the Notification of Requirement to Provide

28

Documentation of Citizenship” (FI 2326 or FI 2326 S, the Spanish version) should be completed and mailed. For more information including due dates, see IHCPPM 2402.15.10. If such person has not verified citizenship or qualified immigration status after 95 days, the person is to be discontinued from eligibility. Children under 19 receiving benefits during their reasonable opportunity period (ROP) are ineligible for a CE period, unless the state can verify their status during the ROP.25

Effective 6/1/24, under CMS guidance, the number of allowable Reasonable Opportunity Periods is unrestricted.26 If a person who received appropriate notices reapplies at least 95 days after being denied for not verifying satisfactory immigration status or citizenship during their Reasonable Opportunity Period, they will acquire a new ROP and if all other requirements are met, Medicaid benefits must be authorized. Refer to IHCPPM 2402.15.10 regarding what documents can be used to verify citizenship. Note: For individuals who state they are not qualified immigrants or that they are undocumented, do not require more documentation of their immigration status. No 95-day Reasonable Opportunity Period applies to individuals who are not attesting to a qualified immigration status. Client statement is all that is needed and if passing, Medicaid can be authorized as Emergency Services Only. 2035.60.00 EFFECTIVE DATE (MED 1, 2, 3)

See 1825.15.00 regarding the date of the application.

The effective date of health coverage is determined in accordance with the following guidelines: For traditional Medicaid and all benefit packages of Hoosier Healthwise except Benefit Package C, the effective date can be no earlier than the third month prior to the month of application if all eligibility requirements are met. This provision for retroactive coverage also applies to individuals who were deceased at the time of application.24 For Hoosier Healthwise Benefit Package C, the effective date can be no earlier than the first day of the month of application. The effective date for an individual who was living in another state just prior to moving to Indiana will be no earlier than the month the individual became an Indiana resident.

SSI recipients are automatically eligible upon receipt of SSI. SSI recipients can obtain three months of retroactive eligibility from the date verification is received by the DFR (including data exchange or award letter). For ongoing members in another category, change processing rules apply (see 2220.05.00).

29

2035.65.00 EFFECTIVE DATE OF QMB MEDICAID (MED 4)

The QMB category of assistance (MA L) has no provision for retroactive coverage. The effective date of QMB coverage begins with the month after the month in which the QMB eligibility determination is made. See 1825.15.00 regarding the date of the application. 2035.70.00 EFFECTIVE DATE OF QDW MEDICAID (MED 4)

The effective date of QDW coverage (MA G) begins with the effective date of Medicare Premium Part A, but no earlier than three months prior to application. See 1825.15.00 regarding the date of the application.

2035.75.00 EFFECTIVE DATE OF SLMB MEDICAID (MED 4)

The effective date of SLMB can be no earlier than the first of the third month prior to the month of application, but not earlier than the date of entitlement to Medicare Part B. The effective date for a recipient who is already bought in and whose Medicaid coverage is being reduced to SLMB is the first day of the month following the closure of the other MA category. For example, if MA D terminates March 31st, the SLMB effective date is April 1st. See 1825.15.00 regarding the date of the application.

2035.80.00 EFFECTIVE DATE OF QI MEDICAID (MED 4)

The effective date of QI (MA I) can be no earlier than the first of the third month prior to the month of application, but not earlier than the date of entitlement to Medicare Part B. The effective date for a recipient who is already bought in and whose Medicaid coverage is being reduced to QI is the first day of the month following the closure of the other MA category. See 1825.15.00 regarding the date of the application. 2040.00.00 REAPPLICATIONS

A reapplication may be made at any time by an individual whose application for assistance was denied or whose assistance was discontinued. If a recipient comes into compliance prior to the effective date of discontinuance, it is appropriate to rescind the adverse action rather than to require a reapplication. If assistance was discontinued at the point of redetermination for failure to provide required information, the person will not be required to submit a new application if the Medicaid mailer and/or the missing information is provided within 90 days from the effective date of

30

discontinuance. Further, eligibility should extend back to the date of discontinuance. Refer to IHCPPM 2238.25.00 and 1610.50.00 (for pregnancy-related change processing). An individual who appeals a denial or discontinuance which had become effective may file a reapplication at any time. He is not to be denied the right to reapply pending the decision of the Administrative Law Judge (ALJ). If the hearing decision is in his favor, the DFR is to take adjusting action as directed in the decision. If the DFR action is sustained, the reapplication is to be processed in the usual manner. The DFR is not to delay the processing of a reapplication taken under these circumstances until the hearing decision is issued as this is not considered an extenuating circumstance for pending a case beyond the time standard.

2050.00.00 MSP APPLICATIONS FROM SSA LIS DATA FILE (MED 4)

On January 1, 2010, in accordance with the Medicare Improvements for Patients and Provider Act of 2008 (MIPPA – P.L. 110-275), the SSA began using a revised application for the Medicare Part D Low-Income Subsidy (LIS) that tells applicants that their application will be sent to the State Medicaid agency unless the applicant checks a box opting out of the referral. Once SSA makes the LIS eligibility determination, the person’s information will be transmitted to the State via the LIS/MSP data file.27 IEDSS will process this file daily and generate worker notifications for every application received. The LIS/MSP data file acts as an application for the Medicare Savings Program (MSP). The applicant will not be asked to sign a separate MSP or Medicaid application. An eligibility interview is not to be scheduled for the LIS/MSP applications that come from Social Security, but the MSP/paper applications require an interview.

2050.05.00 THE MSP APPLICATION DATE (MED 4) The date of the LIS application is the protected date for establishing MSP eligibility. The date that is used to start the 45-day processing clock is the match date that the file is received by IEDSS. The application date is the date the applicant applies for LIS through SSA. Retroactive eligibility is determined from the application date. Example 1: The LIS/MSP data file is received on February 10 for Applicant Joe. The LIS application date recorded on the file is January 4. Based on Joe’s income, he is approved for SLMB and authorized on March 15. MA J is effective October 1 which is 3 months retroactive based on the protected date of January 4. The Lis application was processed within the allowable time standard as it was authorized within 45 days of the date that the LIS/MSP match was received.

31

Example 2: The LIS/MSP data file is received on February 10 for Applicant Lou. The LIS application date recorded on the file is January 4. Based on Lou’s income, she is approved for QMB and authorized on March 15. MA L is effective April 1 which is the month after eligibility is determined. The MIPPA legislation did not change this rule for QMB which does not offer retroactive coverage. This application was processed within the allowable time standard as it was authorized within 45 days of the date that the LIS/MSP match was received.

2050.10.00 INITIAL SYSTEM PROCESSING OF LIS/MSP APPLICATION (MED 4) There are three possible LIS decision types: adjudicated LIS denial, non-adjudicated LIS denial, and LIS approval. Adjudicated LIS denial: In this situation, SSA collected and verified all income and resource information and denied the LIS application. MSP will be denied, and a system-generated notice will be sent to the applicant without further follow up by a worker. The MSP denial notice provides the website address for more information on the MSP and the telephone number of the Area Agency on Aging (AAA) which has an outreach grant for the MSP. The AAA will send the individual an MSP application upon request. Non-adjudicated LIS denial: In this situation, the SSA has accepted self-declaration that the applicant and spouse, if applicable, have resources more than the LIS limit. Question 3 on the LIS application asks if the applicant’s resources exceed the LIS limit. If the applicant checks “yes”, a non-adjudicated LIS denial results. If the applicant does not opt out of applying for the MSP, then SSA will send the application to the State. Follow up processing of the application for MSP is required by the worker as explained in Section 2050.20.00.

LIS approval: In this situation, the SSA has collected and verified information and issued a determination that the applicant is eligible for the LIS. Follow up processing of the application for MSP is required by the worker as explained in Section 2050.20.00. A system generated acknowledgment letter will be sent to the individuals who received LIS approvals and non- adjudicated denials. For applicants with no previous or current case, the notice will explain that an MSP application has been received and they may be contacted for verifications. Applicants who have a current application pending will be advised that processing on their case will continue including eligibility for MSP. For individuals already receiving MSP benefits, the notice will state that they are already covered by the MSP and to call the DFR if they have any questions. 2050.20.00 VERIFICATION AND ELIGIBILITY DETERMINATION (MED 4)

32

Applications received via the LIS/MSP data file are to be processed for MSP eligibility. An individual can file an application for full coverage Medicaid as desired. If a Medicaid application is

33

already pending, the processing will continue including the MSP determination as usual. If a full coverage Medicaid application for the individual is received after the MSP application is set up, the date of the application for full coverage Medicaid would be the date that the full coverage application was received. For LIS approvals, SSA’s verification of the following income types is acceptable verification unless there is a known discrepancy: Social Security, retirement pension, VA, and Railroad Retirement. A discrepancy would include differing information from SSA than existing information on the individual from a previous case or the BENDEX match. All discrepancies must be resolved. If the total of these income types for the applicant and spouse cause MSP to fail and there is no discrepancy, the application can be denied for excess income without follow up.

EXCEPTION: If the household size is more than two if there is a spouse or more than 1 if there is no spouse, then household composition must be obtained from the applicant to determine if there are dependent children under the age 18 and thus the applicant might be financially eligible. Income of the dependent children must be verified as well. All other income and resources listed on the LIS/MSP data file must be verified, and for non- adjudications, none of the LIS income or resource information is acceptable verification for MSP. If the application cannot be denied for excess income as explained above, follow up verification must be obtained. The information from the LIS/MSP data file other than the unearned types is considered leads data, but it is not complete in all circumstances to make an accurate eligibility determination for the MSP.

The new form, Medicare Savings Program – Application Information (State Form 54211), must be included with the Form 2032 when requesting verifications. This form includes the program rights and responsibilities. Citizenship does not have to be verified under existing Medicaid rules. However, it may be possible for an applicant to be a lawful immigrant, and this is not denoted on the LIS/MSP data file. Therefore, the following question must be entered on the 2032: “Are you a citizen of the U.S.? If you answer no, please attach of copy of your immigration document showing your lawful resident status”. The LIS/MSP data file transmits mailing address not residence address. Therefore, Indiana residence must be verified. In addition to checking the “residence” box on the 2032, enter the following: “Is your households address the same as your mailing address? If no, please provide your household address”.

34

The LIS program does not ask for or count the cash value of life insurance so verification of the CSV must be requested of all applicants. The LIS application does not ask for race/ethnicity, so this must be requested. This would not affect the person’s eligibility, however, if not provided. If the applicant’s first response to the first request for verification is timely but incomplete or causes the need for additional clarification, a second request must be sent to clarify. An application is not to be denied based on a partial response to the first verification request. If a response is not received at all by the first due date, a reminder must be sent.

Whenever an MSP-only recipient subsequently asks for full coverage Medicaid, another application is not required.

If the LIS/MSP applicant has full coverage Medicaid already open, an MSP decision can be made based on the information already in the Medicaid case, even if MSP was previously denied or discontinued. However, discrepant information must be resolved.

1 405 IAC 2-1-2 2 405 IAC 2-1-2 3 42 CFR §435.923(f) 4 I.C. 30-5-10-4 5 45 CFR 164.502 6 405 IAC 2-1-2 7 470 IAC 2.1.-1-2 8 470 IAC 2.1.-1-2 9 470 IAC 2.1.-1-2 10 470 IAC 2.1.-1-2 11 470 IAC 2.1.-1-2 12 470 IAC 2.1.-1-2 13 42 CFR 435.911 14 42 CFR 435.912 15 42 CFR 435.911 16 42 CFR 435.911 17 42 CFR 435.952 18 470 IAC 2.1.-1-2 19 405 IAC 1-1-2; SSA 1902(a)(23); 42 CFR 431.51 20 42 CFR §435.603

35

21 42 CFR 435.952 22 42 CFR 435.404 23 Title XXI of the Social Security Act 24 42 CFR 457.570 and 42 CFR 600.525(b)(2) 25 Section 5112 of the Consolidated Appropriations Act, 2023 (CAA, 2023) 26 42 CFR 435.956(b)(4) and 42 CFR 457.380(b)(1)(ii) 27 SSA 1144(c)(3)

Indiana Health Coverage Program Policy Manual Chapter 2200 CONTINUING CASE PROCESSING Sections 2200.00.00 – 2250.00.00

Contents

2200.00.00 CONTINUING CASE PROCESSING ............................................................................ 2 2205.00.00 REDETERMINATIONS .............................................................................................. 2 2205.05.00 ESTABLISHING THE REDETERMINATION (ANNUAL RENEWAL) MONTH....... 2 2205.10.00 SCHEDULING REDETERMINATION IN (ANNUAL RENEWAL) INTERVIEWS .... 3 2205.15.00 REDETERMINATIONS (ANNUAL RENEWAL) BY MAILER ............................... 3

2205.15.05 CHIP (MA 10) RENEWALS………………………………………………………………………… 3 2215.00.00 CHANGES ............................................................................................................... 4 2215.10.00 DATE CHANGE REPORTED ......................................................................... 4 2215.15.00 WORKER RESPONSIBILITIES REGARDING CHANGES .................................... 4 2220.00.00 PROCESSING CHANGES ........................................................................................... 5 2220.05.00 CHANGES REPORTED AND VERIFIED TIMELY .............................................. 6 2220.10.00 CHANGES REPORTED UNTIMELY YET VERIFIED TIMELY .............................. 9 2220.15.00 FAILURE OF ASSISTANCE GROUP TO REPORT CHANGES ............................. 9 2220.20.00 CHANGES REPORTED AND NOT VERIFIED TIMELY ....................................... 9 2220.25.00 PROCEDURES WHEN MEDICAID FACILITY LOSES CERTIFICATION ............... 10 2225.00.00 ADDING AN INDIVIDUAL TO THE AG (MED 2, MED 3) ............................................ 10 2225.10.00 ADDING A NEWBORN CHILD ..................................................................... 10

2225.20.00 REMOVING AN INDIVIDUAL FROM THE CASE………………………………………………10

2232.00.00 TIMELY NOTICE OF ADVERSE ACTION ................................................................... 11 2232.10.00 EXCEPTIONS TO TIMELY NOTICE (MED) .................................................... 12 2235.00.00 CHANGES IN CATEGORY OF ASSISTANCE (CLEVIDENCE RULING) (MED) ................ 12

2236.00.00 REDUCTION IN SCOPE OF MEDICAID COVERAGE (MED) ........................................ 14 2237.00.00 MEDICAID RESOURCE SUSPENSION (MED 1) …………………………………………………….15 2237.05.00 SUSPENSION INCARCERATION/PSYCHIATRIC ADMISSION ........ 15 2237.10.00 REINSTATEMENT OF BENEFITS FOR SUSPENDED INDIVIDUALS ................. 15 2238.00.00 DISCONTINUANCE ................................................................................................ 16 2238.05.00 DISCONTINUANCE DUE TO DEATH ............................................................ 16 2238.06.00 DISCONTINUANCE DUE TO WHEREABOUTS UNKNOWN ........................... 16 2238.10.00 CLOSED CASE FILES ................................................................................... 17 2238.15.00 CERTIFICATES OF MEDICAID COVERAGE ................................................... 17 2238.20.00 CONTINUOUS ELIGIBILITY FOR CHILDREN UNDER AGE 19 ......................... 19

2238.20.05 CONTINUOUS ELIGIBILITY PERIODS FOR CHILDREN IN MA 4,

MA 8 AND MASI………………………………………………………………………………………….19

2238.25.00 REDETERMINATION 90-DAY EXTENSION FOR FAILURE TO VERIFY……………………….21 2239.00.00 CORRECTION OF LIABILITY (MED 1) ...................................................................... 21 2240.00.00 AG CHANGES ADDRESS ......................................................................................... 22 2250.00.00 VOLUNTARY WITHDRAWAL FROM ASSISTANCE .................................................... 22

2200.00.00 CONTINUING CASE PROCESSING

This chapter contains policy regarding continuing case processing, including:

• Redeterminations (Section 2205) • Changes (Section 2215) • Processing Changes (Section 2220) • Adding an Individual to the AG (Section 2225) • Timely Notice of Adverse Action (Section 2232) • Changes in Category of Assistance (Clevidence Ruling) (Section 2235) • Reduction in Scope of Medicaid Coverage (Section 2236) • Suspension of Medicaid Benefits (Section 2237) • Discontinuance (Section 2238) • Correction of Spend-down and Liability (Section 2239) • AG Address Change (Section 2240) • Voluntary Withdrawal from Assistance (Section 2250).

2205.00.00 REDETERMINATIONS

Periodic reviews of eligibility must be made on assistance cases to ensure that benefits are computed correctly. A redetermination is the process in which the caseworker gathers information on the circumstances of the case members and verifies all changeable elements to establish continuing eligibility. For changes in circumstances which happen after initial approval but outside of the annual renewal timeframe, please see 2215.00.00 (and following) further in this chapter.

The requirements for redetermination of eligibility at annual renewal are discussed in this section. Annual renewals will be conducted for both MAGI and non-MAGI individuals once a year.

The only groups which typically do not complete annual renewals are those for whom a determination of income or resources is not required: ongoing pregnancy/postpartum (12 months after pregnancy ends) members, foster children and those receiving Adoption Assistance, former foster children who aged out of foster care at age 18 and have not yet turned 26, and SSI recipients. Any changes in address or other household factors should be followed up on for these members when the change happens.

Ex-Parte (Automatic) Renewals When it is time for annual renewal, the eligibility system will first attempt to gather electronic data to determine whether we have recent and reliable information which shows the member remains eligible. Common data sources which are checked are The Work Number and, for non- MAGI individuals, the Asset Verification System. If electronic data is returned showing the individual is still eligible for Medicaid, they qualify for an ex-parte renewal.

Where electronic data is not returned, the system will evaluate how recently any eligibility factors subject to change have been verified. If the individual has verified the required factors in the last six months (whether for a Medicaid benefit for someone in their household, or as a result of a SNAP application/recertification/interim report for their household), they qualify for an ex-parte renewal.

Individuals renewed on an ex-parte basis will be sent an approval notice which is prepopulated with the information (such as income, resources, and household members) which was used to make the determination. The notice will include instructions to notify DFR if any of the information is not correct. Changes reported after an ex-parte renewal has been completed are processed as changes in circumstances.

Individuals who do not qualify for ex-parte renewal will be sent a redetermination mailer as explained in 2205.15.00.

2205.05.00 ESTABLISHING THE REDETERMINATION (ANNUAL RENEWAL) MONTH

The redetermination month is the month during which eligibility is reevaluated for a new 12- month period. Federal regulations define the maximum time frames for completion of redeterminations for each program. Redeterminations (renewals) will be conducted for both MAGI and non-MAGI individuals once a year. If an individual is not determined to be eligible, their coverage will end on the last day of the redetermination month.

If there are multiple assistance groups in the case, the redetermination month for each individual may be different. The redetermination/renewal month is established based on the following requirements:

• Individuals under MAGI-based income must be redetermined once every 12 months, and no more frequently than once every 12 months1 • For Non-MAGI Medicaid, a redetermination must be completed at least once every 12 months2 • In some cases where all information needed to redetermine eligibility is reconfirmed for the AG, an ex parte redetermination can be done to start a new 12-month eligibility period if additional members are not required to take any action and eligibility is passing.

Example: A household consists of a mother and her child, who are both open in Medicaid. Their AG composition is identical (each is the only person included in the other’s AG, and the income counted for each AG is the mother’s). The mother’s redetermination date is in March, and the child’s redetermination is due in July. When the mother is successfully redetermined in March, we also know everything needed to redetermine the child ex parte, and the child continues to pass Medicaid eligibility. The child’s redetermination due date will be set for a new 12-month period to align with the mother. Both will be sent approval notices for a new 12-month period and will be due for redetermination again in March of the following year.

2205.10.00 SCHEDULING REDETERMINATION (ANNUAL RENEWAL) INTERVIEWS

Interviews cannot be required for MAGI or Non-MAGI Medicaid recipients who are having their eligibility redetermined due to annual renewal. (For more information, see 2205.15.00)

2205.15.00 REDETERMINATIONS (ANNUAL RENEWAL) BY MAILER

For both MAGI and non-MAGI cases, the agency makes a redetermination of eligibility without requiring information from the individual when possible. The redetermination is based on reliable information contained in the individual’s account or other more current information available to the agency (such as data from The Work Number or the Asset Verification System). (see 2205.00.00),

If the agency is unable to automatically redetermine the eligibility of the individual, then an Eligibility Review Form (redetermination mailer) is sent.

Renewal Forms When an individual cannot qualify for ex-parte (automatic) renewal, they will be sent a prepopulated mailer which tells them what information we currently have for them, asks them to tell us of any changes, and requires verification of noted eligibility factors subject to change. If more than one member of a Medicaid assistance group is due for renewal, a combined form will be sent. The form will include a due date of 30 days from the mailing date.

Note: If one member of the household qualified for ex-parte renewal and one member is required to complete the form, and the form is not returned, there will be no negative eligibility impact to individual who was ex-parte renewed.

Renewal forms may be completed by any of the following methods:

• By completing and signing the form by hand and mailing, faxing, or taking the form and any other required documentation to the DFR • By completing and signing the form by hand and uploading the form and any other required documents to the member’s online Benefits Portal account

• By answering the online renewal questions, uploading required documents, and electronically signing in the member’s online Benefits Portal account • At the member’s request, a renewal interview can be completed over the phone and their signature recorded. If a Medicaid member requests an office or phone interview, one must be granted, however interviews cannot be required for renewals for any member. If the member has an interview scheduled and does not keep the appointment, this should not cause a closure. They may still return the form and keep their coverage if they remain eligible.

The non-asset version is used when all assistance groups in a case are Hoosier Healthwise or HIP members that have no asset or resource requirements. The mailer includes a cover page with information about the process and instructions for returning the form.

The asset version is used when one or more of the AGs in a case have an asset or resource requirement. For example, if the members in a case are MA 2 and MA D, the asset version of the form is mailed. The mailer includes a cover page with information about the process and special circumstances involving asset disclosure, as well as instructions for returning the form. Individuals will be evaluated based only on eligibility factors which apply to their type of coverage. Using the prior example, if the form is returned with all needed information except asset verifications and is signed, the MAGI individual would be renewed (if still eligible), a 2032 should be sent for the non-MAGI member. If 2032 is not returned, then only the non-MAGI individual would be closed for failure to verify needed information.

The Eligibility Review Form is sent to the adult AG payee or parent/caretaker of a child AG. If a child is the only case member and there is no authorized representative, the form is sent to the child. A Notice of Redetermination (NOR) is sent to the other adult AG payees and authorized representatives listed as “ongoing” in the case informing them that the Eligibility Review Form has been sent. The NOR identifies the recipients who are being reviewed and the due date listed on the Eligibility Review Form.

• If the individual did not sign the form or more clarification is needed on the information they provided, the DFR should contact the member to request what is needed to complete the renewal process and if written verifications are required, allow 13 days for the missing information to be returned before discontinuing coverage. • If the member fails to respond with required information and a signature, their coverage will be discontinued. • A 90-day reconsideration period applies to annual renewals where coverage is closed for failing to return required information by the due date; for more information see 2238.25.00. • Individuals who complied with the renewal process but were found ineligible will have their information transferred to the Federal Marketplace on the night that closure action is taken on the case. These individuals are eligible to apply on the Marketplace even outside of the typical annual open enrollment period.

2205.15.05 CHIP (MA 10) Renewals

CHIP members may qualify for ex-parte renewal if they meet the requirements, except for those who have overdue premium payments.

CHIP members who do not qualify for ex-parte renewal due to outdated information in the case or due to overdue premium payments will receive a must return mailer. When redetermining eligibility for this new 12-month period, CE protection is lifted, and normal eligibility rules apply. If a member fails to return mailer, documentation, and/or fails to pay outstanding premiums by the last day of the renewal month, benefits will be terminated. If outstanding payments are not received by the last day of the renewal month, members must reapply.

CHIP members discontinued at point of redetermination for failing to verify required information are entitled to 90-day reconsideration period (refer to 2238.25.00). If members come into compliance by submitting all required renewal documentation within this period, their case should be reviewed for a possible rescind. These individuals are not required to submit a new application.

• Individuals who come into compliance before the last day of the renewal month and continue to form CHIP (MA 10) should be restored to a fully open status • Individuals who come into compliance after the last day of the renewal month, but in the 90-day reconsideration period, and continue to form CHIP (MA 10) should restart in a conditional status There may sometimes be a delay in receiving a premium payment, and the record will come in after the case is set for closure. Based on the payment date, individuals who paid their outstanding payment(s) before the last day of the renewal month and meet all other eligibility requirements must be reviewed as a potential rescind and, if eligible, should be restored to a fully open status.

CHIP members closed at renewal for being over the income limit or for non-payment of premiums are not entitled to 90-day recission period and a new application is required. Normal processing guidelines apply for any applications received on or after the effective date of closure. Children who meet all eligibility requirements for CHIP except for payment of the first premium(s) will start out in a “conditional” status until the first premium is received.

2215.00.00 CHANGES

The individual may report a change in circumstances or the DFR may learn of a change which could affect eligibility or the benefit amount. The worker is responsible for promptly evaluating the change and taking any indicated action to adjust the benefit. A person eligible under MASI

reporting changes to DFR should be informed that the reported change (i.e., change of address) should also be reported to the Social Security Administration.

Changes in circumstances include, but are not limited to:

• Changes in income • Changes in composition of the AG • Changes in living arrangement • Changes in resources • Changes in the legal obligation to pay child support • Changes in household tax relationship or tax filing status • Changes in health insurance coverage.

2215.10.00 DATE CHANGE REPORTED

The date a change is reported is the date on which an individual reports the change in person at the DFR, by phone, by or fax, which is sent to the Document Center. This includes speaking directly to the worker or other staff member over the phone or in person. A Member can report changes using a change report form on the Portal. The date the portal change form is submitted on-line is the date a change is reported.

All reports of changes are to be accurately documented in Running Record Comments and should be entered into the eligibility system the same day the change is reported. The eligibility system establishes the date that the information is entered in the system as the date it was reported. The "occur date" is the date on which the change occurred.

2215.15.00 WORKER RESPONSIBILITIES REGARDING CHANGES

Prompt action must be taken on all changes to determine if they affect eligibility. The case record must include the date the reported change was received, whether the change was reported by mail, telephone, the DFR Benefits portal, fax, or personal visit, the nature of change and any other appropriate information. The worker must take appropriate action on all reports of changed information promptly but no later than 10 days from the date of the receipt of the change.

The individual must be notified of any change in eligibility or benefit. In addition, if the change was reported by the AG, the AG will be notified even if there is no change in eligibility or benefit amount.

If the worker is made aware of discrepant information or information that could affect eligibility or level of benefits, but lacks enough information to determine the effect, he will issue a request for verification. This request should be issued on the date of receipt of the change if possible, outlining the needed information or verification, and giving the AG 13 days from the date the notice is issued to provide the information.

If the AG provides the requested information or verification within the designated 13-day period, the worker will take appropriate action. If the AG refuses to provide the requested information or verification within the designated 13-day period, the worker will, on the first day following expiration of the 13-day period, take action to recalculate eligibility and authorize the appropriate action for each AG. The worker must enter the appropriate reason code on Eligibility Determination Results Screen which reflects the element which the AG did not verify.

If a potential change in medical expenses is identified when the AG presents verification of expenses to meet the spend-down, the AG may be asked to confirm if a change has occurred. If the AG voluntarily provides all verification and information necessary to process the change, including the frequency of any new expenses and possible third-party liability, the change must be processed. If the AG is unable or unwilling to provide the necessary information/ verification, the change cannot be processed because the AG is not required to report or provide verification of medical expenses.

All medical expense changes identified from sources other than the household will not be acted upon unless all necessary verifications are obtained, and action can be taken without contacting the AG.

2220.00.00 PROCESSING CHANGES

Individuals are given 10 days to report the change, 13 days to verify the change, and if the action is negative, 10 days (plus three days for mail delivery) timely notice of adverse action. If the individual is doing all that he can to cooperate in verifying the information but is unable to do so, an extension may be granted or the DFR may accept the responsibility of verifying the information.

Document the reason for any extension in Case Notes. In either instance, if the individual and the worker are unable to adequately verify the information within a reasonable time, the worker is to use the best available information to process the change and document in Case Notes.

When it becomes necessary to take adverse action (that is, reduce the benefit level) on an AG, there must be time to give advance notice of the adverse action. This is referred to as timely notice. The time period is 13 calendar days for all programs. Refer to IHCPPM 1610.50.00 for pregnancy-related processing.

The following sections discuss change processing.

2220.05.00 CHANGES REPORTED AND VERIFIED TIMELY

When a change is reported within 10 days of the date the change occurs and is also verified within 13 days of the report date, action is taken as indicated below.

When a change results in positive action or increases the level of benefit, including the addition of a mandatory AG member, the effective date of the change is the month following the month the change was verified. If the Eligibility System does not form the new benefit of as of the first following month, then the case should be reviewed for a possible fiat or override.

Positive changes are changes that will increase the level of benefits and include verification that a member moved into a nursing facility, reductions in income and additions to the household. If a reported change is received stating that a member moved into a nursing facility, this is considered a verified change. If all other eligibility criteria are met (including the data gathering interview, all verifications received etc.), then the MA D category change will take place going forward to the next month.

Example 1: On 03/01, a healthcare application is received for a disabled applicant; the applicant does not receive SSDI or SSI and there is no MRT determination. The applicant/AR is requesting dual processing for HIP and MA D.

On 03/15, the HIP is approved, and the POWER account is paid; the HIP is open 03/01.

On 03/27, verification that the member moved into a nursing facility is received, but the case is still pending a disability determination. On 04/02, MRT approves the MA D, and the case is authorized. Due to adverse timeframes, the HIP is ending 04/30 and the MA D is opening 05/01, but because the reported change of residing in a nursing facility was received 03/27, then the MA D should open 04/01. In this situation, the worker sets up an override /fiat to end the HIP effective 03/31 so a fiat or override can be completed for MA D starting 04/01. The HIP will remain in place for the month of March.

Example 2: On 03/01, a healthcare application is received for a disabled applicant; the applicant does not receive SSDI or SSI and there is no MRT determination. The applicant has a pending waiver application. The applicant/AR is requesting dual processing for HIP and MA D.

On 03/15, the HIP is approved, and the POWER account is paid; the HIP is open 03/01. The waiver approval is received 03/25, and on 04/27, MRT approves the MA D.

Due to adverse timeframes, the HIP is ending 05/31 and the MA D is opening 06/01, but because the waiver approval was received 03/25, then the MA D should open 04/01. In this situation, a fiat or override can be completed for MA D starting 04/01.

Example 3: On 07/25, an individual reports that their last day of work was 07/18 and the last paycheck will be received 07/26. The recipient provides a statement from the employer on 07/30 (within the 13-day guidelines). The earnings are removed from the budget effective 08/01 and any increase in benefits will take place in the 08/01 budget, even if the authorization occurs after adverse.

If the AG’s benefit level decreases, or the AG becomes ineligible because of the change, the decreases in the benefit level is effective according to the normal adverse processing guidelines. Using the same example as above, if the change was verified on 07/30, then a decrease in benefits would take place in the 09/01 budget.

See IHCPPM 4205.10.00 for information on Appealable Actions.

There are several exceptions to this, including the following:

• For individuals who become pregnant and are receiving coverage for Family Planning Services under MA E, if the individual reports that they are pregnant, eligibility for MAGP will need to be determined and coverage may be granted retroactively without requiring another application being filed. In such situations, the appropriate DFR staff member would need to create the new category with an override/fiat, if appropriate, to end date the MA E coverage so MAGP coverage could be granted.

• For an ongoing MA I recipient, if the member enters a nursing facility or is approved for a waiver, a review of the retroactive MA months should be completed to verify if the recipient is eligible for a full coverage category. After a thorough review of both income and resources is completed, and it has been determined that the recipient is eligible for retro months, then the assigned DFR staff member would need to create the new category with an override/fiat, if appropriate, to end date the MA I coverage so the full coverage MA could be granted.

• Health insurance payments for members residing in nursing facilities will be applied the month after it is processed by the DFR. Health insurance coverage begins after the member enrolls and the first payment is made; it does not begin prior to the first payment. If the member has verification that payments were made (such as a bank statement), this should be submitted to PAL for review for a possible deviation. These will be reviewed on a case-by-case basis; there is no guarantee of the deduction being applied retroactively.

If an ongoing HIP AG is determined eligible for a MED 1 or MED 4 category, then change processing guidelines must be followed. If the category change is processed after adverse, but before the end of the month, then please create the new category with an override/fiat to remove the ongoing months of coverage. Retro months cannot be removed.

In situations of dual processing, it is important to inform the applicant/AR that HIP coverage will not be removed for prior approved and fully open (not conditional) coverage. For applicants that are in a nursing facility or are in the process of being approved for a waiver, it is best practice to pursue the MA D process as opposed to processing for HIP coverage.

If a recipient is in a nursing home and was on HIP, a deviation can be completed for medical expenses incurred in a retro month that the recipient was eligible for HIP coverage, if the claim was not a HIP covered service. See IHCPPM 3455.15.10.

It is the provider’s responsibility to work with the Managed Care Entity (MCE) regarding billing issues, up to and including obtaining prior authorization. If a provider was denied prior authorization or a bill was denied by the MCE, the provider must exhaust all grievances and appeals with the MCE before requesting the HIP removal. If the provider disagrees with the MCE determination, then this should be appealed with the MCE, not with the DFR.

If a request to remove pre-existing HIP coverage is received, then the removal will be reviewed on a case-by-case basis. If an actual provider generated bill, or copy of such a bill, is submitted that clearly shows that the provider has billed the Managed Care Entity (if applicable), that the claim was denied, and that the provider has exhausted all appeals and grievances with the MCE, then these can be reviewed by PAL for possible HIP removal; HIP removal is not guaranteed. Please send to PAL for a policy determination.

2220.10.00 CHANGES REPORTED UNTIMELY YET VERIFIED TIMELY

If a change is not reported within 10 days yet is verified within 13 days following the report date, action is taken as indicated below.

When the change results in an increase in benefits or other positive action, the change is effective the month following the date reported and verified.

Example 1: An individual who is required to pay a premium for health coverage is fired from his job on 6/3 and received his last paycheck on 6/23. He called to report the change on 6/28. On 7/3 he faxes in his last paycheck stub. The caseworker verifies by phone that his last day was 6/3 and his last pay was 6/23. The loss of earnings is reflected 7/1 with a supplemental benefit of either a lower premium or no premium for health coverage beginning 7/1.

When the change results in a decrease in benefits or the AG becomes ineligible, the change is effective the month following the expiration of timely notice.

Example 2: An individual begins a job on 5/26 which he reports on 7/19. His earnings require the payment of a premium for health coverage effective 9/1. Recovery is pursued for July and August. Refer to Chapter 4600.00.00.

2220.15.00 FAILURE OF ASSISTANCE GROUP TO REPORT CHANGES

If the DFR discovers that the AG failed to report a change as required above and as a result received benefits to which it was not entitled, a referral is made to Benefit Recovery to initiate claim determination and benefit recovery.

2220.20.00 CHANGES REPORTED AND NOT VERIFIED TIMELY

When a member reports a change, which would increase their benefit or decrease their PAC/premium/liability, and it is reported but not verified by the 13th day, the benefits should continue at the current amount until after the untimely verifications are provided. If they are not provided, the benefit should be left at the previous level except for incarceration (refer to 2237.10.00).

For example: A member reports a decrease in countable income from a job that has already been verified. The worker then sends a 2032 giving the member 13 days to verify the new income. If the decrease in income is not verified within the 13 days, the worker should leave the income at the previous reported/verified amount and reauthorize the case. When the untimely verifications are provided, the change should be implemented from the date the verification was provided rather than the date the change was reported. Normal adverse/recur logic applies.

2220.25.00 PROCEDURES WHEN MEDICAID FACILITY LOSES CERTIFICATION

When a Medicaid-certified long term care facility receives notification from the Department of Health that its Medicaid provider agreement will be terminated, a copy of the notification is sent to the Local DFR Office. Generally, the facility is given 30 days advance notice of the loss of certification. However, the facility does have appeal rights. If the facility appeals and the Department of Health rules that the patients are not in immediate danger, the facility's Medicaid certification may be allowed to continue during a specified period while the deficiencies cited by the Department of Health are being remedied.

The DFR will need to stay in close communication with the facility concerning the facility's continuing Medicaid certification. Steps to change the recipients' data in IEDSS (Person Demographics – Details Page) should not be undertaken immediately by the worker upon receipt of the initial decertification letter. The facility's appeal status and any subsequent rulings of the Department of Health must be ascertained. If the worker cannot obtain the necessary documentation from the facility, the Central Office, Policy Answer Line, should be contacted.

2225.00.00 ADDING AN INDIVIDUAL TO THE AG (MED 2, MED 3)

Each Medicaid assistance group contains only one eligible person.

Other individuals are mandatorily included for budgeting purposes, based on the household composition and income/asset rules for the category of the individual whose eligibility is being determined.

When adding an individual to the case, Medicaid benefits should not be selected for any new individual who does not already have Medicaid unless they have submitted an application.

The only exceptions are:

• A baby born to a mother who was eligible and enrolled for Medicaid on the date of the child’s birth should be opened in MA X without requiring an application for the baby • Individuals who are verified by the Social Security Administration interface (SDX) as SSI recipients, who are not already receiving Medicaid, should be opened into MASI coverage (this usually happens systematically without requiring action by a worker) • Children who previously had MA 4 or MA 8 and are being transferred from the Department of Child Services to be determined for other Medicaid eligibility due to a change in ward/foster/adoption assistance status.

Note: An individual who has applied for or is receiving a Medicare Savings Program benefit may request to also be considered for full coverage Medicaid. This request does not have to be in writing; however, this should be limited to actual member or Authorized Representative request because there may be additional Estate Recovery considerations when changing/adding full coverage to MSP. (See 4705.00.00 for more information on Estate Recovery).

All relevant information for the individual/s being added to the case should be entered on the appropriate screens, and if additional information is needed to determine eligibility for any AG where the new individual’s income/assets will count is needed, a request for information should be sent.

2225.10.00 ADDING A NEWBORN CHILD

An infant born alive to an individual enrolled in any MA category except MA10 is deemed eligible for Medicaid without an application for the infant being submitted. The baby is to be immediately added to IEDSS upon the agency receiving notification of the birth. Refer to Section 2428.00 for more information regarding eligibility in the Newborn category.

Health coverage under the Newborn category is effective the first day of the month in which the child is born and continues for 12 consecutive months. The only allowable reasons to discontinue MA before the end of the 12-month Newborn period are:

• The child no longer lives in Indiana • The child’s parent or caretaker provides a written voluntary withdrawal statement, or

• The child dies.

Newborn coverage continues regardless of whether the infant continues to live with the birth mother or whether the child ever lived with the birth mother in the case of adoption or other custody arrangement. However, if the child is adopted and the names and location of the adoptive parents are unknown, the child can only be covered for the duration of the hospitalization starting with the month of birth. If the infant has not been named, the name assigned to her/him by the hospital for identification purposes should be used.

Information sufficient to enroll the infant in the Newborn category is the child's name, sex, tax filing status and date of birth. Birth notification may be made by the parent; however, notification is also to be accepted from the hospital, authorized representative in the case, medical provider or Hoosier Healthwise health plan that can knowingly provide the required information.

Note: The tax filing status must be entered for newborns (Refer to 2418.00.00) When the 12-month Newborn coverage period expires, eligibility under other medical categories must be explored and verified. The child was deemed to have applied at birth, and therefore an application cannot be required in pursuing a category change.

Newborn coverage does not extend to babies born to mothers covered under the MA 10 category (Hoosier Healthwise Package C). However, upon request by the parent/caretaker or other notification of the birth, an application is to be immediately provided or mailed to the family, or information given about obtaining an application from the internet. Hospitals and other Indiana Medical Providers that are Hoosier Healthwise enrollment centers should be encouraged to take the applications for newborns. They will know the eligibility status of the mother by using their Eligibility Verification System, which will indicate the benefit package of the mother.

2225.20.00 REMOVING AN INDIVIDUAL FROM THE CASE

Individuals who leave a case and do not have any open Medicaid benefits do not need to receive any notice of the change. If they are added to another case, see 2225.00.00 for guidance. Members with open Medicaid benefits must be immediately opened in their new case (Case 2) when they are removed from the case where they no longer live (Case 1).

If the member is removed from Case 1 and not opened in Case 2 right away, their benefits end, and they do not receive any notice or appeal rights. This can lead to a member unexpectedly being turned away at doctor’s offices or at the pharmacy and must be avoided. Correcting the case later, while appropriate to do once we learn of such an error, still opens the member up to hardship during the time they remain closed.

Because Medicaid assistance groups only have one eligible member, a person with Medicaid who leaves the case should never be closed for that reason alone. Even if the member who left is a child and the worker does not know all the household members in the new case or

parent/caretaker relationships, Medicaid must stay open with no breaks unless there is some known eligibility factor which makes the member fail.

If the new address for the member who leaves the case is unknown, the worker should send a request for information to the last known address. If attempts to learn the new address are not successful, the member may be closed with appropriate notice to the last known address; but if they later contact the office the closure should be rescinded if the time when the member’s next annual redetermination (after the residency change) will have been due has not passed.1 (also see 2238.06.00)

2232.00.00 TIMELY NOTICE OF ADVERSE ACTION

Recipients must be given timely, advance written notice of any adverse action. In most circumstances, "timely" is 10 days (plus 3 for mailing) before the date the action is effective. The 3-day mailing period starts the day after the notice is mailed. The Medicaid program has provisions which allow for exceptions to the 10 day (plus 3 for mailing) timely notice period1. The following sections explain the MED timely notice exceptions.

Workers should carefully review the reason code/s displayed. It must be appropriate to the category and/or action. It is necessary that the reason code is carefully reviewed so that the notice will correctly reflect the reason benefits are terminating.

2232.10.00 EXCEPTIONS TO TIMELY NOTICE (MED)

The following situations do not require timely notice, but do require notice to be sent no later than the effective date of action:2

• The DFR has information confirming the death of a recipient. • The DFR has received a voluntary withdrawal of assistance or reduction of coverage (See 2250.00.00 for written/verbal voluntary withdrawal policies). • The DFR has verified that the recipient has been accepted for assistance in a new • jurisdiction (county, state, territory, or commonwealth); or • Recipient has been admitted to an institution where he is ineligible under current plan for further services (For example, member has been admitted to a facility which requires suspension of current coverage).

2235.00.00 CHANGES IN CATEGORY OF ASSISTANCE (CLEVIDENCE RULING) (MED)

When a Medicaid member loses eligibility under their current category of assistance, eligibility under all potential categories must be explored. If the case record contains information that a member is potentially eligible in another category, a new pending category will be formed by the Eligibility System according to the member’s recorded information reflected in their case file and the Medicaid categorical hierarchy (see IHCPPM 2035.30.00).

If there is no information indicating possible eligibility under another category, Medicaid is to be discontinued. If the member is found to be ineligible in the newly formed category, Medicaid is to be discontinued. When eligibility is to be discontinued, a discontinuance notice is mailed to the member, which contains a list of all applicable categorical groups. If the client supplies information indicating potential eligibility under another categorical group prior to the member’s effective date of discontinuance, Medicaid eligibility must be reinstated while eligibility under the new potential category is being determined.

When a change is reported that results in a potential new Medicaid category, Medicaid benefits continue without interruption. If the person is required to pay a CHIP or MEDWorks premium, continued eligibility is conditional upon the first day of the first month the premium categorical coverage begins. Whenever there is an adverse action, members must be given timely notice before the effect of the adverse action takes place. Please, refer to IHCPPM 2232.00.00. MEDICAID MUST NOT BE INTERRUPTED WHILE A DETERMINATION IS BEING MADE CONCERNING THE MEMBER’S ELIGIBILITY IN THE NEW CATEGORY.

If an individual self-attests to being pregnant (refer to IHCPPM 2426.00.00), then eligibility may be considered under that category. For ongoing members (including those authorized conditionally), once pregnancy is reported there should be no closure for income considerations until after the end of the postpartum period.

Additional Information Needed to Determine Category Changes: If the eligibility status for a member under a new category is pending because of missing verification(s), the worker must send the Medicaid Category Change Form, FI 0017, to the member. Form FI 0017 must be completed by a worker and sent to the member with a 13-day deadline. If the additional information that is needed is more than what can fit on the FI 0017 Form, then an additional 2032 should be sent along with the FI 0017 Form. If the client fails to contact the DFR by the due date specified on Form 0017, Medicaid is to be discontinued. If the client contacts the DFR any time after receipt of the discontinuance notice and provides information which was specified on Form 0017, the client must come into compliance prior to the effective date of discontinuance to have eligibility continued. (Refer to IHCPPM 2040.00.00). If the DFR is contacted after the effective date of discontinuance, the client will have to re-apply.

If the category change for an ongoing member is from one MAGI category to another, one non- MAGI category to another, or non-MAGI to MAGI; and the income is not questionable, income does not need to be requested again unless it is required for an active annual redetermination. For category changes from MAGI to non-MAGI, or a change to add full coverage Medicaid to a Medicare Savings Program (QMB/SLMB/QI/QDW) only member, a data gathering interview must be scheduled to review current income, gather information on resources to include the lookback period (IHCPPM 2640.10.10), and (if applicable) determine disability status. If the missing information is related to blindness or disability not being verified (see IHCPPM 2412.10.00 and 2412.30.00) for the member, then DFR must conduct the Social Summary and collect Medical Evidence (refer to IHCPPM 2412.10.00 and IHCPPM 2412.30.05) for the preparation of the medical packet to be sent to MRT for a determination of disability or blindness (refer to IHCPPM 2412.15.15 and IHCPPM 2412.50.00).

Once a member responds timely providing additional information to continue eligibility and provides sufficient verification to determine eligibility under the new category, Medicaid eligibility continues without interruption. If the member provides information indicating possible eligibility under another category but does not provide sufficient verification, FI 2032 must be sent providing a 13-day deadline requesting the new verifications needed for eligibility determination under the new category. If the missing information is not returned by the due date on the 2032, Medicaid eligibility is to be discontinued.

HCBS Waiver Considerations: HIP will not pay for most institutional or HCBS waiver services. If an ongoing Hoosier Healthwise child is in an institution or on an approved HCBS waiver and they are forming a HIP category due to turning age 19, a data gathering interview must be scheduled and the member should be explored for disability Medicaid. In this instance, the Hoosier Healthwise category should continue until eligibility is determined for disability Medicaid. If the member fails eligibility or fails to cooperate in establishing the MA D category, then HIP should be explored.

For ongoing HIP members, if HCBS waiver approval is received, a data gathering interview should be scheduled to determine eligibility for disability coverage.

Example 1: A parent lives with her only child and receives MAGF. The child is seventeen and turns eighteen. The parent is no longer eligible to receive MAGF because she is no longer the caretaker of a dependent under 18. DFR notices that she previously claimed she was disabled but had never had disability determined by MRT or SSA. A Form FI 0017 is sent to the parent and prior to the deadline on that form, she contacts DFR and re-claims that she is disabled. DFR conducts the interview to complete Form 251B, Determination of Disability Social Summary, and the worker requests medical records in accordance with IHCPPM 2412.30.05. Unless medical records are not timely received due to a failure by the member, Medicaid will continue until MRT renders a determination that she does not meet the disability determination. If MRT determines that she is disabled and she meets all other criteria for MA D, her coverage under MAGF will be discontinued but she will then be granted MA D coverage.

Example 2: An ongoing MA 2 member with an approved HCBS waiver turns 19, and HIP is forming. HIP is not a waiver compatible category and will not pay for waiver services (IHCPPM 3310.00.00). Per Clevidence rules, the MA 2 should not be closed and a data gathering interview for disability Medicaid must be scheduled (IHCPPM 2005.00.00). The member complies with data gathering interviews and completes the Social Summary. All documents are submitted including records. MRT approves the disability, and the MA D is approved going forward.

2236.00.00 REDUCTION IN SCOPE OF MEDICAID COVERAGE (MED)

The following circumstances will result in the DFR taking action to reduce the scope of benefits. These are adverse actions requiring timely notice.

• A recipient formerly eligible for full coverage becomes eligible for QMB-only, SLMB- only, or QI coverage • A recipient eligible for full benefits loses eligibility for payment of nursing facility services or Home and Community-Based Services due to a violative transfer of property • A recipient who was eligible for QMB-only coverage becomes eligible for SLMB-only coverage • A recipient who was eligible for SLMB-only coverage becomes eligible for QI coverage • A recipient who was receiving full coverage becomes eligible for Family Planning Services for Women and Men.

2237.00.00 MEDICAID RESOURCE SUSPENSION (MED 1)

For Medicaid (MA) members residing in a nursing home or on HCBS waivers, if a change in circumstances causes temporary resource or asset ineligibility for Medicaid (MA), the member may be suspended for up to two months. This can only be done in situations where it is reasonably certain that the individual will again be resource eligible after the suspension period.

If there is a specified plan to spend the excess to the allowable limit without violating the transfer of property law, a suspension may be appropriate. If the member is eligible before the end of the suspension period, eligibility is to be reinstated without a reapplication. If after the suspension period the recipient remains ineligible, Medicaid must be discontinued (timely notice is required.) It is the member’s responsibility to verify how the resources/assets were spent and that they are under the resource limit for Medicaid. For more information on resource limits, see IHCPPM 3005.10.00 and 3005.25.00.

Note that change processing rules apply (see IHCPPM 2220.00.00 – 2220.20.00).

Example 1: A long-term care member (nursing home or HCBS waiver) is over resources and get suspended. They verify within 60 days that they appropriately spent the resources, then the Medicaid (MA) can be reopened ongoing without a new application. If they verify within 60 days, then the worker will process the unsolicited documents, and the case will be reopened. • 03/01 – The Medicaid (MA) is suspended • 04/30 – Verification is received that the member was under the resource limit as of 04/01 with verification that the funds were used to privately pay the nursing home • Based on change processing rules and that the verification was received on 04/30, the Medicaid (MA) can be reopened 05/01

Example 2: A long-term care member (nursing home or HCBS waiver) is over resources, they get suspended for up to 60 days. • 03/01 – The Medicaid (MA) is suspended • 05/01 – Verifications were not received by the due date, so the Medicaid (MA) is closed • 05/05 – Verifications are received after the closure; the Medicaid (MA) remains closed

Example 3: A long-term care member (nursing home or HCBS waiver) is over resources, they get suspended for up to 60 days. Prior to the suspension date, verification is received that the member is below the resource limit; no funds were given away or transferred. • 02/14 – Suspension notice is sent with suspension beginning 03/01 • 02/21 – Verifications are received showing that the member is under the resource limit (no funds were given away or transferred) • 03/05 – Worker pulls the task and sees that the verifications are in the ECF prior to the effective date; Medicaid (MA) is reinstated effective 03/01

Example 4: A suspended member fails to verify resources by the end of the 60-day suspension period, then the Medicaid (MA) is closed. The notice is sent and gives appeal rights that if they appeal timely, benefits will continue without change. In this scenario, the correct action is to suspend, not reopen the benefits. • 03/01 – The Medicaid (MA) is suspended • 05/01 – The Medicaid (MA) is closed for failure to verify resources • 05/15 – Appeal is filed, the member does not qualify for continued benefits but for suspended benefits

Example 5: A suspended members Medicaid gets closed, but the unsolicited documents are in the ECF (within 60 days of suspension). The member was eligible in month 2 of the suspension period. The worker should fiat months in which the member was eligible (in this scenario, month 2 and open ongoing). • 03/01 – The Medicaid (MA) is suspended • 03/30 – Verification is received that the member was under the resource limit as of 04/01 with verification that the funds were used to privately pay the nursing home • 05/01 – The Medicaid (MA) is closed • 05/15 – The worker finds that the verification was received 03/30, the Medicaid (MA) is reinstated as of 04/01

Example 6: A suspended member submits bank statements showing they are under the resource limit, but it is unknown how the resources were spent down. A 2032 must be sent to verify how the funds were spent. • 03/01 – The Medicaid (MA) is suspended • 03/30 – Verification is received that the member was under the resource limit as of 04/01, but there is no verification showing how the resources were spent down • A 2032 is mailed requesting verification of how the funds were spent (due 04/13) • 04/10 – Verification that the resources were spent to pay the nursing home charges (this is allowable) so the Medicaid (MA) is reinstated as of 04/01

Example 7: A suspended member submits bank statements showing they are under the resource limit, but it is unknown how the resources were spent down. A 2032 must be sent to verify how the funds were spent. • 03/01 – The Medicaid (MA) is suspended • 03/30 – Verification is received that the member was under the resource limit as of 04/01, but there is no verification showing how the resources were spent down; the resources are updated in the eligibility system • Worker updates the resource but adds a penalty to the TOP screen as unverified • A 2032 is mailed requesting verification of how the funds were spent (due 04/13) • 04/14: o No verifications were submitted, or o Verification that the funds were given away is received • In both scenarios, the worker updates the transfer of property • The Medicaid (MA) is reinstated 04/01 with a transfer of property penalty

2237.05.00 SUSPENSION INCARCERATION/PSYCHIATRIC ADMISSION

When a recipient becomes incarcerated or is admitted to a psychiatric facility that results in ineligibility, the individual’s health coverage should be suspended, not discontinued.3 The case action for either condition is always suspension, provided the incarceration or psychiatric facility stay will last at least 30 days. Health Coverage benefits will be suspended until the member is released from the facility.4 There is no limit on the number of times a recipient can be suspended.

For applications and category changes which require a data gathering interview (refer to 2005.00.00 and 2005.05.15), whenever possible, the interview should occur prior to the individual’s release from the institution. This ensures that individuals will have health coverage at release, if eligible.5 Coverage cannot be reinstated prior to an individual’s release (refer to 2237.10.00).

For incarcerated individuals, the suspension policy applies to all MED categories regardless of the age of the recipient. For information on members in a State Operated Facility, see IHCPPM 1623.00.00.

Incarceration or psychiatric admissions which will last for less than 30 days do not require review of the change in circumstances.

Upon receiving notification that a recipient is institutionalized for at least 30 days, a review of the change in circumstances is required to determine whether the recipient remains eligible in the institution (in the case of psychiatric admission) and what impact there is on other case members and other program eligibility. For children who enter juvenile detention facilities, correctional

facilities, and secure facilities not licensed as child-care facilities, state law requires the juvenile court that adjudicated the delinquency to notify the DFR of the detention.

During the period of suspension, case management activity such as redetermination, processing data exchange updates, etc., will not occur when there are no other eligible recipients in the case.6

2237.10.00 REINSTATEMENT OF BENEFITS FOR SUSPENDED INDIVIDUALS

Once it is reported that member is no longer incarcerated or has been released from the psychiatric facility, the Medicaid category should be reinstated. Benefits for individuals who are in suspend status in accordance with Section 2237.05.00, are to be reinstated without a reapplication if the individual returns to an eligible living arrangement.

The DFR can use the member or AR’s self-attestation as verification of release from incarceration, unless questionable.

Coverage for HIP members should start first of the month in the month release date is reported.

In HIP cases the individual will be opened in Basic, with a potential plus flag, regardless of whether they are below or above 100% of the FPL. The member will be given 60 days, from the date of authorization, to pay the PAC payment. If the PAC is not paid within 60 days, members who are below 100% of the FPL will remain in Basic and members who are above 100% of the FPL will be closed.

Coverage for non-HIP members can retro back up to 90 days prior to the month of report, if the member was not incarcerated for those months. In the case of MA10 or MADW with a premium, the AG must be conditionally approved within the 40 days of release/discharge. Follow up verification of eligibility factors is required on reported information and discrepant information.

2238.00.00 DISCONTINUANCE

When an Assistance Group (AG) fails to meet the eligibility requirements of any category within a program, assistance is discontinued for that program. Discontinuance is effective the first day of the month following the expiration of the required timely notice. Refer to IHCPPM 1610.50.00 for pregnancy-related change processing.

2238.05.00 DISCONTINUANCE DUE TO DEATH

When a recipient is deceased, the Person-Details page needs to be updated with the date of death and verification would need to be selected. This action will invoke ED/BC and the AG can then be closed. It is crucial to enter the correct date of death to ensure claims will not be paid in error.

2238.06.00 DISCONTINUANCE DUE TO WHEREABOUTS UNKNOWN

When mail is returned as undeliverable with no forwarding address, efforts must be made to confirm the correct address, including checking documents in the case records, calling the individual at the phone number(s) on record, checking all available electronic resources and sending a 2032 address verification request to the last known address in the case record or to an authorized representative. Sending the pending request form may of course result in another returned mail, but it is an important step to ensure that the client is not discontinued inappropriately.

If it becomes necessary to discontinue assistance because the client cannot be located and mail has been returned as undeliverable with no forwarding address, timely notice is required.

If the closed member’s address becomes known during their eligibility period (the time before their next redetermination would have been due), the closure must be rescinded.2

2238.10.00 CLOSED CASE FILES

When all the AGs in a case are closed, the system will automatically transfer the case to closed files 90 days after the effective date of the discontinuance.

2238.15.00 CERTIFICATES OF MEDICAID COVERAGE

On August 21, 1996, The Health Insurance Portability and Accountability Act (HIPAA) was enacted. This law is designed to improve the availability of health insurance to working families and their children, including eligible individuals who have previous coverage under Medicaid.

The provision of the law that directly affects the Division of Family and Children is the requirement concerning the issuance of certificates of creditable coverage. An individual, who enrolls in a health care plan that imposes an exclusionary period for a pre-existing medical condition, may be able to have that period reduced by prior coverage under another plan, including Medicaid.

The DFR must issue the Certificate of Medicaid Coverage (FI Form 0021) to the individual so that he can present it as documentation to the new health insurance plan. Periods of Medicaid eligibility beginning July 1, 1996, for all full coverage categories and the pregnancy-related category, except as explained below, are included as creditable coverage:

• Exclude QMB-Only, SLMB-Only, and QI coverage. Unlike the pregnancy-related categories, these categories do not provide coverage of regular Medicaid services. • Exclude months of ineligibility for which a recovery claim has been established and is currently in dispute through the administrative hearing process.

• Exclude months the person did not meet spend-down.

The following procedures are to be used when issuing the certificate:

1. The IEDSS discontinuance notices for reasons other than death of the recipient contain the following paragraph which notifies the assistance groups that Certificates of Creditable Coverage are available upon request:

Important information about health insurance coverage. If you enroll in a health insurance plan that does not give you coverage for a preexisting medical condition, you may need to furnish proof of your Medicaid benefits. Ask the Plan Administrator of your health insurance about this. If you need proof of Medicaid eligibility, contact the caseworker whose name is on the first page of this notice and ask for a Certificate of Medicaid Coverage. When it is necessary to issue a manual discontinuance notice (619M), workers must include the above paragraph in the additional information section of the notice. If the recipient's Medicaid coverage since 7-1-96 consisted solely of QMB only or SLMB only, it is not necessary to include the paragraph. However, if since that time, the person had full coverage or pregnancy-related coverage the paragraph must be entered on the notice.

2. Upon request by a former recipient, the FI Form 0021, Certificate of Medicaid Coverage, must be completed and mailed first class to the individual within 10 working days of the request. The DFR is encouraged to try to accommodate requests made in person by giving the certificate to the individual at the time of the request. However, if this is not possible, the aforementioned time frame should be met. When mailing the Certificate, the current address should be obtained from the individual rather than relying on the last address in IEDSS. As an alternative to mailing a Certificate, it can be faxed directly to the health care plan administrator, or the information can be provided by phone to the administrator only if the following conditions are met: (1) The individual requests it; and (2) The alternative method being requested by the individual is acceptable to the plan administrator. If the two conditions are not met, the Certificate must be mailed to the individual.

3. As a general rule, one Certificate is completed per family. However, separate certificates are to be provided if requested. This could be needed if, for example, children are being enrolled in different insurance plans held by non-custodial parents.

4. Enter the name and address of the DFR and indicate the name and telephone number of a contact person in case the health insurance plan has any questions. This person can be the recipient's worker, or anyone designated in the DFR to serve as coordinator for matters concerning the certificates.

5. Enter the name of each recipient in the family requesting the Certificate. Note that the Certificates do not necessarily have to correspond to the former assistance groups. For example, one AG may have been a child living with grandmother and the other AG in

another case was the child's sibling and mother. When the certificate is requested, the mother and her 2 children are now living together. Unless there is a reason to issue separate certificates as requested by the family, or because there are too many eligibility periods, one certificate using all 3 recipients and their Medicaid coverage periods should be issued.

6. Enter the recipient's Medicaid number, i.e., the RID, not the case number.

7. List all creditable coverage periods after July 1, 1996, up to the present time without regard to category changes. For example, if a child were on MA 2 from 1/1/97 to 6/30/97 and MA D from 7/1/97 to 9/30/97, the entry on the certificate would be BEGIN 1/1/97 END 9/30/97

The statement on the Certificate which states that prior breaks in coverage may be included is information for health insurance companies only. The law specifies that certain coverage that has been interrupted cannot count as creditable coverage. The insurance company determines how creditable coverage is applied to an exclusionary period and the statement on the Certificate is simply to alert them to the fact that all coverage periods, regardless of breaks, are being reported on the form. The following is an example of how to enter eligibility periods on a Certificate:

Example: Recipient was eligible from 10/96 through 11/97 with a spend-down. He met his spend-down in the months of 10/96, 12/96, 3/97, and 10/97. Entries on the Certificate should be listed as follows: BEGIN END 10/02/96 10/31/96 12/05/96 12/31/96 03/10/97 03/31/97 10/01/97 10/31/97 (Months that the spend-down is not met are not listed, and the DFR should inquire of HP what months spend-down was/was not met.)

2238.20.00 CONTINUOUS ELIGIBILITY FOR CHILDREN UNDER AGE 19

Effective 1/1/24, children under the age of 19 who are determined or redetermined eligible for any category of Medicaid will remain continuously eligible until their next annual redetermination. Medicaid coverage is to be retained for a full 12 months regardless of income or other factors that would otherwise cause the child to be discontinued. The continuous eligibility period (CE) and/or category is established or reestablished by the effective date of the member’s application decision or annual redetermination decision (can include retro coverage); whichever is most recent.7 Where CE and TMA both exist for a child; they should receive the longest possible protected period based on whether the TMA or the CE ends first.” Category changes from full (Package A, Medicaid or HHW) to limited (Package C, MA 10) benefits are not allowed, and closure should only happen for these reasons:

• Death • Moved out of State • Voluntary withdrawal (See 2250.00.00 for written/verbal voluntary withdrawal policies).

• Child attains age 19 • Eligibility was determined incorrectly due to agency errors, fraud, or false information provided by the child or child’s representative

When redetermining eligibility for a new 12-month period, CE protection is lifted, and normal eligibility rules apply. If the child is no longer eligible, benefits can be denied at redetermination. If the child is still under 19 and is redetermined to be eligible, a new protected CE period begins except for where CE and TMA co-exist for a child. When both CE and TMA exist for a child, member should receive the longest possible protected period based on whether the TMA or the CE ends last.

Example 1: In January, an application is submitted for a child who is 18 years old, and MA 2 is authorized with three months of retroactive coverage. The CE period is set as January through December.

In June, income increases and MA 10 forms for the child. Because MA 10 is not equivalent coverage, MA 2 coverage will continue to form until redetermination.

At the redetermination in December, MA 10 continues to form and can be authorized for the next CE period, which will start in January of the new year and continue until that December.

If a child turns 19 anytime during the CE period, coverage can close. If a member meets eligibility requirements for HIP coverage, HIP can be authorized.

Change reporting (other than a change of address) is not required for a child in a CE period. If redetermination is done for other family members during the child’s CE period, the family is not required to verify any income or assets belonging to the child as they pertain to the child’s eligibility. If the family chooses to verify anyway, the following changes can be made: The child can move from Package C to another medical assistance category. MA 10 premiums can be decreased or increased.

While other category changes may occur during the CE period, a child covered under traditional Medicaid or Hoosier Healthwise Package A is not to be moved to Package C (MA 10) as this would entail the closure of Medicaid. Members can only transition from Package C (MA 10) to Medicaid during the CE period, but not the other way around. Approval of Package C can only be permitted during the child’s Medicaid redetermination.

Example 2: A child is initially approved for MA 10 coverage. In month 4 of the CE period, his mother is due for redetermination. Her Medicaid is closed for failing to provide updated income. Medicaid for the MA 10 child must be left open (even if premium is unpaid).

In month 6 of the child’s CE period, the needed information to rescind the redetermination denial is provided and the income causes the child’s premium to increase. Because he was already receiving MA 10 and this is not a category change, it can be authorized.

In month 8, the child’s mother reports that she is getting fewer hours at work. The newly verified income causes his MA 10 to switch to MA 9. Because this is a beneficial category change, it can be authorized.

It should be noted that children are deemed eligible for coverage in MA X due to their mother’s Medicaid status. Redeterminations are not set for this category; instead, eligibility under a new category of medical assistance must be determined when the child turns 1. Except for citizenship, the usual eligibility factors (including social security number) are to be verified. If found eligible, the child’s first CE period would begin the month the new category is authorized.

Newborns who are hospitalized and/or individuals under 19 who would be eligible for Medicaid if they were in a medical institution qualify for continuous eligibility.8

2238.20.05 CONTINUOUS ELIGIBILITY PERIODS FOR CHILDREN IN MA 4, MA 8 AND MASI

MASI/MA 4/MA 8 children under age 19 are entitled to continuous eligibility, but these categories do not have redetermination dates set. However, IEDSS will establish a CE period for these categories as well.

If eligibility fails in one of these categories, IEDSS will explore the hierarchy and attempt to place the child in a different Medicaid category.

Income will need to be requested for MA 4, MA 8, or MASI if there is no, or no current, income in the case at the time of category transition. When a new category forms and passes, the category that forms can be approved and a new CE period will start, in line with the new redetermination date that is set.

If no new category forms and passes, the individual’s existing CE period will continue in the same category. At the end of the CE period, they will be subject to closure if they are still ineligible for any category of assistance.

Note: If a MASI child is no longer considered disabled by SSA and is approved for an HCBS waiver, an HHW category would be appropriate and will not cause the child to lose their waiver services

during the CE period. Although individuals are not required to apply for disability with SSA, SSA denials supersede MRT disability determination; these restrictions also apply to children under 18. See IHCPPM 2412.25.00 and 2412.50 for more information regarding SSA disability.

Questions regarding continuous eligibility periods should be submitted to PAL for review.

2238.25.00 REDETERMINATION 90-DAY EXTENSION FOR FAILURE TO VERIFY

If an AG is discontinued for failing to verify required information during the re-determination process, the DFR must timely consider eligibility without requiring the AG to submit a new application when the missing verification(s), which were the reason(s) for discontinuance, are received by DFR within 90 days after the AG had eligibility effectively discontinued.

If an AG is denied eligibility, this sub-section is inapplicable. If an AG is discontinued for failing to verify required information after a report of change has been received by DFR, this sub-section is inapplicable. If an AG is discontinued at point of redetermination for any reason(s) other than failing to verify required information, such as being over income, this subsection is inapplicable.

2239.00.00 CORRECTION OF LIABILITY (MED 1)

In specific circumstances, liability amounts which are higher than they should be, can be corrected to a lower amount by completing a liability override. Acceptable reasons to complete the override are as follows:

• Timely appeal filed after cut-off • Beneficial change timely reported and verified after cut-off • Agency error in calculation of spend-down or liability amount • Hearing decision decreased spend-down or liability amount • Court ordered decreased spend-down or liability amount

No other reasons are acceptable in using the liability override function. If a worker encounters a circumstance not listed above and feels the liability correction should be made, contact PAL.

2240.00.00 AG CHANGES ADDRESS

Moving to a new address in Indiana, in and of itself, does not cause ineligibility. A new living situation may trigger new elements to be verified; however, eligibility must not lapse while the systematic process of changing cases is completed.

2250.00.00 VOLUNTARY WITHDRAWAL FROM ASSISTANCE

A recipient may voluntarily withdraw from assistance at any time. The withdrawal may be made in writing or verbally.

If a request is made over the phone the call will be recorded for future reference, and a case note should be made that a withdrawal request was made over the phone with relevant details. A separate written request is not required.

If a request to withdraw from assistance is made verbally in person, a signed statement should be added to the case file.

For verbal voluntary withdrawals, eligibility should be discontinued based on the member’s request without requiring separate written confirmation.

Please note that discontinuance due to voluntary withdrawal should be effective the end of the month in which the request is made.

1 42 CFR 431.231(d) 2 42 CFR 431.213 3 IC 12-15-1-20.4(a) 4 IC 31-37-22-9 5 IC 12-15-1-20.4(b) 6 IC 12-15-1-20.4 7 42 CFR 435.926(c)(2) 8 1902(e)(3) of the Act and 42 CFR 435.225

1

Indiana Health Coverage Program Policy Manual Chapter 2400 NON-FINANCIAL REQUIREMENTS Sections 2400.00.00 – 2435.00.00

Contents 2400.00.00 NON-FINANCIAL REQUIREMENTS ........................................................................ 6

2402.00.00 CITIZENSHIP/IMMIGRATION STATUS ..................................................................... 6 2402.05.00 DECLARATION OF CITIZENSHIP/IMMIGRATION STATUS ............................. 2 2402.10.00 DEFINITION OF U.S. CITIZENSHIP ............................................................... 2 2402.10.05 BORN IN THE U.S. OR A U.S. TERRITORY .................................................... 2 2402.10.10 NATURALIZED CITIZENS ............................................................................ 3 2402.10.15 CHILDREN BORN ABROAD TO U.S. CITIZENS ............................................. 3 2402.10.15.05 CHILDREN BORN ABROAD TO NON-CITIZENS ....................................... 3 2402.10.20 CITIZENSHIP AFTER BIRTH ........................................................................ 4 2402.15.00 VERIFICATION REQUIREMENTS FOR U.S. CITIZENS .................................. 4

2402.15.10 VERIFICATION OF U.S. CITIZENSHIP .......................................................... 4 2402.15.15.20 INCOME/RESOURCE CONDISERATION FOR NATIVE AMERICANS/ALASKAN INDIAN ......................................................................................................... 10 2402.20.00 IMMIGRANTS ........................................................................................... 13 2402.20.05 LAWFULLY ADMITTED FOR PERMANENT RESIDENCE ............................... 13 2402.20.05.05 AMERICAN INDIANS BORN IN CANADA................................................ 14 2402.20.10 CONDITIONAL ENTRANT REFUGEE .......................................................... 14 2402.20.15 REFUGEES UNDER SECTION 207 ............................................................ 15 2402.20.20 PAROLEES UNDER SECTION 212(D)(5) ................................................... 15 2402.20.25 ASYLEES UNDER SECTION 208 AND VICTIMS OF TRAFFICKING .................. 15 2402.20.30 DEPORTATION WITHHELD UNDER SECTION 243(H) ................................ 16

2

2402.20.35 AMERASIAN IMMIGRANTS ....................................................................... 16

2402.20.40 CUBAN AND HAITIAN ENTRANTS .............................................................. 17 2402.20.41 COMPACT OF FREE ASSOCIATION (COFA) ENTRANTS ................................ 17 2402.20.45 VETERAN OR ACTIVE-DUTY MEMBER OF THE ARMED FORCES .................. 18 2402.20.49 IRAQI AND AFGHANI SPECIAL IMMIGRANTS ............................................ 20 2402.20.50 OTHER IMMIGRANTS, VISITORS, AND NON-IMMIGRANTS ........................ 22 2402.20.50.05 DEFINITION OF EMERGENCY SERVICES .............................................. 23 2402.20.55 SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS (SAVE) .............. 24 2403.00.00 NATIVE AMERICANS/ALASKAN INDIANS (MA 10) .................................................. 29 2404.00.00 REQUIREMENT TO PROVIDE SOCIAL SECURITY NUMBER ................................... 30 2404.10.00 COMPLETION OF SOCIAL SECURITY NUMBER REFERRAL ........................ 31

2404.10.05 SOCIAL SECURITY NUMBER REFERRAL FOLLOW-UP .............................. 31 2404.15.00 HOSPITAL ENUMERATION ....................................................................... 31 2404.25.00 REFUSAL TO COMPLY WITH SOCIAL SECURITY NUMBER REQUIREMENT

31 2404.25.10 PENALTIES FOR SSN NON-COMPLIANCE ................................................ 32 2404.30.00 VERIFICATION OF SOCIAL SECURITY NUMBER ....................................... 32 2404.30.05 SOCIAL SECURITY NUMBERS NOT VERIFIED THROUGH DATA EXCHANGE 32 2406.00.00 RESIDENCY ........................................................................................................... 33 2406.05.00 RESIDENCY OF HOMELESS INDIVIDUALS ........................................... 33 2406.20.00 RESIDENCY REQUIREMENTS ................................................................... 33 2406.20.05 RESIDENCY OF NON-INSTITUTIONALIZED INDIVIDUALS ......................... 34 2406.20.10 RESIDENCY OF INSTITUTIONALIZED INDIVIDUALS .................................. 34

2406.20.10.05 OUT-OF-STATE PLACEMENT IN AN INSTITUTION ................................. 36 2406.25.00 TEMPORARY ABSENCE FROM INDIANA ................................................... 36

3

2406.30.00 PERMANENT ABSENCE FROM INDIANA .................................................. 36

2406.35.00 RESIDENCY VERIFICATION ...................................................................... 37 2410.05.00 DEFINITION OF A CHILD (MED 2, MED 3) ................................................. 38 2410.05.05 AGE REQUIREMENTS (MED 3) .................................................................. 38 2410.05.20 CHILD ATTAINS AGE LIMIT (MED 3) .......................................................... 38 2410.05.25 VERIFICATION OF AGE (MED 3) ............................................................... 38 2410.15.00 AGE REQUIREMENT (MED 1) .................................................................... 39 2412.00.00 BLINDNESS OR DISABILITY (MED 1) ..................................................................... 39 2412.05.00 DEFINITION OF BLINDNESS (MED 1) ........................................................ 39 2412.10.00 VERIFICATION OF THE VISUAL REQUIREMENT (MED 1) ........................... 40

2412.15.00 PAYMENT FOR EYE EXAMINATION (MED 1) .............................................. 41 2412.15.05 EYE EXAMINATION REQUIREMENT FOR REAPPLICATIONS (MED 1) ......... 41 2412.15.10 INABILITY TO OBTAIN EYE REPORT (MED 1) ............................................. 41 2412.15.15 DECISION OF MEDICAL REVIEW TEAM (MED 1) ....................................... 42 2412.15.20 REQUIRED RE-EXAMINATION OF EYESIGHT (MED 1) ............................... 43 2412.20.00 TREATMENT FOR RESTORATION OF EYESIGHT (MED .............................. 43 2412.25.00 DEFINITION OF DISABILITY (MED 1) ......................................................... 44 2412.30.00 VERIFICATION OF THE DISABILITY REQUIREMENT (MED 1) ....................... 45 2412.30.10 PREPARATION OF MEDICAL PACKET FOR MMRT (MED 1) ........................ 46

2412.30.15 PAYMENT FOR DISABILITY EXAMINATIONS (MED 1) ................................. 48 2412.40.00 DISABILITY INFORMATION ON REAPPLICATIONS/CATEGORY CHANGES (MED 1) 48 2412.45.00 DECISION OF MEDICAL REVIEW TEAM (MED 1) ....................................... 50 2412.50.00 PROGRESS REPORTS AND ONGOING ELIGIBILITY (MED 1) ..................... 50 2412.55.00 TREATMENT FOR RESTORATION OF PHYSICAL/MENTAL HEALTH (MED 1)

52

4

2414.00.00 SSI STATUS .......................................................................................................... 52

2414.10.00 SSI 1619 STATUS ...................................................................................... 53 2414.10.10 DISABLED ADULT CHILDREN ...................................................................... 53 2414.10.15 PICKLE RULE ............................................................................................ 55 2414.10.20 DISABLED WIDOWS OR WIDOWERS ........................................................ 55 2415.00.00 CATEGORICAL ELIGIBILITY FOR MEDICAID WAIVERS .......................................... 56 2416.00.00 MEDICARE STATUS (MED 4) ................................................................................ 56 2416.05.00 QUALIFIED MEDICARE BENEFICIARY (MED 4) ......................................... 56 2416.10.00 QUALIFIED DISABLED AND WORKING INDIVIDUALS (MED 4).................. 57 2416.15.00 SPECIFIED LOW INCOME MEDICARE BENEFICIARY (MED 4) .................. 58 2416.20.00 QUALIFIED INDIVIDUALS (MED 4) ............................................................ 58

2418.00.00 HOUSEHOLD TAX RELATIONSHIPS (MED 3) ......................................................... 59 2420.00.00 RESIDENCE IN THE HOME OF A SPECIFIED RELATIVE (MED 3) ........................... 59 2420.05.05 Verification of Relationship (MED 3) ........................................................... 60 2420.10.05 VERIFICATION OF LIVING WITH (MED 3) .................................................. 61 2420.15.00 TEMPORARY ABSENCE FROM THE HOME (MED 3) .................................. 62 2422.00.00 INSTITUTIONAL STATUS ....................................................................................... 62 2422.10.00 RESIDENTS OF INSTITUTIONS ................................................................. 62 2422.10.05 RESIDENTS OF PSYCHIATRIC FACILITIES ................................................. 64 2422.10.10 Certification of Need/Inpatient Psychiatric Care .......................................... 64 2422.10.15 PERSONS AGED 65 AND OLDER/INPATIENT PSYCHIATRIC CARE ............. 65 2424.00.00 LEVEL OF CARE/PREADMISSION SCREENING ...................................................... 65

2426.00.00 PREGNANCY (MED 3) ........................................................................................... 66 2428.00.00 NEWBORN STATUS (MED) ................................................................................... 66 The policy stated in this section only applies to a child born to a woman who is eligible and enrolled in any MA category (except MA10) on the date of birth, even if

5

retroactively found eligible. The infant is eligible for 12 continuous months of coverage in the aid category MA X if the child continues to live in Indiana. This policy also includes infants born to mothers who are eligible for emergency Medicaid services only. ................................................................................. 66

2432.05.00 REQUIREMENTS FOR REFUGEES (MED 2) ................................................ 67 2433.00.00 HEALTH INSURANCE COVERAGE CONSIDERATIONS (MA 10) ............................ 68 2434.00.00 ASSIGNMENT OF MEDICAL RIGHTS ..................................................................... 69 2434.05.00 MEDICAL SUPPORT COOPERATION REQUIREMENTS .............................. 70 2434.10.00 IV-D SANCTION REQUEST ........................................................................ 70 2434.15.00 IDENTIFICATION OF MEDICAL RESOURCES .............................................. 70 2434.20.00 THE RIGHT TO CLAIM GOOD CAUSE - MEDICAL SUPPORT ....................... 71 2434.20.05 MEDICAL SUPPORT GOOD CAUSE DETERMINATION .............................. 72 2434.20.10 DFR REVIEW OF GOOD CAUSE DETERMINATION .................................... 72 2434.25.00 PENALTIES FOR MEDICAL SUPPORT NON-COMPLIANCE ........................ 72

2434.30.00 CIRCUMSTANCES WHEN PENALTIES ARE NOT APPLIED ......................... 73 2435.00.00 HEALTH INSURANCE PREMIUM PAYMENT PROGRAM .......................................... 73

6

2400.00.00 NON-FINANCIAL REQUIREMENTS This chapter contains the various non-financial eligibility requirements which must be considered depending upon the types of assistance for which an individual is applying. The major sections in this chapter include:

Citizenship/Immigration Status (Section 2402) Requirement to Provide a Social Security Number (Section 2404) Residency (Section 2406) Age (Section 2410) Blindness or Disability (Section 2412) SSI Status (Section 2414) Medicare Status (Section 2416) Household Tax Relationships (Section 2418) Residence in the Home of a Specified Relative (Section 2420) Institutional Status (Section 2422) Level of Care/Preadmission Screening (Section 2424) Pregnancy (Section 2426) Newborn Status (Section 2428) Health Insurance Coverage Considerations (Section 2433) Assignment of Medical Rights (Section 2434) Health Insurance Premium Payment Program (Section 2435). The requirements for each of these non-financial factors and their verification requirements are described in this chapter.

2402.00.00 CITIZENSHIP/IMMIGRATION STATUS To be eligible for assistance, an individual must be: • A citizen of the United States • A U.S. non-citizen national (a person born in an outlying possession of the United States, American Samoa, or Swain's Island) • An immigrant who is in a qualified immigration status as defined in Section 2402.20, and who meets the specific requirements of each program; or • An individual who meets other specific requirements for a specific program as defined in the following sections.

2 2402.05.00 DECLARATION OF CITIZENSHIP/IMMIGRATION STATUS The policy stated in this section does not apply to MA X. On the application, each applicant declares whether or not they are a citizen of the United States. A Systematic Alien Verification Entitlements request and response of inaccurate documentation does not serve this purpose. An applicant's statement or any other third-party information does not constitute a determination of unlawful status. A worker should not seek to obtain an immigrant's status unless the immigrant requests help in obtaining this verification.

A refusal to declare citizenship or immigration status will result in the ineligibility for that individual.1

2402.10.00 DEFINITION OF U.S. CITIZENSHIP To be considered a U.S. citizen, an individual must meet one of the following conditions: • Be born in the U.S. or a U.S. territory (2402.10.05) • Be a naturalized citizen (2402.10.10); or • Be born abroad to a U.S. citizen and meet specified criteria (2402.10.15).

2402.10.05 BORN IN THE U.S. OR A U.S. TERRITORY An individual is considered born in the U.S. or a U.S. territory if either of the following conditions are met: • The individual is born in one of the United States or the District of Columbia (D.C.); or • The individual is born in one of the following current territories: o Puerto Rico o Northern Marianas o American Samoa o Harcon Tract o Swain's Island o Guam o The Virgin Islands.

3 2402.10.10 NATURALIZED CITIZENS An individual is considered a naturalized citizen when U.S. citizenship is gained after his birth either: (1) through individual naturalization; or (2) derived from a naturalized parent Women who could have been lawfully naturalized and, prior to September 22, 1922, were married to citizens, or were married to aliens who became citizens before that date, automatically become citizens. An alien married to a U.S. citizen on and after September 22, 1922, must apply for naturalization to become a U.S. citizen.

2402.10.15 CHILDREN BORN ABROAD TO U.S. CITIZENS In most instances, citizenship is acquired at birth if at least one of the natural parents is a U.S. citizen. It should not be presumed, however, that the child was a citizen at birth unless at least one citizen parent was a previous U.S. resident or lived in a U.S. territory. (Refer to Section 2402.10.05.)

For children born before May 24, 1934, U.S. citizenship may only be established in this way for legitimate children through their citizen father who would have had to meet the above- mentioned residency requirement. For children born after May 24, 1934, both parent’s U.S. citizenship and residency may serve as the basis for the foreign-born child's own U.S. citizenship.

2402.10.15.05 CHILDREN BORN ABROAD TO NON-CITIZENS In some instances, children born abroad do not automatically acquire their parents’ citizenship, nationality, or immigration status. Children born abroad must be reported and registered with the nearest embassy or consulate to establish a record of the child’s citizenship or nationality. It should not be presumed that a child born abroad to at least one parent of another county automatically obtains dual citizenship. Approved U.S. Immigration documentation must be provided as evidence of citizenship or nationality. For the most up-to-date list of approved CHE documentation refer to https://www.uscis.gov/save/save-resources/information-for-save-users- cuban-haitian-entrants. Children born outside of Cuba/Haiti to Cuban/Haitian parent(s) are not considered Cuban Haitian Entrants (CHE) unless approved U.S. Immigration documentation is provided as proof of citizenship or nationality and SAVE verification confirms status (Refer to 2402.20.40).2 When a nationality other than Cuban or Haitian is noted in the “Country of Citizenship” section of SAVE verification for CHEs, the person is ineligible for services under the Cuban-Haitian Entrant category.3 Parents who are CHE must register all children born abroad with embassy or consulate and provide evidence of child’s citizenship or nationality to the Department of Homeland Security Services (DHS). The immigration status and citizenship for children born

4 abroad should always be verified through SAVE when an individual or family attest to a “qualified alien” status. Approved U.S. Immigration Documentation for Cuban/Haitian Children Born Abroad

• Unexpired Cuban/Haitian passport • Nationality Certificate or Identity Card • Non-Haitian birth certificate listing a Haitian national parent (parent must have approved documentation or evidence of Haitian nationality4 • Citizenship Letter • Certificate of naturalization or certificate of citizenship issued by the Haitian government accompanied by photo identification Note: A consular certificate documenting an individual’s birth outside of Cuba to at least one Cuban parent is not sufficient evidence to establish Cuban citizenship.

2402.10.20 CITIZENSHIP AFTER BIRTH Children become U.S. citizens after birth when all the following requirements are met: • At least one parent is a U.S. citizen either by birth or naturalization • The child is under 18 years of age • The child is residing in the United States in the legal and physical custody of the United States citizen parent, pursuant to a lawful admission for permanent resident. (If adopted, the child must meet all the requirement above, as well as satisfy the requirements applicable to adopted children under Section 101(b)(1) of the Social Security Act.)5

2402.15.00 VERIFICATION REQUIREMENTS FOR U.S. CITIZENS Verification of citizenship is required for Medicaid eligibility when applicants declare themselves to be U.S. citizens.

2402.15.10 VERIFICATION OF U.S. CITIZENSHIP In compliance with federal law (Section 1903(x) of the Social Security Act as added by the Deficit Reduction Act of 2005) documentation of citizenship is required as a condition of eligibility for

5 Medicaid, Hoosier Healthwise, and HIP. The requirement applies to applications filed on and after August 15, 2006, and redetermination interviews occurring on or after August 15, 2006. Proof of citizenship must be provided to the DFR for persons declaring on the application to be citizens with either documentary evidence or electronic verification through the VLP, except in the following circumstances: • The individual is eligible in the Newborn (MA X) category. Further, citizenship documentation is not required for these children at the time of any future eligibility determinations that occur after the child ages out of the Newborn category.

• The individual is an SSI (Supplemental Security Income) recipient. Citizenship would have been documented by SSA, so further proof would not be needed for Medicaid. • The individual is a Medicare beneficiary. • The individual receives Social Security benefits based on their own disability. • The individual is a ward of the DCS (Department of Child Services). Federal citizenship requirements for Medicaid are met for wards without verification by the DFR because federal rules allow an exception for them as children receiving assistance with IV-B funds. • The individual is a recipient of foster care or adoption assistance under Title IV-E.

Case Record Requirements: If electronic verification is not available through the VLP, original documents or certified copies of original documents must be viewed and copied for the case file. The copy must be annotated: “Copy of original document” or “Copy of certified copy” as appropriate. Also, a case note entry as to the way in which citizenship was documented must be made.

Once completely and acceptably verified, citizenship is not to be re-verified at subsequent reapplications and redeterminations. While medical coverage is pending for verification of citizenship, the VR field for citizenship on the Person Details Screen should be coded “unverified.” A case note entry must be made for every contact made with the client and every action taken by the caseworker regarding citizenship verification. It is important that the comments are specific. Simply indicating that “the client could not get a birth certificate” is not sufficient.

Case Processing Procedures: Such procedures include: • Providing the “Notification of Requirement to Provide Documentation of Citizenship” (FI 2326 or FI 2326 S, the Spanish version) if citizenship has not been electronically verified through the VLP. When an application interview is not required (refer to IHCPPM 2005.00.00), the form should be sent on the same day a worker processes

6 the application. When an application interview is required (refer to IHCPPM 2005.00.00), the form should be sent on the date of intake. The names of all persons for whom documentation is required should be listed. Each applicant whose name is on the form will have 95 days to provide proof of citizenship beginning the date after the form is sent. Please note, the “Pending Verifications for Applicants/Recipients” (FI 2032) is not to be used in lieu of this form. Giving the applicant a 95-day deadline (on the FI 2326) to provide the documents. • Assisting the family in locating verification sources when necessary. This would include such things as helping to find websites, telephone numbers or mailing addresses so that out-of-state birth certificates can be ordered. • Entering a detailed case note comment for each contact made with the client regarding citizenship verification.

If an applicant has provided all required criteria to allow for an eligibility determination, except for fulfilling his citizenship verification requirement, the applicant should be determined eligible without undue delay. If documentation of citizenship was not provided to the DFR by the applicant and electronic verification of citizenship through VLP is not received after 95 days after the applicant received “Notification of Requirement to Provide Documentation of Citizenship”, eligibility is to be discontinued. If the person reapplies at least 95 days after being denied for not verifying citizenship, they are eligible for a new ROP. During each succeeding ROP, Medicaid must be authorized if all other eligibility requirements are met (Refer to 2035.40.05). Note: Effective 6/1/24, per CMS guidance, the number of Reasonable Opportunity Period is unrestricted. Members who reapply for Medicaid at least 95 days from initial denial for not verifying satisfactory immigration status or citizenship during their Reasonable Opportunity Period, will acquire a new ROP and if all other requirements are met, Medicaid benefits must be authorized.6

Referring the case to the supervisor so that an inquiry can be sent to the Policy Answer Line (PAL) if there is uncertainty as to whether benefits should be denied or discontinued for failing to meet the citizenship requirement. The applicant may request a birth certificate by telephone, mail, or online at https://www.vitalchek.com/birth-certificates.

There are two general sources of citizenship documentation: primary, for which one source document is acceptable and secondary, which requires a source document for citizenship and proof of identity.

Primary sources of citizenship documentation are:

7 • A U.S. passport, issued without limitations, even if it is expired. Please note, however, that passports issued to persons born in Puerto Rico must be current. Refer to IHCPPM, Section 2402.15.15 • A Certificate of Naturalization – N-550 or N-570 • A Certificate of Citizenship – N-560 or N-561 • Documentation from a federally recognized tribe. The document must identify the federally recognized Indian Tribe which issued it, identify the individual by name, and confirm the individual’s membership, enrollment in, or affiliation with that Tribe. Some examples include Tribal enrollment/membership cards, a certificate of degree of Indian blood issued by the Bureau of Indian Affairs, a Tribal census document, or a document issued by a Tribe indicating an individual’s affiliation with the Tribe. These documents are examples of documents that may be used, but do not constitute an all-inclusive list of such documents.

When any of the above documents are submitted as citizenship verification, no further proof of identity is required. Secondary sources of citizenship documentation are:

• A U.S. public birth certificate showing birth in one of the 50 States, District of Columbia, Puerto Rico (if born on or after January 1, 1941), Guam (if born on or after 1899), the U.S. Virgin Islands (if born on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (if born after November 4, 1986) • A Certification of Report of Birth (DS-1350) • A Consular Report of Birth Abroad of a Citizen of the United States (FS-240) • A Certification of Birth Abroad (FS-454) • A United States Citizen Identification Card (I-197) • An American Indian Card (I-872) issued by the Department of Homeland Security with the classification code “KIC”. • A Northern Mariana Card (I-873) • A Final Adoption Decree showing the child’s name and place of birth in the U.S. • Evidence of civil service employment by the U.S. government before June 1, 1976 • An official military record of service that shows a U.S. place of birth.

The above sources are preferred secondary sources. The following two sources can be used only when the individual has provided a plausible reason as to why the preferred sources are not available: • An extract of a hospital record, on hospital letterhead, established at the time of birth, if created five years before the initial Medicaid application date. • A life, health or other insurance record showing a U.S. place of birth if created at least five years before the initial Medicaid application date.

8 The following “last resort” documents are to be used rarely and only when the more reliable sources listed previously are not available or cannot reasonably be obtained. Please note that this would not include situations where the individual is unwilling to pay the cost of ordering a birth certificate. • A Seneca Indian tribal census record showing a U.S. place of birth, which was created at least 5 years before the application for Medicaid • A Bureau of Indian Affairs tribal census record of the Navajo Indians, showing a U.S. place of birth, which was created at least five years before the application for Medicaid • A U.S. State Vital Statistics official notification of birth registration showing a U.S. place of birth, which was created at least five years before the application for Medicaid • A statement signed by the physician or midwife who attended the birth, showing a U.S. place of birth, which was created at least 5 years before the application for Medicaid • Institutional admission papers from a nursing facility or other institution showing a U.S. place of birth • Clinic, doctor, or hospital records created at least five years before the application for Medicaid that indicate a U.S. place of birth. For children under sixteen, the document must have been created near the time of birth, or five years before the application for Medicaid • A religious record (recorded by a religious organization) in the U.S. created within three months of the individual’s birth. Please note that entries in a family’s personal religious text are not considered to be religious records for the purpose of citizenship verification • Early school records showing a U.S. place of birth • A special affidavit signed, State Form 53691, under penalty of perjury, by two individuals (other than the applicant/recipient) who have personal knowledge of the event establishing the person’s citizenship status. At least one of the individuals must be unrelated to the applicant/recipient and both must prove their own citizenship.

As stated previously, when secondary documentation is used, the individual’s identity must also be verified. Sources of identity documentation include: • A driver’s license with picture or other identifying information • A school picture ID • Nursery or day care records for a child not yet in school • A U.S. military card or draft record • State, federal, or local government ID containing information identical to that on a driver’s license • A military dependent’s ID card • A U.S. Coast Guard Merchant Mariner card

9 • A Certificate of Degree of Indian Blood or other U.S. American Indian/Alaska Native tribal document, if it contains a photograph or other identifying information. • Three or more corroborating documents verifying the individual’s identity. Examples would be high school and college diplomas from accredited institutions, marriage certificates, property deeds and titles, and employee ID cards. • For children under 16, clinic, doctor, and hospital records. • For children under 16 if none of the above records are available, a special affidavit signed under penalty of perjury by the parent, guardian, or caretaker relative is acceptable. • Identity affidavits may also be used for disabled individuals in residential care facilities. They are acceptable only if there is no other means of verifying the individual’s identity and should be signed by the residential care facility director or administrator.

Please note that an affidavit cannot be used to verify identity if affidavits were used to verify citizenship. 2402.15.15 VERIFICATION OF CITIZENSHIP FOR PERSONS BORN IN PUERTO RICO

The purpose of this section is to explain the effect of legislation enacted in 2009 by the Commonwealth of Puerto Rico on Medicaid and Hoosier Healthwise eligibility. The legislation was enacted by the Commonwealth to reissue certified birth certificates for its residents. This is relevant to the citizenship verification process because, due to its commonwealth status, persons born in Puerto Rico are U.S. citizens at birth. Individuals born in Puerto Rico and applying for Medicaid for the first time on or after November 1, 2010, are affected by the reissue of Puerto Rican birth certificates. For those individuals, a birth certificate issued prior to July 1, 2010, cannot be accepted. If using a birth certificate to document citizenship, these applicants will have to obtain a new certified birth certificate. The applicant may request a birth certificate by telephone, mail, or online at https://www.vitalchek.com/birth-certificates. Instructions in Spanish, for obtaining a new Puerto Rican birth certificate can be found at www.prfaa.com/certificadosdenacimiento/. The instructions should be printed out for applicants without computer access. It should be noted that the case processing procedures found in IHCPPM, Section 2402.15.10 also apply to persons born in Puerto Rico.

As with other individuals declaring U.S. citizenship, a passport issued to a person born in Puerto Rico is a primary source of citizenship documentation. However, the policy regarding passports of persons of Puerto Rican birth differs in that the passport cannot have expired. If the applicant’s passport has expired, an alternate document, as listed in IHCPPM, Section 2402.15.10, will need to be obtained.

As with citizenship issues involving American born applicants, questions can be submitted to the Policy Answer Line (PAL). Similarly, you are encouraged to contact PAL before denying or

10

discontinuing benefits because the individual has not obtained a new birth certificate from Puerto Rico. Please note that persons of Puerto Rican birth who are reapplying for medical assistance or whose eligibility is being redetermined are not to be required to obtain new birth certificates if their citizenship has been documented previously.

2402.15.15.20 INCOME/RESOURCE CONDISERATION FOR NATIVE AMERICANS/ALASKAN INDIAN Medicaid provides health coverage to low-income American Indians and Alaskan Natives (AI/AN) who meet Medicaid eligibility standards. The American Recovery and Reinvestment Act (ARRA) of 2009, Medicaid provides certain income and resource exclusions as well as the exemption of Medicaid premiums and other cost sharing for AI/AN enrollees who are affiliated with a federally recognized tribe.7 Any individual declaring Native American racial-ethnic heritage should be asked if they are members of a federally recognized tribe. If it is attested that the individual is a member of a recognized tribe, membership must be verified. Verification is accomplished by viewing the I.D. card or tribal letter issued to each enrolled member. The I.D. card or letter should specifically state that the individual is an enrolled member, and that the tribe is recognized by the federal government. If documentation has been lost, AI/AN members may provide the telephone number of the tribal administrative office so that membership can be verified. If member declares potential tribal membership but has never been formally enrolled, they are not eligible for the cost sharing exemption. The following provisions are afforded to AI/AN enrollees who are members of a federally recognized tribe.

Consideration of Income and Resources for Medicaid/CHIP Eligibility Income is defined for Medicaid and CHIP purposes as anything an individual receives (e.g., wages, self-employment, interest, dividends, Social Security payment (IHCPPM 2805.00.00)) that the individuals can use to pay for family’s necessities. Resources are defined as cash or anything an individual owns (e.g., checking or savings accounts, real estate, personal property, stocks, bonds (IHCPPM Chapter 2600) that the individual can convert to cash to pay for the family’s necessities. All Income remaining (not paid out) during the month of receipt is considered a resource in the following months (IHCPPM 2605.20.00). Income and resources are countable or excluded based availability or ownership. Refer to IHCPPM 2805.10.00 and 2805.15.00. Income and resources owned by AI/AN individuals who do not have the legal right or power to liquidate resource; or access income for usage, is exempt for Medicaid or CHIP eligibility).8

Income Exceptions

11

Certain types of *Tribal per capita payments and other type of Tribal income are excluded from consideration as income. Per capita distribution of all funds held in a trust by the Secretary of Interior for members of an Indian Tribe are excluded from consideration as income and resources.9The following nonexclusive types of income are exempt in the determination of Medicaid and CHIP eligibility determinations: 10 • Income from selling culturally significant jewelry or basketwork. • Per capita payments from a tribe which comes from natural resources, usage rights, leases, or royalties. • Income received from farming, fishing, natural resources on Indiana land trust. • Interest Income *Per capita payments refer to the distribution of money or other items of value to all tribal members, or to identified groups of members, paid directly from the net revenues of any tribal gaming activity.11 Non-Excluded Income Tribal funds distributed by the tribe to individual on a per capita basis, but which are not retained in trust by the Secretary of Interior are not excluded from income and resources and therefore are considered countable income in the month of receipt.12The following types of income are not exempt for Medicaid/CHIP.

• Tribally managed gaming revenues • Any money from a per capita distribution that have not been held in trust by Secretary of Interior Resource Exceptions Resources include an individual’s right to harvest or extract natural resources from land the individual owns or has ownership interest (e.g., mineral rights, fishing rights, timber rights). When an individual does not have the legal right, authority, or power to liquidate resources or use either the income or resource, it is excluded.13 The following types of resources are exempt in the determination of Medicaid and CHIP eligibility. • Property held in trust under supervision of Secretary of the Interior • Property connected to the political relationship between Indiana Tribes and the Federal government. • Property with unique Indiana significance • Ownership interest in rents, leases, royalties, or usage rights related to natural resources or the sale of natural resources. • Proceeds from extraction of natural resources held by Tribe. Note: The proceeds received from the sell or exchange of a resource (i.e., gravel, timber fish, oil) by an AI/AN member, is considered a resource not income.

12

Non-Excluded Resources • Cash • Savings or checking account. • Stocks • Bonds (non-Tribal Economic Development) • Proceeds from the sale or exchange of natural resources by the owner of property/or owners of rights for geographical area. • Real Property (that does not meet exemption requirement)

Estate Recovery Medicaid estate recovery rules do not apply to the following resources: 14 • Ownership interest in trust or non-trust property (including real property) and improvements located on reservation. • Certain trust lands and Alaska native regions • Income from treaty-protected natural resources • Cultural religious or spiritually significant items • Items that support traditional or subsistence lifestyle

Premiums and Cost Sharing Protections Under Medicaid ARRA prohibits states from imposing Medicaid premiums or any other cost sharing on AIAN applicants and participants. The following types of protections are available to AIAN members: 15 • Premiums • Cost sharing • Enrollment fees • Deductibles • Copayments

Note: Children who are AI/AN are exempt from cost-sharing requirements, therefore cannot receive coverage under Children’s Health Plan, Package C. Worker should follow processing guidelines located in IHCPPM 2403.00.00. Managed Care Entity Requirement AI/AN individuals enrolled in Medicaid/CHIP are not required to enroll in a managed care program. Eligible HIP members who choose to opt-out of managed care and enroll in Fee-for- Service will be covered under MANA (Refer to 1620.35.05).

The only tribe currently recognized in Indiana is the Pokagon Band of the Potawatomi Indians, however it is important to remember that members of federally recognized tribes may be living anywhere.

13

For the most current list of recognized tribes/communities, please check the Tribal Leaders Directory; https://www.bia.gov/service/tribal-leaders-directory. Please submit a PAL for questionable eligibility, income, or resources.

2402.20.00 IMMIGRANTS Individuals who are not citizens of the United States may qualify for assistance based on their status granted by the U.S. Citizenship and Immigration Service (USCIS). Listed below are "qualified" immigrants as defined in federal law. However, the eligibility of these immigrants varies among the programs and is based on certain factors as explained in the following sections. Do not authorize or deny assistance based solely on this list. Read the following sections to understand the distinctions in program eligibility and benefits. Immigrants in any other USCIS classification are not eligible for full coverage Medicaid but can be eligible for emergency Medicaid coverage. • Lawful Permanent Resident under the Immigration and Naturalization Act (INA) • Asylees under Section 208 of the INA • Refugees under Section 207 of the INA • Parolees under Section 212(d)(2) of the INA if paroled for at least one year • Persons whose deportation is withheld under Section 243(h) of the INA • Conditional entrants under Section 203(a)(7) of the INA in effect prior to April 1, 1980 • Cuban and Haitian entrants • Amerasians admitted pursuant to Section 584 of P.L. 100-202 and amended by P.L. 100-461. The eligibility provisions are mandated by federal law: Title IV of the Personal Responsibility and Work Opportunities Reconciliation Act (P.L. 103-193) as amended by the Balanced Budget Act of 1997 (P.L. 105-33), the Agricultural Research, Extension and Education Reform Act of 1998 (P.L. 105-185), and the Farm Security and Rural Investment Act of 2002 (P.L. 107-171).

2402.20.05 LAWFULLY ADMITTED FOR PERMANENT RESIDENCE Under the Immigration and Nationality Act (INA), a Lawfully Admitted Permanent Resident (LPR) is one who has been lawfully accorded the privilege of permanently residing in the U.S. as an immigrant in accordance with Section 101(a)15 and 101 (a)20 of the INA, with such status not having changed since admission. Lawful Permanent Residents should present USCIS Form I-551 as documentation of their immigration status. Caseworkers should check the coding on the I-551 for code, RE-6, RE-7, RE-8,

14

or RE-9. This denotes entry as a refugee with subsequent adjustment to LPR status. Refer to Section 2402.20.15 concerning eligibility of refugees. Lawful Permanent Residents who were residing in the U.S. prior to 8/22/96 are eligible for full Medicaid coverage. However, LPRs who enter the U.S. on and after 8/22/96 are eligible for emergency coverage only for 5 years unless they are honorably discharged U.S. veterans or in active duty in the U.S. military. Further, spouses or dependent children of veterans or military personnel who die during active military duty can be eligible for full coverage (Refer to Section 2402.20.45). At the end of the 5-year period, LPRs can be eligible for full coverage.

2402.20.05.05 AMERICAN INDIANS BORN IN CANADA A North American Indian born in Canada may freely enter and reside in the U.S. and is lawfully admitted for permanent residence if he is of at least 50% American Indian blood. This does not include the spouse or child of such an Indian nor a non-citizen whose membership in an Indian tribe or family is created by adoption unless such person is of at least 50% American Indian blood. Sources of verification are: • Birth or baptismal record issued on a reservation • Tribal records • Letter from the Canadian Department of Indian Affairs • School records.

2402.20.10 CONDITIONAL ENTRANT REFUGEE Section 203(a)(7) of the Immigration and Nationality Act (INA) in effect before April 1, 1980, provides conditional entrant refugee status for persons who, because of persecution or fear of persecution on account of race, religion, or political opinion, have fled from a Communist or Communist-dominated country or from the area of the Middle East or who are refugees from natural catastrophes. (Section 203(a)(7) of the INA was replaced by Section 207 effective April 1, 1980.)

Individuals with this status can be eligible for full Medicaid coverage. (Note a person entering the U.S. on and after 8/22/96 will not be given this USCIS status, since it is no longer in effect.) Verification is established by viewing USCIS Form I-94, Arrival-Departure Record, bearing the stamped legend "Refugee - CONDITIONAL ENTRY" and citing the section of the INA under which they were admitted, or USCIS Form I688B annotated "274a.12(a)(3)" or I-766 annotated “A1”, “A3”.

15

2402.20.15 REFUGEES UNDER SECTION 207 Individuals admitted as refugees under Section 207 of the INA are eligible for full coverage Medicaid once they obtain this status. Refugees usually adjust to Lawful Permanent Resident status after 12 months in the U.S. Refugees will have USCIS Form I-94 annotated with a stamp showing entry as refugee under Section 207 and date of entry, USCIS Form I-688B annotated "274a.12(a)(3)", or I-766 annotated "A3". USCIS Form I-571 also indicates status as a refugee but does not reflect the date of admission. If Form I-94 is not available, verification must be obtained from the USCIS.

2402.20.20 PAROLEES UNDER SECTION 212(D)(5) Individuals who were granted parole under Section 212(d)(5) for at least one year, and who entered the U.S. prior to 8/22/96 can be eligible for full Medicaid coverage. Those who enter the U.S. on and after 8/22/96 can be eligible for emergency Medicaid only, unless they are veterans of the U.S. military or in active duty in the U.S. military. Veterans and military personnel can be eligible for full Medicaid coverage. (Refer to Section 2402.20.45 concerning veterans and active- duty military.) Verification is established by viewing USCIS Form I-94 annotated with a stamp showing granting of parole under Section 212(d)(5) of the INA and a date showing granting of parole for at least 1 year- or Form I-688B annotated “274a.12(a)(4), 274a.12(c)(11) or Form I-766 annotated “C11” or “A4”.

2402.20.25 ASYLEES UNDER SECTION 208 AND VICTIMS OF TRAFFICKING Asylees can be eligible for full-coverage Medicaid.

Verification of the asylee status includes USCIS Form I-94 annotated with a stamp showing granting of asylum under Section 208 of the INA or a grant letter from the Asylum Office of the USCIS. Forms I-688B annotated "274 a.12 (a)(5)" or I-766 annotated "A5" indicate status as an asylee. The date of the form does not reflect when the status was granted. Request Form I-94, the grant letter, or the person's copy of a court order. Verify with USCIS if none of these are available.

Victims of trafficking who are non-U.S. citizens are eligible for full-coverage Medicaid under the Trafficking Victims Protection Act of 2000 (Public Law 106-386). Severe forms of trafficking in persons is defined as Sex Trafficking which is the recruitment, harboring, transportation,

16

provision or obtaining of a person for the purpose of a commercial sex act induced by force, fraud or coercion, or in which the person is forced to perform such act is under the age of 18 years; or Labor Trafficking which is the recruitment, harboring, transportation, provision or obtaining of a person for labor or services, through the use of force, fraud, or coercion, for the purpose of subjection to involuntary servitude, peonage, debt bondage or slavery. In addition, minor children, spouses and in some cases the parents and siblings of victims of severe trafficking may also be eligible for benefits.

Victims of trafficking are issued T Visas by U.S. Citizenship and Immigration Service (USCIS). Eligible relatives of trafficking are entitled to visas designated as T-2, T-3, T-4, or T-5 (Derivative T Visas). In the case of an immigrant who is awarded a T Visa, and who is under 21 years of age on the date the T Visa was filed, Derivative T Visas are available to the immigrant’s spouse, children, unmarried siblings under 18 years of age on the date on which the immigrant’s Visa application was filed as well as the parents of the immigrant victim. In the case of an immigrant who is awarded a T Visa and was 21 years of age or older; on the date the T Visa application was filed, the Derivative T Visas are available to the immigrant’s spouse and children.

2402.20.30 DEPORTATION WITHHELD UNDER SECTION 243(H) Individuals with a deportation withheld order are eligible for full-coverage Medicaid.

An immigrant who has had deportation withheld under this status will have an Order of an Immigration Judge showing deportation withheld under Section 243(h) of the INA and date of the grant. USCIS Forms I-688B annotated "274a.12(a)(10)" or I-766 annotated "A10" indicate deportation was withheld under Section 243(h) or removal withheld under Section 241(b)(3), but normally do not reflect the date of withholding. Request the person's copy of the court order. If not available, verification must be obtained from the USCIS.

2402.20.35 AMERASIAN IMMIGRANTS Certain Amerasians from Vietnam, with their close family members, have been allowed entry into the U.S. in immigrant status through the Orderly Departure Program beginning March 20, 1988. They can be eligible for full coverage Medicaid. Acceptable documentation of this status is any of the following:

• I-94 indicating codes AM1, AM2, or AM3 • I-551 indicating codes AM6, AM7, AM8 • Vietnamese Exit Visa, Vietnamese Passport, or U.S. passport if stamped by the USCIS with the codes AM1, AM2, or AM3 • Temporary I-551 stamp in foreign passport • I-571 Refugee Travel Document.

17

2402.20.40 CUBAN AND HAITIAN ENTRANTS Cuban and Haitian Entrants (CHEs), as defined in Section 501(e) of the Refugee Education Assistance Act of 1980, can be eligible for full coverage Medicaid.16 CHE is not a derivative status therefore family members do not automatically acquire CHE eligibility and may be subject to 5- year bar. CHEs can have a wide variety of immigration documentation, that do not categorially establish whether individuals are CHE, therefore SAVE verification is always required.17 Citizenship and immigration status must be verified for all members attesting to CHE eligibility. Note: Children born abroad to Cuban/Haitian Entrants are not considered CHE unless eligibility and immigration status is verified with approved U.S. Immigration documentation that provides evidence of citizenship or nationality and confirmed through SAVE (Refer to 2402.10.15).

Please submit a PAL for questionable CHE eligibility or immigration status.

2402.20.41 COMPACT OF FREE ASSOCIATION (COFA) ENTRANTS Effective December 27, 2020, Compact of Free Association (COFA) Entrants as defined in the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), and amended by the Consolidated Appropriations Act, 2021 can now be eligible for full coverage Medicaid if they otherwise qualify. This includes individuals that are citizens of Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau (PAL). COFA citizens are not citizens or nationals of the United States; however, if they live in the 50 U.S. states and District of Columbia and meet all other Medicaid eligibility rules, they may now be considered for full-coverage Medicaid. COFA citizens who meet financial eligibility criteria based on their income and other non- financial eligibility criteria are exempt from the 5-year bar. Medicaid may provide retroactive coverage for up to three months prior to the month of application, if the individual would have been eligible for a category of assistance which includes retroactive coverage during that period had they applied.

NOTE: The only exceptions are: • For children who only qualify for the separate CHIP program (in Indiana, this is aid category MA10), children who are COFA citizens and being determined in MA10 should be processed according to their immigration status without regard to COFA citizenship.

18

• COFA citizens who adjust to Lawful Permanent Resident (LPR) status must meet all other eligibility requirements including the 5-year waiting period (if applicable) under 8 U.S.C. § 1613 (a). The 5-year waiting period for COFA citizens who adjust to LPR status prior to December 27, 2020 begins the date adjustment to LPR status was granted. The 5-year waiting period for COFA citizens who adjust to LPR status on or after December 27, 2020, is the date of entry or December 27, 2020, whichever is earlier.

Calculation of 5-year waiting period

2402.20.45 VETERAN OR ACTIVE-DUTY MEMBER OF THE ARMED FORCES As explained in the previous sections, immigrants with certain USCIS classifications who would otherwise be subject to assistance limitations can be eligible if they are veterans, are on active duty in the military, have served minimum active-duty service requirements, or are spouses or dependent children of veterans or military personnel who die during active military duty. The exemption for veterans also applies to individuals who served in the Philippine Commonwealth Army during World War II or as Philippine Scouts following the war. An eligible veteran is a person who served in the active U.S. military, naval, or air service, and was released with a discharge characterized as honorable and not on account of alienage. Veterans should have received a full copy of DD Form 214 (Certificate of Release of Discharge from Active Duty) that contains the necessary information. An honorable discharge is denoted by the entry of "Honorable" in the "Character of Service" block of DD Form 214.

If the evidence characterizes the discharge as anything other than "Honorable", such as "Under Honorable Conditions", the individual and family members cannot be determined eligible based on the veteran exception. Eligibility based on veteran status cannot be established if the reason Example 1: COFA citizens living in U.S. since January 1, 2020, who adjust to LPR status on March 1, 2020, would have a 5-year waiting period beginning status adjustment date (i.e., until March 1, 2025). Example 2: COFA citizens living in U.S. since January 1, 2019, who adjust to LPR status on January 1, 2025, would have one year remaining of the 5-year waiting period (i.e., until December 27, 2025). Example 3: COFA citizens living in the U.S since January 1, 2021, who adjust to LPR status January 1, 2025, have under one year remaining of the 5-year waiting period (i.e., January 1, 2026).

19

for discharge was based on alien status, lack of U.S. citizenship or other "alienage" reasons, or if the "Separation Code" block contains an entry JCP, KCP, SCP, or YCP. Those codes establish discharge based on alienage. If the individual states that he or she meets the veteran requirements but is unable to present the appropriate discharge papers as documentation, the worker should contact the Veterans Affairs Regional Office. The eligibility exception for veterans also applies to the Hmong and other Highland Lao tribal people who fought on behalf of the U.S. Armed Forces during the Vietnam conflict.

Persons who fulfill the minimum active-duty service requirements or their un-remarried surviving spouse and dependent children are also exempt from other alien requirements. Minimum active duty served by a person who initially enters service after 9/7/80 is 24 months of continuous active duty or the full period for which the person was called or ordered to active duty.

A person who is on active duty in the U.S. Armed Forces (other than active duty for training) is also not subject to the assistance limitations placed on immigrants in his classification. Documentation of active-duty status is the individual's Armed Forces of the United State Geneva Conventions Identification Common Access Card (CAC). The CAC, a “smart” card about the size of a credit card, is the standard identification for active-duty uniformed service personnel. Other types of verification of active-duty status include but are not limited to a copy of the soldier’s orders indicating active-duty status, an enlistment contract, or a letter from the soldier’s commanding officer. A blue (retiree) or beige (dependent) card is not evidence of active duty.

2402.20.47 Battered Non-Citizen (Spouse/Child)

Under Title VI of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, certain immigrants may be eligible for Medicaid benefits. Battered immigrants who are determined to be qualified non-citizens may be eligible to receive full coverage or emergency services. Violence Against Women Act (VAWA) self-petitioners or battered immigrants who meet the definition of qualified non-citizen and entered the country prior to 8/22/96 with a prima facie determination or have been in qualified status for five years are eligible for full coverage Medicaid.18 Battered immigrants who entered the country on or after 8/22/96 are subject to a five-year bar and will be eligible for emergency services only until they have held the qualified status for five years (or until status adjustment is approved to one eligible for full coverage with no five-year bar). The five-year waiting period begins the date applicant/member obtains qualified status and not when they enter the United States.19

To be considered to have a qualified status, a battered immigrant must show he or she has an approved OR pending petition which makes a prima facie case for immigration status under one of the following categories:

20

• A Form I-130 petition filed by their spouse, or in the case of a child, by the parent or in the case of an unmarried adult son or daughter of a lawful permanent resident (LPR), by the parent.

• A Form I-360 petition as a widow(er) of a United States citizen (USC) under 8 U.S.C. 1154(a)(1)(A)(ii).

• An approved self-petition filed with the Immigration and Naturalization Service (INS) under the Violence Against Women Act (VAWA) on Form I-360 OR an I-360 pending with the INS, and INS has issued a Notice of Prima Facie Determination. In addition, a child of a self-petitioner may also derive immigration status from the self-petition. INS should include the names of any qualifying children on the Notice of Approval or Notice of Prima Facie Determination. Review of these VAWA applications includes a determination that the applicant has been subject to battery or extreme cruelty. • An application for VAWA cancellation of removal or suspension of deportation has been granted OR is pending and the immigration court finds that the applicant has a prima facie case for this relief. Review of VAWA applications for cancellation/suspension includes a determination that the applicant has been subject to battery or extreme cruelty. • Some immigrants, including battered immigrants, have been petitioned for by family members to immigrate here. As part of that process, family members must also file an "affidavit of support" as well as the immigration petition. Note: Immigration status should not be changed in IEDSS until member receives a Notice of Approval or other documentation confirming a qualified immigration status change. A battered spouse, child, or parents who have a pending or approved petition with the Department of Homeland Security (DHS) is subject to the five-year bar.20

2402.20.49 IRAQI AND AFGHANI SPECIAL IMMIGRANTS Certain Iraqi and Afghan nationals have special immigrant status under section 101(a)(27) of the Immigration and Nationality Act (INA) and may be eligible for Medicaid and Hoosier Healthwise. Iraqi and Afghani Special immigrants are eligible for all benefits available to the same extent and for the same period as refugees pursuant to Section 207 of the Immigrations and Nationality Act.21

Both Iraqi and Afghani special immigrants will either enter the U.S. as Lawful Permanent Residents (LPRs) with the special immigrant visa or will adjust to special immigrant status after

21

entering the U.S. under another immigration status (such as an asylee or parolee). Therefore, unless the immigrant is a qualified alien and is eligible under current program rules, the date of eligibility may or may not coincide with the special immigrant’s date of entry. This policy is based on the Department of Defense Appropriations Act of 2010 (Section 8120, P.L. 111-118) enacted on December 19, 2009.22 On 8/2/21, the Department of State approved three additional immigration categories for Afghan evacuees entering the U.S. who are eligible for Medicaid benefits.23

Afghans with a Special Immigrant Visa (SIV): Afghans granted a SIV have been affiliated with the U.S. mission in Afghanistan, e.g., as translators and interpreters, or are the spouse or an unmarried child under the age of 21 of such individuals. SIVs are Legal Permanent Residents (LPR also known as U.S. green card holders).

• Afghans granted SIVs are in a qualified non-citizen status and are eligible for Medicaid or CHIP to the same extent as refugees, without a five-year waiting period, if they meet other eligibility requirements. • Afghans granted SI/SQ Parole who are ineligible for Medicaid/CHIP because they are over income limits or do not have other coverage (e.g., employer-sponsored insurance) may be eligible for Marketplace coverage with financial assistance of Refugee Medical Assistance (RMA). Special Immigrant (SI/SQ) Parolees: Such SI/SQ Parolees are eligible for a SIV but were evacuated to the U.S. before completing the process to receive a SIV.

• Afghans granted SI/SQ Parole for more than one year are in a qualified non-citizen status and are eligible for Medicaid or CHIP as refugees, without the five-year waiting period, if otherwise eligible.

• Afghans granted SI/SQ Parole who are ineligible for Medicaid/CHIP because they are over income limits or do not have other coverage (e.g., employer-sponsored insurance) may be eligible for Marketplace coverage with financial assistance of Refugee Medical Assistance (RMA). All Other Parolees (aka Humanitarian non-SI/SQ Parolees): Such Humanitarian (non-SI/SQ) Parolees are Afghans who were evacuated for urgent humanitarian reasons and paroled into the United States but have not been granted a SIV and may not be eligible for the SIV program.

• Effective 10/1/21, Afghan nationals who entered the U. S with humanitarian parole, are eligible to receive the same services as refugees (admitted under Section 207 of the INA).

• Afghans who are Humanitarian (non-SI/SQ) Parolees for more than one year are in a

22

qualified non-citizen status and are eligible for Medicaid or CHIP as refugees, without the five- year waiting period, if otherwise eligible.

• Afghan parolees deemed to be unaccompanied children eligible for Unaccompanied Refugee Minor (URM) services are eligible to receive the same services as refugees (admitted under Section 207 of the INA). Note: Eligible Afghans include individuals paroled into the United States between July 31, 2021, and September 30, 2022; or those paroled into the United States after September 30, 2022, and, either the spouse or child of such a parolee or the parent or legal guardian of an unaccompanied child paroled during that period.

Verification is established by passport with an immigrant visa stamp noting that the individuals has been classified under IV (Immigrant Visa) Categories SI1, SI2, SI3, SI6 ,SI7, SI8 or SQ1, SQ2, SQ3 , SQ6, SQ7, SQ8 and a DHS stamp or notation on passport or I-94 showing date of admission; DHS Form I-551 (“green card”) with an IV (immigrant visa) code for category, or I-94 noting SQ or SI Parole (per section 602(B)(1)AAPA/Sec 1059(a) NDAA 2006). If a person would be determined otherwise eligible for Medicaid under any category due to meeting all verification requirements of Medicaid, except for the verification of either citizenship or qualified immigration status, then the person must be determined eligible for Medicaid (Refer to 2035.40.05 for processing guideline).

2402.20.50 OTHER IMMIGRANTS, VISITORS, AND NON-IMMIGRANTS Any other immigrants, including those who lack immigration documentation or whose immigration status cannot be verified, who are not specified in the previous sections can be eligible for emergency Medicaid coverage only if they meet all other requirements of the category in which they qualify. However, eligibility for emergency services only may not be approved under the MA 10 category. A child who is undocumented or a visitor or non-immigrant as described in paragraph four below, is not eligible for Hoosier Healthwise Benefit Package C, regardless of family income. It is important to remember that the eligibility restrictions and prohibitions apply only to the applicant's immigration status, not other family members. For example, a child who is a U.S. citizen may have parents who lack immigration documentation or whose immigration status cannot be verified. The child in this circumstance can be eligible for health coverage, if all other requirements are met, without regard to parents' status.

If an immigrant alleges to be in a qualified immigrant status as defined in the previous sections, but is unable to present documentation, the Local Office is to advise them in writing of their obligation to contact the USCIS to obtain the documentation if not obtainable through using

23

SAVE. If the verification cannot be obtained through SAVE and the applicant does not provide documentation from the INS, they are eligible only for emergency Medicaid coverage only. If such an applicant has provided all required criteria to allow for an eligibility determination, except for fulfilling his immigration verification requirement, the applicant should be determined eligible without undue delay. If they do not verify immigration status within the 90-day timeframe from notice to provide immigration status was sent and the immigration status is not electronically verified within 95-days from when the form was sent, then the eligibility must be changed to emergency services only.

Certain visitors and non-immigrants, as described below, may be eligible for emergency Medicaid coverage.24 They must meet all eligibility requirements except the factor of citizenship/immigration status and Social Security numbers. These non-citizens would have the following types of documentation: • I-94, Arrival - Departure Record • I-185, Canadian Border Crossing Card • SW-434, Mexican Border Visitor's Permit • I-186, Non-Resident Alien Mexican Border Crossing Card • I-95A, Crewman's Landing Permit • I-184, Crewman's Landing Permit and Identification Card.

Note that these individuals may not meet the State residency requirement and would not be eligible for health coverage:

Visitors, tourists, foreign students, temporary workers, crewmen on shore leave, diplomats, members of foreign information media, exchange visitors, and so forth, who are lawfully admitted for specific periods of time and with no intention of establishing a permanent residence in the U.S. Under no circumstances are immigrants who lack immigration documentation or whose immigration status cannot be verified, who are applying for or receiving traditional Medicaid or Hoosier Healthwise, to be reported by the Division of Family and Children to the U.S. Citizenship and Immigration Service (USCIS). This also applies to family members of such applicants. Note: Effective 6/1/24, per CMS guidance, the number of Reasonable Opportunity Period is unrestricted. Members who reapply for Medicaid at least 95 days from initial denial for not verifying satisfactory immigration status or citizenship during their Reasonable Opportunity Period, will acquire a new ROP and if all other requirements are met, Medicaid benefits must be authorized.25

2402.20.50.05 DEFINITION OF EMERGENCY SERVICES

24

This section applies to all categories except MA 10, MARP, MASP, and MASB. The classifications of immigrants who qualify for emergency services only (see Section 2402.20.50) are not eligible for MA 10, MARP, MASP, and MASB. Emergency services are defined as services required for a medical condition (including labor and delivery) manifesting itself by acute symptoms (including severe pain) serious enough that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the individual's health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

A non-citizen eligible only for emergency services will receive a Hoosier Health Card. When providers use their Eligibility Verification System, the enrollee's limited coverage will be reported. Providers are alerted to this coverage limitation and have information on the definition of an emergency and claims payment restrictions. The DFR is not expected to address claims payment difficulties or disputes concerning the emergency nature of an illness. Providers are to be referred to Provider Assistance at the Fiscal Contractor.

2402.20.55 SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS (SAVE) In addition to obtaining documentation from the AG or through an electronic interface or batch process (as discussed in Section 2402.20.05), the DFR is required to verify each alien's immigration status with Systematic Alien Verification for Entitlements (SAVE)if the verification is not obtained electronically or through a batch process from the appropriate citizenship or immigration source. SAVE was established by the Immigration and USCIS to implement a provision of the Immigration Reform and Control Act of 1986 which mandated direct verification of alien immigration status with USCIS. NOTE: SAVE procedures are not to be initiated for individuals who declare that they are U.S. citizens by birth or naturalization. (Verification requirements for citizens are discussed in Sections 2402.15.00 and 2402.15.05.)

All alien applicants must present original documentation of alien registration or another form of documentation which is reasonable evidence of their status if the immigration status is not able to be verified through an electronic interface or batch process. When a satisfactory immigration status is not electronically verified, a SAVE request is always required for status confirmation (with or without documentation provided by AG). Aliens without documentation should be referred to the local CIS office prior to using SAVE procedures. Most alien applicants will present documentation that contains an Alien Registration Number (A-number). The seven- or nine-digit number preceded by the letter "A" is unique for everyone.

25

The DFR requests SAVE verification by utilizing the Policy Answer Line (PAL). A SAVE request must include the case name and number and each alien case member's name, alien registration number, and program choices. The name of the person making the request should also be included. Upon receipt of a SAVE request, Central Office staff accesses the SAVE database for the following information:

• Verification number (this number must be documented in the case record • Last name • First name • Date of birth (mm/dd/yy) • Employment eligibility statement • Immigration status • Country of birth • SSN if known • Alternate ID number, if known • Date of entry (mm/dd/yy).

The data is then transmitted to the Local Office from the Policy Answer Line (PAL).

Through access of the SAVE database by Central Office staff, we may receive a response from SAVE indicating “Additional Verification Required”. If this occurs, Central Office staff will respond to the Local Office with a request for further information that will include: • I-94 Number • Eligibility system Case Number • Document Type (Examples of which could include): o I-327 - Re-entry Permit o I-551 - Permanent Resident Card o I-571 - Refugee Travel Document o I-688 - Temporary Resident Card o I-688A - Employment Authorization Card o I-688B - Employment Authorization Document o I-766 - Employment Authorization Card o I-94 - Arrival/Departure Record Card o Other - use document description • Unexpired Foreign Passport • Document Date • Document Expiration Date • Date of Birth.

26

Upon receipt of this additional information, Central Office staff will submit the information to SAVE. This secondary request to SAVE takes approximately 3-7 business days for CIS to research. The response from SAVE will either note the requested alien status or will request the need for a Documentation Verification Request (Form G-845) to be sent. The G-845 is to be sent to CIS with a copy of the original documentation provided by the AG. This material is sent to the following address: U.S. Citizenship and Immigration Services 10 Fountain Plaza, 3rd Floor Buffalo, NY 14202 Attn: Immigration Status Verification Unit.

NOTE: If the original alien documentation presented by the AG does not contain an alien registration number, the Local Office must contact CIS as indicated above. Central Office staff cannot access the SAVE database without the alien registration number. When the Form G-845 has been returned to the Local Office, any necessary changes to the Alien-Summary Page should be made. NOTE: Normal case processing is to continue once the AG has provided the initial verification of alien status. Benefits are not to be delayed, denied, or reduced based on pending SAVE verifications. If an applicant has provided all required criteria to allow for an eligibility determination, except for fulfilling his immigration verification requirement, the applicant should be determined eligible without undue delay. If he does not verify immigration status within the 90-day timeframe from when notice to provide immigration status was sent and the immigration status cannot be verified electronically, then his eligibility must be discontinued (Refer to 2035.40.05).26

2402.20.60 Ukraine Special Immigrants Certain Ukraine nationals have special immigrant status under section 401 of the Immigration and Nationality Act (INA) and may be eligible for Medicaid and Hoosier Healthwise. Ukraine Special immigrants are eligible for all benefits available to the same extent and for the same period as refugees pursuant to Section 207 of the Immigrations and Nationality Act.27 A citizen or national of Ukraine, or a person who last habitually resided in Ukraine may qualify for Specifical Immigrant status.28 These individuals may enter the United States (U.S.) as Lawful Permanent Residents (LPRs) with a special immigrant visa or may adjust to special immigrant status after entering the U.S. under another immigration status (such as an asylee or parolee). Therefore, unless the immigrant is a qualified alien and is eligible under current program rules, the date of eligibility may or may not coincide with the special immigrant’s date of entry (See Eligibility Period below). This policy is based on the provisions in the Additional Ukraine Supplemental Appropriations Act, 2022 (Section 401, P. L. 117-128) enacted on May 21, 2022.29

27

On 5/21/22, the U.S Congress enacted the Additional Ukraine Supplemental Appropriations Act (AUSAA) granted states authorization to provide medical assistance available to refugees, for specific Ukrainian populations and other non-Ukrainian individuals in response to their displacement from Ukraine resulting from Russia’s February 24, 2002, invasion.30 Individuals from Ukraine may fall under one or more immigration status; Temporary protected status (TPS), humanitarian parolee status only, or TPS and humanitarian parolee status.

Temporary Protected Status (TPS): The Department of Homeland Security (DHS) designated Ukraine for TPS status for 18 months, effective April 19, 2022, or later through October 19, 2023. Ukrainian Nationals (citizens) and Individuals with no nationality who last habitually resided in Ukraine and who have continuously resided in the U.S. since April 11, 2022 and have been continuously physically present in the U.S. since April 19, 2022 can apply for TPS status.

• Ukrainian nationals granted TPS only or who have a pending application for TPS are considered “lawfully present,” but are not considered “qualified non-citizens and therefore are subject to the five-year waiting period. • TPS application is available to eligible Ukrainian nationals who entered the U.S. between April 19, 2022, and October 19,2023 and meet all other eligibility requirements. Verifications include Employment Authorization Document (EAD) with a category of A12 or C19, I-797, Application for Temporary Status, or any verification or documentation from DHS or other authoritative document. Note: Ukrainian nationals paroled into the U.S. before February 24, 2022, who are granted parole for more than one year are qualified non-citizens, but subject to the five-year waiting period.31 Individuals with TPS status only with no humanitarian parole are subject to the 5-year waiting period.32 These individuals should be entered in Eligibility System as parolees. Applicants/members who do not meet eligibility criteria for Medicaid, may be eligible for coverage through the Federal Facilitated Market Exchange (FFM).

Special Immigrant Parolees: Ukrainian nationals who enter the U.S. as parolees on or between February 24, 2022, and September 30, 2023, may be eligible for Medicaid and CHIP to the same extent as refugees, without a five-year waiting period, if they meet all other eligibility requirements for the state. The following Ukrainian parolees are considered “qualified non- citizens for the purposes of Medicaid and CHIP eligibility. Ukrainian National Humanitarian Parolees, Non-Ukrainian National Parolees, and Ukraine nationals paroled after 9/30/23.

• Ukrainian National Humanitarian Parolees (UHP): Ukrainian nationals (citizens) admitted to the U.S as humanitarian parolees (UHP) between February 24, 2022, and September 30, 2023, are considered “qualified non-citizens” and eligible for Medicaid or CHIP as

28

refugees, without the five-year waiting period, if otherwise eligible. Individuals from this population may be eligible for retro coverage, no earlier than 2/1/22. Verification is established by Form I-94 noting humanitarian parole (per INA section 212(d)(5) or 8 U.S.C. § Foreign passport with DHS/CBP admission stamp noting “DT” Foreign passport with DHS/CBP admission stamp noting Uniting for Ukraine or “U4U” Or Foreign passport with DHS/CBP admission stamp noting Ukrainian Humanitarian Parolee or “UHP” Or Form I-765 Employment Authorization Document (EAD) receipt notice with code C11 Or Form I- 766 Employment Authorization Document (EAD) with the code C11.

• Non-Ukrainian National Parolees: Humanitarian parolees who last habitually resided in Ukraine but are not Ukraine nationals (citizens) who entered the U.S. between February 24, 2022, and September 30, 2023, may be considered qualified non-citizens and eligible for Medicaid or CHIP as refugees, without the five-year waiting period. Verification is established any of the forms or stamps listed above for UHPs and documentation of last habitual residence in Ukraine. • Paroled after September 30, 2023: Individuals who enter the U.S from Ukraine and meet the criteria of humanitarian parole or non-Ukrainian national parolee (UHP) and whose relationship to primary eligible member meets eligibility requirements: o A spouse or child o A parent, legal guardian, or primary caregiver of an unaccompanied refugee minor or an unaccompanied Ukraine citizen . Note: Individuals with TPS status that includes humanitarian parole (UHP) and/or non-Ukrainian national parolees should be entered as Refugee on the Alien Details screen. Individuals who do not meet eligibility criteria for Medicaid, may be eligible for coverage through FFM. Eligibility Ukraine nationals (citizens) or non-Ukrainian citizens who last habitually resided in Ukraine and entered the U.S. as a parolee between February 24,2022 and September 30, 2023 and meet all other eligibility requirements are eligible for Medicaid or CHIP to the same extent as refugees, without a 5-year waiting period. When applicable, retro coverage is available if all other eligibility requirements are met (e.g., income, residency, etc.). Ukrainian nationals paroled in into the U. S before February 24, 2022, who are granted parole for more than one year are subject to the five-year waiting period. Medicaid/CHIP eligibility for Ukrainian nationals granted TPS who later adjust to humanitarian parolees can begin no earlier than the status adjustment date. Ukrainian nationals who are paroled in the U.S. after September 30, and whose relationship to primary eligible member meets eligibility requirements are eligible for Medicaid and CHIP to the same extent as refugees.

Reasonable Opportunity Period (ROP)

29

If worker is unable to verify Ukrainian national’s immigration status promptly, and the individual has attested to having an eligible immigration status and meets all other eligibility requirement, then the person must be determined eligible for Medicaid during the 90-day ROP. (Refer to 2035.40.05 for processing guideline). Please submit a PAL for questionable eligibility or immigration status.

2403.00.00 NATIVE AMERICANS/ALASKAN INDIANS (MA 10) Children who are Native Americans or Alaskan Indians (NA/AI) are exempt from the cost-sharing requirements of the Children's Health Plan, Package C of Hoosier Healthwise.33 A child must be a member of a federally recognized tribe or have received a service from the Indian Health Services, a tribal health program, or urban Indian health program, or through a referral from one these programs to receive the exemption. Any individual claiming Native American racial-ethnic heritage for a child applicant or recipient should be asked whether the child is a member of a federally recognized tribe or the child received a service as mentioned above. If it is alleged that the individual is a member of a recognized tribe, membership must be verified for the exemption to apply. Verification is accomplished by viewing the I.D. card or tribal letter issued to each enrolled member. The I.D. card or letter should specifically state that the child is an enrolled member, and that the tribe is recognized by the federal government. If the documentation has been lost, the parent/caretaker may provide the telephone number of the tribal administrative office so that the child's membership can be verified. If the parent declares potential membership but the child has never been formally enrolled, he/she is not eligible for the cost sharing exemption.

The only tribe currently recognized in Indiana is the Pokagon Band of the Potawatomi Indians. The tribe's I.D. card features a red tribal emblem (an eagle on a branch) and an enrollment number and shows the child as a member of the Pokagon Band of the Potawatomi Tribe as certified by the tribal chairman. If the parent indicates that the child is an enrolled member, but written documentation has been lost or stolen, enrollment may be verified by calling the Pokagon Band Administrative Offices at 1-888-782-1001. Although the Pokagon Band is the only certified tribe in Indiana, it is important to remember that members of federally recognized tribes may be living anywhere. A child who is an enrolled member of any federally recognized tribe is entitled to the exemption, if otherwise eligible for MA 10.

Since these individuals are not to be required to pay a premium or co-payments, it will be necessary to fiat MA 9 eligibility once it has been established that the child qualifies in all other

30

respects for MA 10. The situation must be fully documented on CLRC (Running Record Comments).

2404.00.00 REQUIREMENT TO PROVIDE SOCIAL SECURITY NUMBER The policy stated in this section does not apply to MA Q or MA X or to individuals who are eligible for emergency services only under Medicaid.

Each applicant must, as a condition of eligibility, furnish his Social Security Number (SSN).34 A verbal statement from the individual or his authorized representative is sufficient to meet this requirement. If the SSN is unknown or has never been obtained, the individual must apply for an SSN through the local Social Security Administration (SSA) office. The procedure to apply for a number is outlined in Section 2404.10.00. Household members who are not applying for Medicaid do not have to provide their SSN as a condition of eligibility. The determination of eligibility is not to be delayed, denied, or discontinued due to the waiting on an SSN to be issued. Certain applicants, because of well-established religious objections, may refuse to obtain an SSN and would not be required to obtain one as a condition of eligibility for Medicaid. The term well established objections mean that the applicant meets both of the following criteria:

• Is a member of a recognized religious sect or division of the sect • Adheres to the tenets or teachings of the sect or division of the sect and for that reason is conscientiously opposed to applying for or using a national identification number.35

The caseworker must request that AG members whose income or resources are included in the budget, but who are not participating members of the AG, provide their SSN for purposes of data exchange. These individuals are not required to comply with this request. Refer to Section 3205.00.36 If any applicant/recipient shows multiple cards for himself to the Local Office, it is to be reported to the local SSA District Office for investigation. The same procedure applies if it is suspected that multiple SSNs exist.

31

2404.10.00 COMPLETION OF SOCIAL SECURITY NUMBER REFERRAL The policy stated in this section does not apply to MA Q, MA X or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting non- citizens. An applicant/recipient who does not have an SSN or who cannot remember the SSN, must contact the SSA and apply for a number. The relevant Social Security Administration websites include: • https://www.ssa.gov/ssnumber

• www.ssa.gov/forms/ss-5.pdf

2404.10.05 SOCIAL SECURITY NUMBER REFERRAL FOLLOW-UP The policy stated in this section does not apply to MA Q, MA X, or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting non- citizens. If an individual has fully complied with the SSA's requirements for an SSN application and is otherwise eligible, the Local Office is not to deny assistance, delay granting assistance, or discontinue assistance pending issuance of the SSN.37

2404.15.00 HOSPITAL ENUMERATION The policy stated in this section does not apply to MA Q, MA X or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting non- citizens. The notice provided by hospitals indicating that an individual applied for an SSN is sufficient verification of compliance with eligibility requirements only if the notice (SSA-2853) contains the applicant's name and is signed and dated by a hospital representative and includes the title of the representative.

2404.25.00 REFUSAL TO COMPLY WITH SOCIAL SECURITY NUMBER REQUIREMENT

32

The policy stated in this section does not apply to MA Q or MA X or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting non- citizens. Penalties may be assessed when an individual does not apply for, or provide, an SSN. These penalties are discussed in the following sections.

2404.25.10 PENALTIES FOR SSN NON-COMPLIANCE The policy stated in this section does not apply to MA Q or MA X or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting non- citizens.

The refusal of an applicant to provide or apply for an SSN results in their ineligibility.38 This ineligibility will continue until the applicant who has failed to comply comes into compliance with the SSN requirement. When the ineligible individual is a parent or sibling required to be included in the AG, his or her income and resources must be considered when determining the financial eligibility of the remaining AG members.39

2404.30.00 VERIFICATION OF SOCIAL SECURITY NUMBER The policy stated in this section does not apply to MA Q, MA X or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting aliens.

Eligibility systems complete a data exchange with the SSA for the purpose of verifying SSNs. When an SSN is verified, the eligibility system will be automatically updated.

2404.30.05 SOCIAL SECURITY NUMBERS NOT VERIFIED THROUGH DATA EXCHANGE The policy stated in this section does not apply to MA Q, MA X or immigrants who lack immigration documentation or whose immigration status cannot be verified or visiting aliens. If verification does not occur through interface, the eligibility system will generate task T0286 SVES SSN Verification - SSN not in SSA File. The eligibility worker must obtain verification of the individual's SSN to ensure the correct number is being submitted for verification. The following documentation is acceptable:

• Social Security card

33

• Correspondence from SSA containing the individual's name and account number (if the number has an A, J, M, or T suffix, this is the SSN) 32 • A Social Security check issued on the individual's own account number • a Medicare card issued on the individual's own account number (if the number has an A, J, M, or T suffix, this is the SSN) • A SSA certificate of award which will contain a claim number (if the number has an A, J, M, or T suffix, this is the SSN).

The caseworker must establish that Social Security coverage is provided under the individual's own account number and not someone else's with the individual as a beneficiary. Once verification is obtained, the caseworker will update the information in the eligibility system.

2406.00.00 RESIDENCY To receive assistance, an applicant must be a resident of Indiana.

2406.05.00 RESIDENCY OF HOMELESS INDIVIDUALS Homeless individuals and residents of public or private nonprofit shelters for the homeless and/or Domestic Violence victims located in Indiana meet Indiana residency requirements. An otherwise eligible individual must not be required to reside in a permanent dwelling or have a fixed mailing address.

2406.20.00 RESIDENCY REQUIREMENTS Federal regulations regarding residency specifically prohibit states from denying MA to any individual on the grounds that he has not resided in the state for a specific period or did not establish residence in the state prior to entering an institution. However, workers must make sure those individuals who were not approved are not Indiana residents according to the eligibility rules. In determining whether an individual meets the residency requirement, "capability of indicating intent" is a factor. An individual is considered incapable of indicating intent if they meet any of the following criteria:

• Has an I.Q. of 49 or less, or a mental age of seven or less • Is judged legally incompetent

34

• Is found incapable of indicating intent based on medical documentation obtained from a physician, psychologist, or other person licensed by the state in the field of mental Developmental Disability.

2406.20.05 RESIDENCY OF NON-INSTITUTIONALIZED INDIVIDUALS Individuals under age 21: • The state of residence is the state where the individual is currently living. • If the individual is emancipated from his parents or married, and can indicate intent, the state of residence is the state where he is living with the intention to live there permanently or indefinitely.40

Individual’s age 21 and over, the state of residence is the state where the individual is: • Living with the intention to remain there permanently or indefinitely. • Living and where he entered with a job commitment or seeking employment (whether currently employed); or • Living, if incapable of indicating intent.41

2406.20.10 RESIDENCY OF INSTITUTIONALIZED INDIVIDUALS Individuals under age 21:

For any institutionalized individual who is neither married nor emancipated, the state of residence is one of the following: • The parents' state of residence at the time of the individual's placement in the institution (if a legal guardian has been appointed and parental rights are terminated, the guardian's state of residence is used instead of the parents') • The current state of residence of the parent who files the application if the individual is institutionalized in that state (if a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent's) • The state of residence of the person who filed the application if the individual has been abandoned by his parents, does not have a legal guardian, and is institutionalized in that state.42

35

If the individual is emancipated from his parents or married, and can indicate intent, the state of residence is the state where he is living with the intention to live there permanently or indefinitely. Individuals age 21 and over: • For an institutionalized individual who can indicate intent, the state of residence is the state where he is living with the intention to remain there permanently or indefinitely • For an institutionalized individual who became incapable of indicating intent at or after age 21, the state of residence is the state in which the individual is physically present, except when another state makes a placement. (Refer to Section 2406.20.10.05 regarding out-of-state placement.)43

For any institutionalized individual who became incapable of indicating intent before age 21, the state of residence is one of the following: • That of the parent applying for Medicaid on the individual's behalf, if the parent lives in a separate state (if a legal guardian has been appointed and parental rights are terminated, the state of residence of the legal guardian is used instead of the parent) • The parent's state of residence at the time of the individual's placement in the institution (if a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent's) • The current state of residence of the parent who files the application, if the individual is institutionalized in that state (if a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent's); or • The state of residence of the person who files the application, if the individual has been abandoned by his parents, does not have a legal guardian, and is institutionalized in that state.44 The applicant's intent to remain in Indiana must always be determined. If the applicant can indicate intent according to the criteria in Section 2406.20.00, the worker must ask the applicant if he plans to remain in Indiana permanently or indefinitely. An applicant who intends to return to the state of origin whenever a bed becomes available, or one who will return to the other state after a temporary institutionalization, is not to be considered an Indiana resident.

NOTE: Be alert to situations in which the family searched for a bed in the other state before resorting to placement in Indiana and when the applicant is on a waiting list for a facility in the other state. When a person resided in another state prior to placement in an Indiana facility, the worker will need to ask the reason(s) the applicant was placed in Indiana instead of in a facility in the state

36

where the person had resided prior to the placement. In many cases the family member's clear intent may be to move the applicant back to the other state as soon as a bed becomes available. However, it is the applicant's intent that must be determined. If the applicant is incapable of indicating intent, he is considered an Indiana resident unless the other state arranged the placement. Section 2406.20.10.05 explains what constitutes placement by a state.

2406.20.10.05 OUT-OF-STATE PLACEMENT IN AN INSTITUTION The state arranging or making a placement is considered as the individual's state of residence. This includes any agency of the state or entity recognized under state law as being under contract with the state for such purposes.45

Any action beyond providing information to the individual and his family would constitute arranging or making a state placement. The following actions do not constitute state placement: • Providing basic information to individuals about another state's Medicaid program, and information about the availability of health care services and facilities in another state; or • Assisting an individual in locating an institution in another state, provided the individual can indicate intent and independently decides to move. When a state has made a placement of a competent individual and such individual leaves that facility, the individual's state of residence is where he is physically located. When a placement is initiated by a state because the state lacks enough appropriate facilities to provide services to its residents, the state making the placement is the individual's state of residence.

2406.25.00 TEMPORARY ABSENCE FROM INDIANA Residence is retained until abandoned. Temporary absence from Indiana, with subsequent returns to the state or intent to return when the purpose of the absence has been accomplished, does not interrupt continuity of residence. Assistance cannot be discontinued when an individual leaves the state temporarily and no other state recognizes him as a resident for assistance purposes during the absence.46

2406.30.00 PERMANENT ABSENCE FROM INDIANA If the recipient leaves Indiana with the intent of establishing residence in another state, assistance is to be discontinued.

37

2406.35.00 RESIDENCY VERIFICATION Indiana residency must be verified upon initial application and at any point where it becomes questionable. 1 Residency for minor children can be considered verified if their parent/caretaker has verified residency and states the children live with them, again unless the information is questionable. It is appropriate to request verification of when residency is in question due to, for example, returned mail or a data exchange record that shows an out-of-state residence for the member/s. Documentation that provides a name and address, such as the following, may be used to verify residency:

• Driver's license • School records • Other forms of I.D. • Employment records • Church records • Rent/mortgage receipts and/or utility bills • Local postal record • Written statement from a third party.

In the event no written documentation is available, collateral contact such as the following may be used: • Landlord • Neighbor • Utility company • School • Shelter manager • Employer. If the new address for an ongoing member is unknown, the worker should send a request for information to the last known address. If attempts to learn the new address are not successful, the member may be closed with appropriate notice to the last known address; but if they later contact the office the closure should be rescinded if the time when the member’s next annual redetermination (after the residency change) would have been due has not passed.2

Exception: Homeless individuals may self-attest to Indiana residency without hard copy verification. 2410.00.00 AGE Some Medicaid categories have age related requirements. Age may be either a requirement for eligibility, or a requirement for special budget considerations.

38

2410.05.00 DEFINITION OF A CHILD (MED 2, MED 3) To be considered a child for program eligibility purposes, an individual must be under the age of 18 and unmarried, divorced or separated.

For MA O, there are special age requirements associated with this category. Please, refer to 2410.05.05.

2410.05.05 AGE REQUIREMENTS (MED 3) Note: Effective 1/1/23, Former foster care children enrolled in Medicaid (any state) on their 18th birthday will transition to MA 15 (Refer to 1620.74.00 and 2035.30.25).

2410.05.20 CHILD ATTAINS AGE LIMIT (MED 3) When a child attains the age limit on the first day of the month, he is ineligible for that month. When a child attains the age limit on a date other than the first of the month, the child is eligible for the entire month. Ineligibility will begin the first day of the following month.

2410.05.25 VERIFICATION OF AGE (MED 3) Acceptable sources of verification of age include, but are not limited to, the following:

• Birth certificate or health department records • Hospital records • Physician's records • Bureau of Vital Statistics • Baptismal, confirmation, or other church records • Passport • Naturalization papers • Immigration papers • Alien registration card

39

• Court records, including adoption records, in which the child's age has been noted • Records of social agencies (including the Local Office) • Insurance company records • School records.

2410.15.00 AGE REQUIREMENT (MED 1) There is no age requirement for MA B and MA D.

To be eligible for Medicaid under the MA A category, an applicant must be 65 years of age or older.47 An otherwise eligible individual who turns age 65 during a month is eligible for Medicaid under the aged category for that entire month. An applicant must meet the disability or blind requirements in the month preceding the month in which he becomes age 65 to be considered under the blind or disabled category. Refer to Section 2412.25.00.

To be eligible for MEDWorks (MADW and MADI) an individual must be at least 16 years of age but less than 65 years of age.48

2412.00.00 BLINDNESS OR DISABILITY (MED 1) The policy stated in this section only applies to the MA B, MA D, MADW, MADI, and MA R categories of assistance. During the interview, it is important to ask whether each applicant for health coverage is blind and/or disabled and ensure that the response is correctly reflected in the eligibility system. This will enable the blind and or disabled category to be correctly evaluated even if initially the applicant qualifies under another category.

To qualify for assistance as blind or disabled individual, specific medical criteria must be met. These requirements are discussed in the following sections.

2412.05.00 DEFINITION OF BLINDNESS (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance. The visual requirement, which must be met to receive MA under the Blind category, is as follows: • An individual is considered blind if he has central visual acuity of 20/200 or less in the better eye with correction or a field defect in which the peripheral field has contracted to such an

40

extent that the widest diameter of visual field subtends an angular distance of no greater than 20 degrees.49

2412.10.00 VERIFICATION OF THE VISUAL REQUIREMENT (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance. The visual requirement is verified as follows50: • The applicant is receiving Supplemental Security Income (SSI) benefits as a "blind individual", "blind child", or "blind spouse".51 This is verifiable by the State Data Exchange (SDX); or • If the applicant alleges to be receiving SSI based on blindness, but it is not verifiable through the SDX, the applicant can obtain proof of SSI Blind status from the Social Security Administration. This verification must be directly issued by the SSA and must be current within 30 days: or • The Medicaid Medical Review Team reviews visual information submitted by the eligibility worker and determines that the person meets the definition of blindness. When blindness cannot be verified by the SDX or statement from the SSA, the MMRT will decide of blindness. The policy and procedures outlined below are to be followed by eligibility workers.

If both applicant’s eyes are missing, a statement from a medical practitioner is required. This is merely corroborating evidence, not a full examination, and can be a certification from any medical professional treating the applicant including the ocularist who fitted the individual’s prosthetic eyes. This certification can be a current statement or copy of existing medical records in which the fact that the individual’s eyes are missing is noted.

In all other situations, the applicant will be required to have an eye examination by an ophthalmologist or optometrist52 licensed in the State of Indiana.53 The requirement to have an eye examination is applicable even for the applicant who objects to such on religious grounds.54 The report must be based on an examination given not more than six months prior to the date of the eye examiner's report.55 The findings of the eye doctor must be submitted on Form 45, Physician's/ Optometrist's Report on Eye Examination. The caseworker is to send the eye report to the doctor, or the applicant, if able to do so, may take the forms to the doctor on the date of the appointment. The caseworker should follow up to be sure that the doctor received the forms. If the doctor prefers, he may submit a letter containing the same information as the Form 45. The eligibility worker is responsible for carefully reviewing the eye report to ensure that all items are completed, and the form is legible, signed and dated by the doctor. The complete packet of visual information is submitted to the MMRT.

41

2412.15.00 PAYMENT FOR EYE EXAMINATION (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance. The maximum payment for an eye examination necessary to establish initial or continuing eligibility for MA is $29.56 The maximum payment for completion of an eye report based on a previous examination for which the doctor has already been paid is $10.57

Providers should be referred to www.in.gov/Medicaid for procedures to submit claims for payment on Medicaid Blind exams or submission of medical records.

2412.15.05 EYE EXAMINATION REQUIREMENT FOR REAPPLICATIONS (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance. The guidelines enumerated below are to be followed for reapplications: • If receipt of SSI based on blindness is verified as explained in Section 2412.10, the blindness requirement is met. • If the date previously established by the MMRT for a re-examination of eyesight is in the future, or the MMRT waived further eye examinations in its previous determination, the visual requirement is met. • Any future eye examination must be completed for continuing eligibility.58 • If the eligibility worker is aware that the applicant had vision restorative eye surgery since the last eye examination in the case, a current eye report is to be submitted to the MMRT.

2412.15.10 INABILITY TO OBTAIN EYE REPORT (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance.

In no instance is an application to be denied solely because the eye doctor did not return Form 45 to the Local Office if the applicant is still interested in pursuing his application. As it is the joint responsibility of the applicant and the caseworker to make every effort to obtain visual information, caseworkers must monitor a pending application closely for receipt of the visual information in accordance with the following guidelines:

42

• If the visual information is not received within 20 days from the date of application, the caseworker should check the notice history (CNHS) to make sure the "Initial Letter to Blind Applicant" has been sent to the applicant to remind him that determination of eligibility cannot be made without the necessary visual information. CM08 is the code on CNHS for the 20-day initial letter. • If the applicant contacts the local office after receiving the initial letter, the caseworker should advise him to personally contact the doctor. The caseworker should also immediately contact the doctor by letter or telephone. • If the visual information has not been received within 30 days from the date of application, the caseworker should check CNHS to ensure that the "Follow-up Letter to Blind Applicant" has been sent to the applicant. CM09 is the code on CNHS for the 30-day follow-up letter. • If the applicant responds within the time specified in the follow-up letter, the caseworker must: Personally, contact the doctor or, as a last resort, refer the applicant to another eye doctor. If the applicant does not respond to the follow-up letter by the specified date, the application is to be denied.

2412.15.15 DECISION OF MEDICAL REVIEW TEAM (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance.

The MRT will make one of the following decisions regarding the applicant's blindness and enter the decision in the eligibility system: • The applicant meets the definition of blindness and further re-examinations of eyesight are waived. • The applicant meets the definition of blindness, and a re-examination of eyesight is needed at a future specified date. • The applicant does not meet the definition of blindness; or • Additional visual information is required to decide as to whether the applicant meets the definition of blindness. If additional medical information is needed from the eye doctor due to omissions or inconsistencies on the eye report, the MRT will secure the requested information directly from the doctor. If a consultative examination is needed to clarify diagnosis, the MRT will contact the applicant to arrange the examination and obtain the eye report.

As of June 1, 2014, a positive determination of blindness made by MRT is no longer considered effective when the SSA has determined blindness for an individual. If MRT determines a person to be blind and a later determination is made by SSA that agrees with the MRT decision, there is no change regarding the determination of blindness for that individual. If MRT determines a person to be blind and the SSA later determines the person is not blind, the person will no longer

43

be considered blind. The SSA determination supersedes the MRT approval, and the MA B must be terminated. If a SSA denial is received, and the denial is not appealed within 65 days, then the MED 1 category should be closed, and the Medicaid hierarchy must be explored (see IHCPPM 2412.50.00).

2412.15.20 REQUIRED RE-EXAMINATION OF EYESIGHT (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance.

The applicant whose vision might be expected to improve will be required to have a re- examination of eyesight as a condition of continuing MA eligibility. For recipients who initially met the visual requirement because of receiving SSI based on blindness, the caseworker must verify at each redetermination that the recipient continues to receive such benefits. If, for any reason, the recipient's SSI eligibility has been terminated, he must have an eye examination and an eye report must be submitted to the MRT. If the worker questions the continued eligibility of a recipient about the visual requirement, arrangements are to be made for the recipient to have an eye examination. A letter of explanation is to be attached to the eye report and submitted to the MRT.

2412.20.00 TREATMENT FOR RESTORATION OF EYESIGHT (MED 1) The policy stated in this section only applies to the MA B and MA R categories of assistance. A blind recipient is required to cooperate in any treatment plan recommended by the examining ophthalmologist and approved for payment by Medicaid which may fully or partially restore his eyesight.59

A recipient cannot be required to undergo any treatment if good cause for refusing exists. "Good cause" includes, but is not necessarily limited to:

• The treatment is contrary to his religious beliefs • Previous surgery of the same type recommended was unsuccessful; or • The recommended treatment is very risky because of its magnitude or unusual nature.60

44

If the blind person refuses the recommended treatment without good cause, the worker is to report this fact and the reason(s) for his refusal to the MRT. The decision to discontinue MA due to the refusal of recommended treatment will be made by the MRT. This determination cannot be made by the eligibility worker.

2412.25.00 DEFINITION OF DISABILITY (MED 1) To qualify as Disabled under MA D, MADW, or MA R, an individual must be determined disabled according to SSI criteria.61

Disability for adults is defined as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which as lasted or can be expected to last for a continuous period of not less than twelve (12) months.62

If the individual is a child under the age of 18, the individual will be disabled if the child has a medically determinable physical or mental impairment, which results in marked and severe functional limitations, and which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve (12) months. No child who engages in substantial gainful activity may be considered disabled.63 If MRT determines a person to be disabled and a later determination is made by SSA that agrees with the MRT decision, there is no change regarding the determination of disability for that individual.

If MRT determines a person to be disabled and the SSA later determines the person is not disabled, then the SSA determination supersedes the MRT approval, and the MA D will be reviewed for possible termination of MED 1 benefits. If a SSA denial is received, and the denial is not appealed within 65 days (see IHCPPM 2412.50.00), then the MED 1 category should be closed, and the Medicaid hierarchy will be explored (see IHCPPM 2412.50.00). An individual can qualify for the basic category of MEDWorks, MADW, if that person meets the above disability definition except for the fact that he is working. The above definition also applies to MA R. A recipient of MEDWorks in the basic category, MADW, who becomes ineligible in that category due to medical improvement, can qualify in the medically improved category of M.E.D. Works, MADI, if the medical condition has not been resolved, or the person is not completely recovered.64

45

2412.30.00 VERIFICATION OF THE DISABILITY REQUIREMENT (MED 1) The policy stated in this section only applies to the MA D, MADW and MA R categories of assistance. The Disability requirement is verified by any one of the following categories: • The applicant is receiving Supplemental Security Income (SSI) benefits as a "disabled individual", "disabled child", or "disabled spouse." This is verifiable by the State Data Exchange (SDX) • The applicant is receiving Social Security Disability (SSDI) as verified by the SSA BENDEX data exchange and the “onset of disability” date is documented • If the applicant alleges to be receiving Social Security benefits based on disability, but it is not verifiable through the SDX or BENDEX, the applicant can obtain proof of Disability status from the Social Security Administration. This verification must be directly issued by the SSA, must be current within 30 days of receipt by the DFR, and must specify receipt of benefits based on the individual’s disability • The Medicaid Medical Review Team reviews medical evidence and social history information submitted by the eligibility worker and determines that the person meets the definition of disability. Additionally, in the above circumstance of proof of disability status from the SSA, the MMRT will record the disability approval in the system upon receipt of documentation from the eligibility worker.

When disability cannot be verified by the SSA data exchanges or statement from the SSA, the MMRT will decide of disability. The policy and procedures outlined below are to be followed by eligibility workers. In no situation can the individual be considered as “not cooperating” due to failure to obtain documentation from the SSA regarding disability status. This is an available option for the individual and if this verification is not obtained, the eligibility worker must pursue medical information collection as explained in the following sections. An individual who has been determined by the SSA to not be disabled, will not meet the Medicaid definition of disability unless the condition has worsened since the SSA denial, or the individual has had onset of a new condition not considered by the SSA. In this situation, medical information must be submitted to the MMRT for decision.65

2412.30.05 Exceptions when MRT will determine disability SSA will determine disability for Medicaid except in the following circumstances where MRT will determine disability: a. An individual has never applied to the SSA for disability benefits

46

b. An individual has applied to the SSA for disability benefits, but SSA has not yet rendered a decision c. An individual had applied to the SSA and the SSA determination denied disability is more than 12 months old and the individual is currently claiming a change in condition since the SSA denial d. An individual had applied to the SSA and the SSA determination denied disability less than 12 months ago, the individual is currently claiming a change in condition since the SSA denial, and the individual has applied to SSA for reconsideration of its disability decision, but the SSA refused to reconsider

For purposes of c) and d), when the individual has appealed the SSA determination, the date considered to be the SSA determination is the date the SSA made its original determination, not the date of the SSA hearing decision.

Children are eligible to receive most services, including waiver services, under a Hoosier Healthwise category (see IHCPPM 3310.00.00).

2412.30.10 PREPARATION OF MEDICAL PACKET FOR MMRT (MED 1) The policy stated in this section only applies to the MA D, MADW, and MA R categories of assistance.

The medical packet submitted to the MMRT consists of the social history summary obtained from the applicant or representative during the interview and medical evidence obtained from the individual’s medical providers.

Social Summary: The eligibility worker must thoroughly complete the social summary leaving no sections blank. Information includes work history, education, living arrangements, economic status, medical treatment history, SSI/SSDI status and other pertinent information that indicates the extent to which the disability interferes with the applicant's ability to function in his social, family, and economic situation.

If the applicant is a child, the social summary should reflect the developmental and educational achievements (or lack of same) of the child. If the child is not attending school, the eligibility worker should obtain as much information as possible from the parent or representative about the child's development relative to the normal development of a child of his chronological age. If the child is in special education or learning-disabled classes, the social summary must contain information about the reason he is in these classes, the degree of learning delay and what classes/subjects are involved.

47

Treatment history for the previous 12 months must be thoroughly discussed during the interview and recorded on the social summary. If the applicant does not have any medical services to list in the “Treatment History Section”, eligibility workers are to enter “none” in this section. Leaving it blank or entering “N/A” is not sufficient for an MMRT decision. Medical Evidence: A complete 12-month medical history on the individual is needed unless the documented impairment began less than 12 months prior to application. The eligibility worker is to request copies of all medical records from physicians, clinics, and/or hospitals indicated by the applicant as having treated/examined the applicant for his/her documented impairment(s) since the onset of the condition(s) or 12 months prior to the date of application, whichever is longer. Evidence must include medical history, clinical findings, laboratory findings, diagnosis, treatment, and medical assessment.

The applicant, who is not under the care of a physician, is to be examined by a physician licensed to practice medicine in Indiana or another state. The requirement to have a medical examination is applicable even for the applicant or, in the case of a child, the guardian or parent, who objects on religious grounds. For an applicant who has no physical impairment at all, but whose disability is based solely on mental status, an examination is required by a psychiatrist, psychologist, or mental health professional holding HSPP certification. If a current physical examination is needed, the Local Office is to forward the Form 251, Authorization for Physical Examination to Determine Disability for Medical Assistance form to the examining physician:

The applicant, if able to do so, and agrees to do so, may take the forms to the doctor. Caseworkers should follow up to be sure the doctor received the forms.

Failure to receive medical evidence is not an acceptable reason for denial of an application if the disabled person is still interested in obtaining Medicaid coverage. As it is the joint responsibility of the applicant and the caseworker to make every effort to obtain the medical information, caseworkers must monitor a pending application closely for receipt of the medical information in accordance with the following guidelines: • Give the applicant a 30-day deadline to arrange for an examination and inform the eligibility worker of the appointment date, with a follow-up 10-day deadline if the applicant does not respond. • When requesting medical records from a provider, give a 20-day deadline; with another follow-up 20-day deadline if the records are not received after the first letter. Telephone contact should be made to the provider with a 3rd 20-day deadline given if the provider indicates intention to submit the records. • When a provider does not respond to any of the requests for medical records, the eligibility worker is to notify the applicant or authorized representative to contact the provider. A 10-day deadline is to be given for the applicant/representative to contact the worker. This step in the process is not a condition of eligibility being imposed on

48

the applicant to obtain the medical records. It is an attempt to engage the applicant’s help in obtaining the records, with the only requirement being to contact the eligibility worker. • Partial records may be submitted by the local office to the MRT if all attempts to obtain the medical history documentation have not been successful. The providers who did not respond must be listed in the medical packet.

MRT will request Additional Information from providers and the applicant when additional testing or consultative exam is needed to make the determination of disability.

2412.30.15 PAYMENT FOR DISABILITY EXAMINATIONS (MED 1) The policy stated in this section only applies to the MA D, MADW, MADI, and MA R categories of assistance.

The maximum payment for a disability examination, including completion of the report, is $65. The maximum payment for completion of a report based on a previous examination for which the doctor has already been paid is $10. Psychological exams/testing are reimbursed at the rate of $80 per hour.66 Additional payments may be allowed for x-rays, tests, and so forth, which are necessary to confirm the primary diagnosis if approved by the MMRT. Providers should be referred to in.gov/Medicaid for procedures to submit claims for payment on Medicaid disability exams or submission of medical records.

2412.40.00 DISABILITY INFORMATION ON REAPPLICATIONS/CATEGORY CHANGES (MED 1) The policy stated in this section only applies to the MA D, MADW, and MA R categories of assistance.

The guidelines to follow concerning the submission of medical/social information to the MRT for individuals who are reapplying for Medicaid and those whose Medicaid category is changing back to a disability category are outlined below. These guidelines apply when a decision is required by the MRT because the individual’s disability is not verifiable through the SSA data exchanges. A. Medicaid Reapplications

If the most recent SSA or MRT decision for an applicant is disapproval, new medical and social information must be submitted to the MRT, and the conditions in Section 2412.30.05 are

49

applicable. (Note that the applicant may or may not have last received Medicaid under the MA D category.) If an applicant was previously discontinued under MA D, MADW, or MA R, 48 months or more before the date of the reapplication, new medical and social information is required, unless the applicant is still considered disabled according to the SSA. If new medical and social information is required to be sent to MRT, the conditions in Section 2412.30.05 are applicable.

If an applicant last received Medicaid under MA D, MADW, or MA R and was closed for a non- disability related reason 48 months or less prior to the date of the reapplication, new medical information is not required unless a Progress Report as required by the MRT is due. The Progress Report is required by the due date previously established by the MRT, but not sooner. If there is a pending SSA application and an SSA denial is received, and the denial is not appealed within 65 days (see IHCPPM 2412.50.00), then the MED 1 category should be closed, and the Medicaid hierarchy must be explored (see IHCPPM 2412.50.00). Additionally, if an improvement in the applicant’s condition is noted, a Progress Report should be submitted immediately; however, if the MRT had not previously required a Progress Report, Medicaid is to be approved if all other requirements are met pending the MRT's decision on the Progress Report. A Progress Report will be considered inapplicable if the person is still considered disabled according to the SSA. If new medical and social information is required to be sent to MRT, the conditions in Section 2412.30.05 are applicable.

If the disability approval was made by an Administrative Law Judge, Agency Review, or court decision in reversing an MRT decision, the above requirements regarding the time frames are applicable to that decision.

B. Category Change to MA D, MADW, or MA R If 48 months or less have elapsed since the date that the recipient last received Medicaid under MA D, MADW, or MA R, new medical information is not required unless a Progress Report as required by the MRT is due. The Progress Report is required by the due date previously established by MRT, but not sooner. The Progress Report will not be required if the person is considered disabled according to the SSA. If the Progress Report is required, Section 2412.30.05 is applicable.

If more than 48 months have elapsed since the date that the recipient last received Medicaid under MA D, MADW, or MA R, new medical and social information is required unless the individual is considered disabled according to the SSA. If new medical and social information is required, Section 2412.30.05 is applicable. The above requirements include changes back and forth between QMB/SLMB-also coverage and QMB/SLMB-only coverage. For example: John receives full coverage Medicaid as a QMB-also (MA D and MA L). Effective 6/1, MA D is closed due to excess resources and MA L remains open,

50

so his coverage is reduced to QMB-only. In December, John notifies the DFR that his resources have been depleted and he wants reconsideration for full coverage Medicaid. Because his MA D was closed for a non-disability reason less than 48 months ago, new medical information is not required unless the SSA no longer considers John to be disabled and he is not claiming a change in condition since that SSA determination.

2412.45.00 DECISION OF MEDICAL REVIEW TEAM (MED 1) The policy stated in this section applies to the MA D, MADW, and MA R categories of assistance. The Medicaid Medical Review Team, which is comprised of physicians, nurses and consultants, will review the medical evidence and the social information and make one of the following decisions:

• The applicant meets the disability requirement; a progress report is not required. • The applicant meets the disability requirement; a progress report is required by a date specified by the MMRT. • The applicant does not meet the disability requirement. Whenever necessary, the MRT will request Additional Information from medical providers and the applicant to decide as to whether the applicant meets the disability requirement. The MMRT decision and reason for a denial when applicable, is transmitted to the eligibility system. The MMRT will issue a detailed explanation for a denial to the applicant and a copy will transmit to the applicant’s electronic eligibility file. This letter along with the eligibility decision notice that contains appeal rights should be used in the appeals process.

As of June 1, 2014, a positive determination of disability made by MRT is no longer considered effective when the SSA has determined disability for an individual. If MRT determines a person to be disabled and a later determination is made by SSA that agrees with the MRT decision, there is no change regarding the determination of disability for that individual. If MRT determines a person to be disabled and the SSA later determines the person is not disabled, then the SSA determination supersedes the MRT approval. If a SSA denial is received, and the denial is not appealed within 65 days (see IHCPPM 2412.50.00), then the MED 1 category should be closed, and the Medicaid hierarchy must be explored (see IHCPPM 2412.50.00).

2412.50.00 PROGRESS REPORTS AND ONGOING ELIGIBILITY (MED 1) The policy stated in this section only applies to the MA D, MADW, MADI, and MA R categories of assistance.

51

When a Progress Report is required by the MRT or an ALJ, or when it is learned that the individual’s disabling condition has improved, the caseworker must conduct an interview with the recipient, complete a new social summary, and obtain medical information following the same guidelines listed in Section 2412.30.05. For members that are currently open in MADW, the MRT will determine if they are to remain eligible in that category or if they should transition to the medically improved category MADI. However, this would depend on whether they have medically recovered to the point at which the disability definition is no longer met. If the recipient remains eligible, another Progress Report may be required.

For an ongoing MA D, MADW, MADI, and MA R members, when the DFR is notified that SSA benefits have terminated due to loss of disability status, either by the SSA data exchanges or direct documentation, member’s must be sent a 2032 to verify that a timely appeal with SSA has been filed. Per SSA guidelines, members have 65 days in which to appeal the denial. A pending verification form must be sent with a deadline date of the 65th day from the date the 2032 sent. Continued benefits must be verified by the SSA data exchange or by direct documentation issued to the beneficiary by the SSA. If SSA benefits based on disability continue due to a timely appeal, the Medicaid disability requirement continues to be met until the SSA rules on the appeal that the person is no longer disabled. In this situation, a new progress report is not needed.

Pending applicants for Medicaid under a disability category that receive an SSA denial are not eligible for the 65-day continuation period. Workers do not need to request verification of an appeal with SSA prior to taking action. The MRT process can continue and if eligible the disability category can be approved, pending outcome of the SSA appeal.

When ongoing members are determined disabled by MRT and are approved for MA D, then subsequently denied disability benefits by the SSA because the SSA determined the person to not be disabled, members shall remain eligible in MA D for a minimum of 65 days from the date the SSA was denied. If the member appeals the determination with the SSA within the 65-day period from the SSA denial, they shall remain eligible for MA D while the SSA appeal is being processed. This can be verified either by electronic verification or hard copy issued to the beneficiary by the SSA. While the actual period to appeal is 60 days, The Social Security Administration allows an additional 5 days for the mailing of the decision notice which, in effect, increased the overall number of days disability applicants have to get their appeal to their local Social Security offices to 65 days.

Once a final determination regarding disability is made by the SSA, the decision is considered binding whether the appeal upholds the original SSA denial or is fully favorable to the member. If the SSA appeal decision finds that the individual is not disabled, the individual cannot be

52

considered disabled for Medicaid purposes and will be explored for other categories of Medicaid assistance. If an individual does not appeal the SSA determination within 65 days from the date the SSA denial, the determination of disability made by the SSA is binding, and the individual will not be considered disabled for purposes of Medicaid eligibility. Medicaid under a disability category is to be discontinued with timely notice when a final determination decision is made by the SSA. Prior to any such discontinuance, consideration of eligibility in one of the other Medicaid categories must be pursued.

2412.55.00 TREATMENT FOR RESTORATION OF PHYSICAL/MENTAL HEALTH (MED 1) The policy stated in this section applies to the MA D, MADW, MADI, and MA R categories of assistance.

A disabled recipient is required to cooperate in any treatment plan recommended by the examining physician and approved for payment by Medicaid, which may fully or partially restore his physical or mental health.67 A recipient cannot be required to undergo any treatment if good cause for refusing exists. "Good cause" includes, but is not necessarily limited to: • The treatment is contrary to his religious beliefs • Previous surgery of the same type recommended was unsuccessful • The recommended treatment is very risky because of its magnitude or unusual nature; or • Amputation of a major limb is involved.68

If the recipient refuses the recommended treatment without good cause, the caseworker is to report this fact and the reason(s) for his refusal to the Medical Review Team, Office of Medicaid Policy and Planning.

The decision to discontinue MA due to the refusal of recommended treatment will be made by the MRT.

2414.00.00 SSI STATUS

53

In some situations, an individual's benefit status with the Supplemental Security Income (SSI) program influences his non-financial eligibility. The following sections discuss these situations. Effective June 1, 2014, SSI recipients are deemed eligible for Medicaid coverage in Indiana. SSI recipients will be eligible under the MASI category. The following sections cover special groups of former SSI recipients that are considered eligible for Medicaid.

2414.10.00 SSI 1619 STATUS Section 1619 of the Social Security Act provides an incentive to the blind or disabled SSI recipient to continue work when his earned income reaches levels that would otherwise jeopardize eligibility. Individuals in 1619(a) status receive reduced SSI benefits, while individuals in 1619(b) status receive no SSI benefits.

A recipient's 1619-SSI status is verified through data exchange. The eligibility system automatically updates an individual's SSI status on the Disability Details page and notifies the worker of the update through a task. Blind or disabled SSI recipients who are in SSI 1619(a) or 1619(b) status are eligible for continued Medicaid coverage if they were on Medicaid in the month immediately preceding the month in which an individual's 1619 status last began. The only non-financial requirement that must be met is state residency. If 1619 status is subsequently lost because the individual is no longer considered disabled, a progress report must be submitted immediately to the MRT to see if the individual qualifies for MEDWorks. If a re-examination of eyesight is required for a blind recipient in 1619 status, notification to the MRT is unnecessary. However, an eye report is required immediately upon termination of 1619 status.

Refer to Section 3475.00.00 for additional information about Medicaid eligibility for persons in 1619 status.

2414.10.10 DISABLED ADULT CHILDREN A Disabled Adult Child (DAC, sometimes known as CDB’s or childhood disability beneficiaries) is an individual who meets the following criteria: • Over the age of 18; and

54

• Determined, even if retroactively, by the Social Security Administration (SSA) to have had an onset of disability prior to age 22; and • Based on that disability, received Supplemental Social Security (SSI) as a child or would have been eligible to do so. Furthermore, these individuals subsequently: • Become eligible for new or increased payment of Retirement, Survivors, and Disability Insurance (RSDI) • The new payment occurs during a month when also eligible for SSI • The total compensation from RSDI is more than the SSI benefit the individual would otherwise receive • Therefore, SSI payments are reduced to $0 and the larger RDSI payment becomes the new monthly benefit amount. These applicants/recipients must be treated as SSI recipients for Medicaid purposes and must not be denied/closed for being in DAC status. DAC status can be identified by a Social Security Claim Number (CAN) which is different than the individual’s own SSN and ends in the Beneficiary Identification Code (BIC) “C.” The member will also have a disability date which was prior to the 22nd birthday, and the Medicaid Eligibility Code received from SSA will indicate referral to the state for Medicaid determination due to entitlement or increase in DAC benefits.

The disability determination remains valid, and income will not count in the Medicaid budget, so long as DAC status remains active. For DAC members residing in the community, and not in an institution or on a HCBS waiver, the entire RSDI amount should be entered as SSI income to ensure that it is disregarded for MED 1 but will be budgeted/excluded correctly for other assistance groups and programs which have different budgeting rules for SSI income and/or DAC status. The modification of unearned income for the DAC needs to be clearly documented in the eligibility system’s note section. These members are not opened automatically into MASI coverage and should not be placed into the MASI category due to resource requirements and the need for an annual redetermination to verify eligibility factors including continuing DAC status. They must apply if not an ongoing recipient of Indiana Medicaid, and applicants/recipients must verify all eligibility factors including resources.

Individuals with DAC status are not eligible for MAGI processing47 and must receive coverage in another MED 1 category. Receipt of Medicare does not disqualify the DAC from these special provisions, and they are potentially eligible under MED 4 as well.

55

If a DAC member is in a nursing home or is on an approved HCBS waiver, then the post-eligibility budget will form and the SIL budget applies (see IHCPPM 3455.14.00 and 3010.20.15). 69 70 To get the SIL budget to form correctly, the worker should take the entire RSDI amount, subtract the SSI maximum allotment (see example below) and enter that amount on the Unearned Income-Details page in the eligibility system. The remaining amount would then be entered as SSD income. The budget would correctly reflect the liability.

2414.10.15 PICKLE RULE This rule is named after former U.S. Representative James Pickle. Individuals who would continue to receive SSI but for an increase in their in other benefits from the SSA due to the annual cost-of-living-adjustment (COLA) increases are considered eligible for Medicaid. This only applies to those that would continue receiving SSI, not SSDI payments.

2414.10.20 DISABLED WIDOWS OR WIDOWERS When an SSI recipient who is at least 60 through 64 years of age, is a widow or widower, and loses SSI benefits solely due to receipt of other new or increased benefits from Social Security, and the individual is not entitled to Medicare Part A, the person is automatically eligible for Medicaid.71 The person’s countable income from Social Security should be reduced to the applicable SSI benefit amount.

When an SSI recipient who is at least 50 through 59 years of age, is a widow or widower, and loses SSI benefits solely due to receipt of other new or increased benefits from Social Security, and the individual is not entitled to Medicare Part A, the person’s countable income from Social Security should be reduced to the applicable SSI benefit amount. Individuals who have been receiving the special income disregard under Darling v. Bowen in IHCPPM 3455.05.05.25 are entitled to Medicaid eligibility as long as they have been continuously entitled and maintained entitlement to widow’s or widower’s disability benefits from Social Security.72 DAC member is receiving $2000 a month. In 2017, the SSI allotment is $735. In the Eligibility System, enter SSI income of $735, and the remaining amount of $1265 as SSD (total amount of $2000 - $735 = $1265).

56

2415.00.00 CATEGORICAL ELIGIBILITY FOR MEDICAID WAIVERS To be eligible under a Medicaid Home and Community-Based Services waiver, an individual must qualify under one of the specific aid categories that are approved for the waiver. Workers must ensure that waiver applicant/recipients are considered for Medicaid in the proper category. Verification of the specific waiver for which an individual is either applying or already approved, must be obtained from the waiver case manager. Please, refer to IHCPPM 3310.00.00 for permissible categories to receive HCBS waivers. There are various special eligibility provisions that are applicable in certain categories and under certain waivers as explained in Chapters 3300 and 3400.

2416.00.00 MEDICARE STATUS (MED 4)

Individuals whose status with the federal Medicare program meets certain requirements, and who also meet other eligibility requirements, can qualify for limited Medicaid coverage under a Medicare Savings Program (MSP, also known as Buy-In). The following four sections specify the categories under which this is possible.

If a member that is 65+ is eligible for Medicare, they are required to contact SSA and apply, including Part D (prescription coverage). If they fail to do so, Medicaid will not pay for Part D-eligible prescription drugs. Members should be directed to SSA.gov.

• If a member has Part B but no Part A, the worker should add Part A to the eligibility system with the same start date as the B. This will form the buy in category and pay for Part A (if not free to the member) if they qualify for one of the Medicare Savings Programs that pays for Part A premiums (as described in the following sections). Regardless of which Medicare Savings Program/Buy-In category the person may qualify for, these categories will not form if only Part B is added.

• If a member has Part A but no Part B, the worker should add Part B to the eligibility system with the same start date as the A. This will form the buy in category and pay for Part B.

2416.05.00 QUALIFIED MEDICARE BENEFICIARY (MED 4) The policy in this section applies to the MA L category of assistance. To be eligible as a Qualified Medicare Beneficiary (QMB) an individual must be entitled to Medicare Part A. An individual meets this requirement if he is enrolled in Medicare Part A or is eligible for enrollment if a monthly Part A premium is paid. Medicare Part A enrollment can be verified by viewing the Medicare card, a TPQY, or by correspondence from the SSA. If there is no Medicare Part A enrollment, those who are eligible for Medicare Part A with a monthly premium

57

can be identified as follows:

• Usually have only SSI income • Are age 65 or over; and • Have a HIB number ending in M, J3, J4, K3, or K4, and sometimes T. Also refer to Page VII-2 of the Medicaid Enrollment Manual Buy-In Section. No other verification of age is required, nor does the disability requirement applicable to the Medical Assistance for the Disabled category apply to individuals eligible as QMB only.

A QMB must also satisfy the citizenship, residency, SSN, and medical assignment requirements explained in the respective sections of this chapter. Refer to Section 3010.35.05 for QMB income standards and Section 3005.25.00 for QMB resource standards. QMB coverage is limited to payment of the following:73 • The monthly premium for Medicare Part B • The monthly premium for Premium Hospital Insurance under Medicare Part A, for individuals not entitled to free Part A o These premiums are required of certain persons entitled to hospital insurance benefits only by voluntary enrollment in the premium paying Part A program) • Medicare Part A and B deductibles and co-insurance. An individual can be simultaneously eligible under another full coverage category and QMB • Co-payments for Medicare Part C (Medicare Advantage plans).74 (Refer to Section 3465.05.00)

2416.10.00 QUALIFIED DISABLED AND WORKING INDIVIDUALS (MED 4) The policy in this section applies to the MA G category of assistance.

Disabled and working individuals who lost or will lose Medicare coverage because of their working status, are entitled to enroll in Medicare Part A under the provisions of the Omnibus Budget Reconciliation Act of 1989 (OBRA-89). If they also meet certain other eligibility requirements, they are eligible for the category of assistance entitled Qualified Disabled and Working Individuals (QDW).75

QDW coverage is limited to payment of the monthly premium for Medicare Part A only. These individuals may also enroll in Medicare Part B (if they are enrolled in Part A), but they will always be responsible for paying the Part B premium themselves. The individuals who contact the DFR and wish to apply for the QDW category of assistance should be asked to provide a notice from SSA informing them that they will lose their Medicare because of their working status. The affected Medicare beneficiary will receive such a notice in

58

each of the three months prior to discontinuance of Medicare. An individual whose Medicare was previously terminated should provide a notice he has received from SSA, or some other evidence from SSA, that his Medicare was terminated because he was working. A QDW must also satisfy the citizenship, residency, SSN, and medical assignment requirements explained in the respective sections of this chapter.

Refer to Section 3010.35.15 for QDW income standards and Section 3005.25.00 for QDW resource standards. An applicant/recipient is not eligible for QDW if he is otherwise eligible for Medicaid.76

2416.15.00 SPECIFIED LOW INCOME MEDICARE BENEFICIARY (MED 4) The policy in this section applies to the MA J category of assistance. Persons who are entitled to Medicare Part A may qualify under the Specified Low Income Medicare Beneficiary (SLMB) category. The eligibility requirements are the same as those for QMB (refer to Section 2416.05.00) except the income standards are higher. (Refer to Section 3010.35.10 for SLMB income standards.) Coverage is limited to payment of the Medicare Part B premium.77

An individual can be simultaneously eligible for SLMB and a full coverage category or can be eligible as "SLMB-only". A recipient entitled as "SLMB-only" will not receive a Medicaid ID card. If the individual's countable income exceeds the QMB standard, eligibility for SLMB will be determined. (Refer to Section 3005.25.00 for SLMB resource standards.)

2416.20.00 QUALIFIED INDIVIDUALS (MED 4) The policy in this section applies to the MA I category of assistance.

Persons who are entitled to Medicare Part A may qualify under the Qualified Individuals category of assistance, QI. An individual eligible under any other Medicaid category cannot be eligible as a QI. The QI category is designated as MA I in the eligibility system. The non-financial, income, and resource eligibility criteria are the same as for QMB except that the individual's income for the appropriate family size must be between 120% and 135% of the Federal Poverty Level. (Refer to Section 3010.35.20 for QI income standards and 3005.25.00 for QI resource standards.) QI coverage is limited to payment of the Part B Medicare premium.78

Qualified Individuals will not receive a Medicaid ID card.

59

2418.00.00 HOUSEHOLD TAX RELATIONSHIPS (MED 3)

Applicants or recipients whose eligibility is reviewed must attest whether they have filed or expect to file taxes or whether they have been claimed or expect to be claimed as a tax dependent in the year eligibility is being determined or re-determined. The household tax relationship is required for all newborns. If household tax filing status is unavailable or questionable, member contact should be made initiated, and documentation should be requested. When tax dependency cannot be reasonably established the answer should default to “no” unless otherwise indicated. Newborn tax dependency that cannot be “reasonably established “should default to “no” or correspond to siblings’ tax relationship included in the case. Certain individuals regardless of their tax attestation are required to file taxes based on their gross income, filing status, age, and tax dependency. These MAGI tax households should be entered in eligibility system according to IRS threshold.79 A person’s tax filing status will determine the AG formation for that individual. Please, refer to IHCPPM 3200 for specific policy for MAGI categories.80

When the category being determined is non-MAGI, the tax filing status of an applicant or recipient is not required to determine eligibility.

Note: Filing taxes is not an eligibility requirement for Medicaid or CHIP.81No case should be denied or closed for not verifying tax relationship. When tax dependency cannot be reasonably established, the inclusion of such individual in the household is determined in accordance with the non-filer tax rule, however the “required to file” question must be based on the IRS threshold.82

2420.00.00 RESIDENCE IN THE HOME OF A SPECIFIED RELATIVE (MED 3) The following policy is limited to MAGF, MASB/MASP (Low-Income Parent/Caretaker, or LIPC), and TMA HIP. For more information on TMA HIP and MA F, please, refer to IHCPPM 3800. For MAGF, MASB/MASP (LIPC), and TMA HIP relationship or assistance group determination refer to IHCPPM 3205.05.00 through 3205.20.00. LIPC status does not rely on any certain tax- filing status but is based on relationship and residency requirements which mirror Temporary Aid for Needy Families (TANF) rules.

To be considered LIPC for the categories listed here, the MAGF, MASB/MASP (LIPC), or TMA HIP applicant/recipient must be living together with (see IHCPPM 2420.10.05) and serving as the caretaker of a minor child with whom they share a specified degree of relationship. The individual with whom the person resides must be the parent (adoptive or biological) or step- parent of the minor child; or the child must be related to the applicant/recipient as specified in either of the following groups:

60

• Any blood relative within the fifth degree of relationship, including, but not limited to, those of half-blood, including first cousins, first cousins once removed, nephews, nieces, uncles, aunts, and individuals of preceding generations as denoted by prefixes of grand, great, great-great, or great-great-great • Legal spouses of any individuals named above, even though the marriage was terminated by death or divorce. A guardian may be considered a Low-Income Parent/Caretaker only when such person is a relative listed above and the child lives with that person. Once the youngest child who meets these criteria turns 18 years old, LIPC status for the parent/caretaker ends.

2420.05.05 Verification of Relationship (MED 3) The following policy is limited to MAGF, MASB/MASP (Low-Income Parent/Caretaker or LIPC) and TMA HIP and should be used when determining whether a parent/guardian can be treated as LIPC in the eligibility determination. It is the responsibility of the applicant/recipient to assist the worker to verify the degree of relationship between an applicant/recipient and a specified relative.

The relationship of a child to a relative listed in the previous section, except for an alleged father, is verified when the caseworker either: • Sees the child's birth certificate; or • Obtains verification from two of the sources listed below, when the birth certificate is not seen: o Hospital records established at the time of birth (including a hospital issued birth certificate). o Physician's records. o Marriage records. o Court records, including adoption records. o Social Security Administration records. o Church documents, such as baptismal certificates. o Passport. o Immigration records. o Naturalization records. o School records. o Records of social agencies (including the Local Office); or o Signed statement from an unrelated reliable person having specific knowledge about the relationship of the child to the specified relative o I-94 records with spouse/child designations (For refugee or other eligible non-citizen immigration status applicants, the I-94 will suffice as suitable documentation of

61

familial relationship if there is no birth certificate or related documentation available. The following policy is limited to MAGF, MASB/MASP (Low-Income Parent/Caretaker or LIPC) and TMA HIP and should be used when determining whether a parent/guardian can be treated as LIPC in the eligibility determination. It is the responsibility of the applicant/recipient to assist the worker to verify the degree of relationship between an applicant/recipient and a specified relative.

The relationship of a child to a relative listed in the previous section, except for an alleged father, is verified when the caseworker either:

• Sees the child's birth certificate; or • Obtains verification from two of the sources listed below, when the birth certificate is not seen: o Hospital records established at the time of birth (including a hospital issued birth certificate). o Physician's records. o Marriage records. o Court records, including adoption records. o Social Security Administration records. o Church documents, such as baptismal certificates. o Passport. o Immigration records. o Naturalization records. o School records. o Records of social agencies (including the Local Office); or o Signed statement from an unrelated reliable person having specific knowledge about the relationship of the child to the specified relative

2420.10.05 VERIFICATION OF LIVING WITH (MED 3) The "living with" requirement may be satisfied by the applicant's/recipient's statement unless discrepant information exists.

If there is a question whether the child is living with his relative, verification may be obtained from other sources based on the individual situation. Such sources include, but are not limited to: • Seeing the child in the home • School records • Childcare provider's records

62

• Landlord's statement • Hospital, clinic, or physician's records • Social Security or other benefit records • Church records • Court support order • Child welfare records; and • Signed statement from a reliable individual having personal knowledge of the child living with the specified relative.

2420.15.00 TEMPORARY ABSENCE FROM THE HOME (MED 3) When MAGI rules apply for all MED 3 categories, absence of the recipient child or parent/caretaker relative from the home for limited periods of time does not affect eligibility, provided that the absent member intends to return to the home.83

2422.00.00 INSTITUTIONAL STATUS An institution, as defined by federal regulation, is an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.84

2422.10.00 RESIDENTS OF INSTITUTIONS The Medicaid eligibility of an individual who resides in an institution is governed by the type of institution, in addition to the other eligibility factors. A public institution is an institution that is the responsibility of a municipal, county, state, or federal governmental unit, or over which such a governmental unit exercises administrative control. Individuals who are serving time for a criminal offense and incarcerated in public correctional institutions such as jails, prisons, and detention facilities including those for juveniles, are not eligible for Medicaid/Hoosier Healthwise. 85These individuals are defined as “inmates of public institutions”. An individual on parole, or sentenced to home detention except during those times when reporting to a prison for an overnight stay, individuals living voluntarily in a detention center, jail, or county penal facility after their case has been adjudicated and other living arrangements are being made for them (such as a transfer to a community residence) and infants who are permitted to stay in a correctional facility with their inmate mothers are examples of persons who can be eligible for Medicaid if they meet all of the other program requirements.

63

The following individuals are not eligible for Medicaid: • Individuals (including juveniles) who are being held involuntarily in detention centers awaiting trial • Inmates involuntarily residing at a wilderness camp under governmental control • Inmates involuntarily residing in half-way houses under governmental control • Inmates receiving care as an outpatient • Inmates receiving care on premises of a prison, jail, detention center, or other penal setting • Individuals involuntarily living in state or local corrections-related supervised community residential facilities (operated by a governmental entity or a private entity, i.e.: work release facilities).

If the individual does not have freedom of movement and association while residing at the facility, then the individual does not qualify for Medicaid. Freedom of movement includes the ability for residents to use community resources (such as libraries, grocery stores, recreation, education, and so on) at will. These individuals can leave in the morning from these facilities and are just required to return by a specific time in the evenings. The ability to move at will means the residents are able to go about the community with freedom of movement but still abide by the facilities’ house rules.

Structured movement means the residents are only allowed to leave the work release facility for work, court appearances or court ordered programs. These individuals are not able to be in the community at will and are held to a strict time schedule and are also subject to being monitored by program staff while out in the community. Individuals may be eligible for Medicaid while residing in the types of institutions listed below, public, and private, if they are not inmates as described in the above paragraphs. (Special eligibility considerations for persons in psychiatric facilities are explained in Section 2422.10.05.) • Nursing facilities providing skilled and/or intermediate levels of care • Acute care hospitals • Intermediate Care Facilities for the Mentally Handicapped/Developmentally Disabled (ICF/IID or CRF/DD) • Public institutions designed to serve no more than 16 persons and which provide services beyond food and shelter, such as social services, help with personal living activities, or training in socialization and life skills 86 • Public educational or vocational training institutions such as Indiana Schools for the Blind and Deaf and Silvercrest Developmental Center

64

• Medicaid certified state institutions, or portions thereof, under the direction of the Indiana Family and Social Services Administration, Division of Mental Health (note section 2422.10.05) • Public residential care institutions such as county homes • Any other type of privately owned group living arrangement such as a foster home or group home • Former inmates with freedom of movement, (i.e.: halfway house, work release, etc.) even if there is a curfew in effect, are prohibited from certain locations and sleep in a lock down facility. These residents still have the freedom of movement during the day hours and would qualify for Medicaid. • Home detention or electronic monitoring in a private home • Out of State TBI facilities which are Medicaid certified (note section 2406.20.10.05).

2422.10.05 RESIDENTS OF PSYCHIATRIC FACILITIES Residents of psychiatric facilities (public or private) may be eligible for Medicaid under the conditions specified below.

A psychiatric facility, or institution for mental diseases (IMD) as referred to in federal regulations, is defined as a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care to persons with mental diseases, including medical care, nursing care, and related services.87 Individuals residing in an IMD, as defined above, can be eligible for MA, if they are: • Age 65 or older; or • Under age 21 Eligibility for MA does not automatically mean that claims for inpatient psychiatric hospital and psychiatric residential treatment facility services will be reimbursed. These claims are subject to prior authorization requirements. Refer to section 2422.10.10.

Additionally, if a recipient is receiving approved inpatient services prior to age 21, coverage continues until services are no longer required or the recipient reaches age 22, whichever comes first.88

2422.10.10 Certification of Need/Inpatient Psychiatric Care For individuals under the age of 21 or aged 65 and older to be eligible for Medicaid reimbursement of inpatient psychiatric hospital and psychiatric residential treatment facility services, an approved prior authorization (PA) , is required. The PA contractor determines whether a PA request is approved, based on medical necessity and administrative criteria.

65

The facility is responsible for the completion and submission of the prior authorization request to the appropriate reviewing authority. State facilities submit the PA request to the IHCP office; privately owned facilities submit the PA request to the appropriate prior authorization contractor based on the program assignment of the member. If a prior authorization request is disapproved for inpatient psychiatric hospital and psychiatric residential treatment facility services individuals described in 2422.10.05 may still be eligible for all other Medicaid services, while residing in the psychiatric facility, provided that all other financial and non-financial eligibility criteria are met.

2422.10.15 PERSONS AGED 65 AND OLDER/INPATIENT PSYCHIATRIC CARE For applicants/recipients aged sixty-five and older who are admitted to Medicaid certified psychiatric facilities, the procedures explained above are applicable except that a disapproved Form 1261A does not render the person ineligible for Medicaid. Disapproval indicated on screen Living Arrangement/Domicile-Details page means that Medicaid will not provide reimbursement to the facility for inpatient psychiatric services. If the recipient remains in the facility, community budgeting is to be used. Refer to Section 2422.10.10.

2424.00.00 LEVEL OF CARE/PREADMISSION SCREENING A Medicaid applicant/recipient who enters a nursing facility, Intermediate Care Facilities for the Mentally Retarded (ICF/IID), or Community Residential/Developmentally Disabled (CRF/DD) must first undergo preadmission screening to determine whether the individual requires the level of care provided by a nursing facility or is entitled to reimbursement on his behalf in an ICF/IID or CRF/DD. When completing Facility-Details Page, the caseworker will assume preadmission screening/level of care is approved unless there is information to the contrary. The preadmission screening field should be completed by entering "S" - screened, followed by the date that the individual entered the nursing facility. (The date that the preadmission screening was completed may be used if it is known.) The caseworker may then proceed with the eligibility determination, including authorization if the individual passes eligibility.

If preadmission screening and/or level of care is denied for the individual, the DFR will receive a Form 450B, Physician's Certification for Long Term Care Services, which indicates a denial. The worker should monitor the Forms 450B that are received by the DFR. When a denial is received, the worker should change the preadmission screening field on –Facility-Details Page. The

66

individual's eligibility will then be redetermined by eligibility system without the post-eligibility budget.

2426.00.00 PREGNANCY (MED 3) Within the MED 3 category, the policy stated in this section applies only to MAMA and MAGP (For definition, see Section 1620.50.00). To qualify for assistance under these categories, the pregnant woman must self-attest that she is pregnant.58 These categories are calculated with MAGI methodology and a woman must be found income eligible in the month of application to be eligible for retro and ongoing coverage.59

Pregnant women may receive assistance under other categories of assistance, if otherwise eligible, per the rule of first category (i.e., MASI, MA D, MADW, MADI). Once determined eligible, a pregnant woman’s coverage is maintained throughout the pregnancy (without regard to changes in income) and until the end of the 12-month postpartum period.

2428.00.00 NEWBORN STATUS (MED)

The policy stated in this section only applies to a child born to a woman who is eligible and enrolled in any MA category (except MA10) on the date of birth, even if retroactively found eligible. The infant is eligible for 12 continuous months of coverage in the aid category MA X if the child continues to live in Indiana. This policy also includes infants born to mothers who are eligible for emergency Medicaid services only. An application is not required, and the only eligibility factor considered at the time of the birth is that the infant's birth mother was eligible for Medicaid. The infant will automatically be eligible for 12 months of continuous coverage which can only be interrupted due to loss of Indiana residency, voluntary withdrawal from the caretaker/parent (See 2250.00.00 for written/verbal voluntary withdrawal policies), or death of the child.

Refer to Section 2225.10.00 for case processing information and Information about adding a newborn to the case. The newborn must be enrolled in Medicaid without delay.

67

If the mother is determined eligible for Medicaid/Hoosier Healthwise for the month of the child's birth, the child is eligible in the Newborn category even when the mother applies for Medicaid after the child is born. If the child is born during a month of the mother's retroactive coverage and she is eligible for that month, the baby eligible for the Newborn category. Coverage in the Newborn category continues for the 12-month period if the child goes to live with someone other than the birth mother, including adoption when the child leaves the hospital and goes directly to live with the adoptive parent(s). However, if the identity and location of the adoptive parent(s) are not known, or the child is adopted by parents living out of state, benefits under the Newborn category are provided for the birth month through discharge and removed the subsequent month. If the infant has not been named, the name assigned to the child by the hospital for identification purposes may be used. If the child is adopted by parents living out of state, newborn coverage in Indiana is approved for the birth month only.

2432.00.00 RESERVED

2432.05.00 REQUIREMENTS FOR REFUGEES (MED 2) A refugee's eligibility for MA is first considered for all categories of assistance other than Refugee Medical Assistance. 54 The eligibility system automatically determines a refugee's eligibility in this manner to comply with federal regulations. (Refer to Section 1620.05.00.) Newly arrived refugees will not be placed into HIP 2.0 since this category does not provide immediate coverage at the level which they require. Because these individuals and families arrive in the country with the increased need for additional screenings and services, the conditional period would be a hardship for them and could delay the effective date of their coverage for up to 60 days.

Whenever possible refugees will be placed in another Medicaid category with no conditional period, so that Medicaid will be effective, beginning three months retroactive to the month of application or as of the date they first arrived in the country, whichever is later. Low-income parent/caretaker refugees who qualify financially will be covered under MAGF in the fee-for-service delivery model for up to twelve months after arriving in the country. Low- income parent/caretaker refugees arriving in the country on or after 5/5/25 and who meet all other eligibility requirements will be covered up to 4 months.89 Members who do not qualify for any other Medicaid but pass eligibility for MA Q (Refugee Medical Assistance (RMA) up to 12 months in the U.S prior to 5/5/25 and up to 4 months in the U.S on or after 5/5/25) will be covered in that category so that they may get coverage on the day that they apply.

68

Only members who do not initially qualify for any other Medicaid, but also fail financial eligibility for MA Q, (Refugee Medical Assistance (RMA) up to 12 months in the U.S prior to 5/5/25 and 4 months on or after 5/5/25) will be allowed to be authorized conditionally in a HIP 2.0 category. Because this will only be applicable for members who are over the low-income parent/caretaker income standard, they will receive Regular coverage unless Medical Frailty is confirmed. This will not offer them services, for the most part, on the day they apply; but will provide them with some coverage as soon as the initial POWER Account payment is made.

In addition, the worker must refer refugees who are 65 years of age or older, or who are blind or disabled, to the SSA to apply for assistance under the SSI program. Cash Assistance is to be furnished to eligible refugees until eligibility under the SSI program is determined. Note: Eligibility is based on Income and resources on the date of application date, however applicants/members must comply with all eligibility requirements and provide requested verifications for self and/or family to be determined eligible for Medicaid and/or RMA.90

2433.00.00 HEALTH INSURANCE COVERAGE CONSIDERATIONS (MA 10) There are certain limitations to eligibility under Hoosier Healthwise Package C relative to the coverage or possible coverage of the children under other insurance 91 as follows: Access to the State of Indiana Health Insurance Plan: • Children whose parents, caretakers or spouses can cover them under the State of Indiana's health coverage plans offered to State employees are not eligible for MA 10. This prohibition applies even if the State employee has chosen not to cover the child, and regardless of whether an open enrollment period is available to the employee at the time of the application. The prohibition does not apply if it is a non-custodial parent who is the State employee.

If the requirements for coverage under the State benefit package appear to be met but the State employee maintains that the child in his or her care cannot be covered, the employee must present or obtain verification from the agency's health plan administrator. The application should be pended awaiting this verification. Coverage by other health insurance: • Children who are covered by comprehensive health insurance (hospital and medical or major medical) are not eligible for MA 10, this differs from the limitation above as the

69

issue is verified coverage, not merely access. If a child has health insurance, the MA 10 eligibility determination must pend for verification of the insurance benefit types. Dropping health insurance coverage: • The state may no longer impose a waiting period following the loss of health insurance for CHIP applicants.92 Children whose health insurance coverage has been dropped voluntarily may receive MA 10 without a waiting period. The application asks for information concerning the reason for the termination of coverage. If "could not afford" is indicated as the reason, the insurance is considered to have been terminated voluntarily, however the child is not subject to the 90-day waiting period. Termination of insurance due to loss of employment (even if the loss was due to a voluntary quit) does not affect the child's eligibility for MA 10.

The following reasons for health insurance being dropped will not cause CHIP coverage to be subject to a 90-day waiting period:

• Loss of employment • Coverage limit reached • Non-custodial parent dropped insurance coverage • Divorce/death of parent • Employer ended insurance coverage • Insurance premium is more than 5 percent of the family income for the child’s coverage • Cost of family insurance coverage is more than 9.5 percent of family income • Child has special health care needs • Withdrawing from FFM Coverage because now eligible for Medicaid or CHIP (must present verification/letter that FFM coverage has ended; cannot have dual coverage) • Could not afford

Note: Effective 6/1/24 per CMS guidance the 90-day waiting for period for “any” reason was eliminated.93 The eligibility system will disenable dropdown options pertaining to recently lost coverage.

2434.00.00 ASSIGNMENT OF MEDICAL RIGHTS As of July 1, 2011, in support of P.L.153-2011, the assignment of medical rights became operational by State law. This means that no separately executed assignment of rights is required for Medicaid eligibility.

70

Cooperation in identifying and providing information about responsible third parties, including absent parents, as well as cooperation in obtaining third party payments and medical support, is required unless the applicant/recipient establishes good cause.94

2434.05.00 MEDICAL SUPPORT COOPERATION REQUIREMENTS This section does not apply to pregnant women (MAGP), Transitional Medical Assistance (MA F), or applicant/recipient children under 18 whose eligibility is being determined under a category other than MAGF. The applicant/recipient is required to cooperate, unless good cause is established, in obtaining medical support and payments for medical care as follows:95

• Provide the DFR with all information regarding existing and future medical insurance coverage. • Advise the DFR of any existing or future court orders which provide support for medical care. • Advise the DFR of any legal action taken or intended to be taken against a third party for injuries he has sustained in an accident; (this also applies to any other applicant/recipient for whom he is legally responsible). • Assist in obtaining any support for medical care available to him under any order of a court or administrative agency. • Assist in obtaining any third-party payments which may be available; and • Pay to the Central Office or DFR any money from any third party who is paid directly to him for medical services which were or will be paid by Medicaid.

2434.10.00 IV-D SANCTION REQUEST When an IV-D sanction request is received, it must state that the custodial parent or legal guardian failed to cooperate in obtaining medical support. Information regarding policy after the receipt of an IV-D sanction request is found in Section 2434.20.00.

2434.15.00 IDENTIFICATION OF MEDICAL RESOURCES The DFR must secure information from the applicant and any other knowledgeable source such as a parent, authorized representative or legal guardian on medical resources that are available or were available during the retroactive period to pay for the applicant's medical expenses. Medical resources include, but are not limited to:

71

• Health insurance policies, including health insurance policies from the Federal Marketplace, carried by the applicant, or carried for the applicant by an employer or relative. • Government financed health programs, such as: o Medicare - Parts A and/or B o CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) o CHAMPVA (Civilian Health and Medical Program of the Veterans Administration) and Veterans' benefits. o Tricare o Workman's compensation (for employment related accidents) o Automobile insurance (for automobile accidents). It is crucial that all medical resources be identified so that, if the applicant is determined to be eligible for MA, the Medicaid Fiscal Contractor, when processing provider claims, can seek payment from these resources before payment is made by Medicaid.

2434.20.00 THE RIGHT TO CLAIM GOOD CAUSE - MEDICAL SUPPORT Upon receipt of a medical sanction request from IV-D, a Medical Assignment Good Cause Notice (FI 2009) must be sent to the client prior to any enforcement of a sanction. The Good Cause notice gives the client 20 days to come into compliance with the medical support obligations by:

Claiming good cause by returning the form, along with evidence supporting their claim, to the DFR. If the form is not returned within the 20 days, the sanction is enforceable. If the form is returned within 20 days, the sanction is not enforceable, pending the good cause decision. A copy of the notice must be retained in the case record. Please note that a good cause notice must also be given to an applicant/recipient who is deciding whether to claim good cause. Good cause is defined as any circumstances in which cooperation would result in serious physical or emotional harm to the individual for whom medical support is sought. The evidence needed to substantiate a good cause claim is specified on the good cause notice.

If the client returns the Good Cause Notice to the local office, the form and any other related documentation should be sent to Central Office for review. While Central Office is deciding, benefits cannot be delayed, denied, or discontinued, if all other financial and non-financial eligibility requirements have been met.

If Central Office determines that Good Cause has been established, the sanction is not enforceable.

72

If Central Office determines that Good Cause was not met, the sanction is enforceable.

A sanctioned person who reapplies for medical assistance must be given another opportunity to comply with the medical support requirements. Consequently, there should be no automatic denial of assistance. If the applicant is otherwise eligible, the benefit is to be provided and the individual should be referred to the IV-D office again.

2434.20.05 MEDICAL SUPPORT GOOD CAUSE DETERMINATION The Central Office will notify the DFR in writing of the decision on the recipient's good cause claim. If the decision is that good cause does not exist, the DFR must notify the recipient and give him the opportunity to cooperate. Continued refusal to cooperate will result in the discontinuance of Medicaid except in the case of minor applicants/recipients, who are not penalized for their caretaker's refusal to cooperate.

2434.20.10 DFR REVIEW OF GOOD CAUSE DETERMINATION At the time of each redetermination, the DFR must review the good cause claim. If the determination of the existence of good cause was based on a circumstance which has changed so that good cause may no longer exist, the DFR must notify the Central Office of such change and recommend that the good cause finding be rescinded.96

2434.25.00 PENALTIES FOR MEDICAL SUPPORT NON-COMPLIANCE This section does not apply to pregnant women (MAGP), Transitional Medical Assistance (MA F), or applicant/recipient children under 18 whose eligibility is being determined under a category other than MAGF.

Medicaid must be denied or terminated for any competent adult applicant/recipient who refuses, without good cause, (Section 2434.20.00), to cooperate in obtaining medical support.

IV-D sanctioned TANF recipients do not automatically lose Medicaid eligibility due to the TANF sanction. The reason for the sanction must be reviewed to determine if the sanctioned individual is out of compliance with his/her medical support requirements before discontinuing Medicaid eligibility.

73

2434.30.00 CIRCUMSTANCES WHEN PENALTIES ARE NOT APPLIED An individual can prevent a sanction by coming into compliance with the medical support obligations within the 20 days given by the Medical Assignment Good Cause Notice (FI 2009). In addition to successfully claiming good cause a person can demonstrate compliance within the 20 days by providing proof of a scheduled appointment with the IV-D office. Also, please note that Medicaid eligibility must be approved/continued for the minor applicant/recipient whose custodial parent or legal guardian refuses, without good cause, to cooperate in obtaining medical support.

Example: A recipient father refuses to cooperate in obtaining medical support for his recipient child; the father is not eligible for Medicaid, but the child is.

2435.00.00 HEALTH INSURANCE PREMIUM PAYMENT PROGRAM The Indiana Medicaid through the Health Insurance Premium Payment Program (HIPP) pays for health insurance premiums of Medicaid-eligible Individuals when it is cost effective for the State. HIPP is required to purchase (wherever available and cost effective) employer-based group health insurance on behalf of covered Medicaid recipients and makes enrollment in this type of insurance plan a condition of the covered recipients' Medicaid eligibility, (exceptions below).97 Exceptions: • Policyholder is an absent parent who is court ordered to maintain the insurance • Member has Medicare coverage (Medicare recipients are ineligible for HIPP Program). • Member is enrolled with Managed Care Entity (MCE). • Insurance that only provides catastrophic limited benefit, limited duration, or indemnity coverage. • Premiums that are fully reimbursed by an employer, subsidy, or another third party.

Note: Non-members who do not meet eligibility requirements (i.e., no eligible household members, failure to enroll in a group health plan, etc.) are deemed ineligible for HIPP. If a non- Medicaid eligible family member must be enrolled in the group health plan to obtain coverage for the Medicaid eligible member, Fee for Participation (FFP) is available for premiums only (no other cost sharing expenses) for the non-Medicaid eligible family member(s). 98 A family member may reside in a separate household.

Potential HIPP cases are identified by DFR or a TPL Casualty Analyst. If a worker believes an individual and/or their dependent enrolled in the IHCP meet eligibility requirements for the HIPP

74

Program, a Medical Insurance Questionnaire (State Form 46771) must be completed with the member and current health insurance information should be entered on the Third-Party Liability Information Details- screen. If the policy premium information indicates a high-cost diagnosis, or above-threshold annual medical bills, a request for Medical Resource Information (Form 3510) should be mailed to the member’s employer. Upon receipt of the fully completed 3510, worker submits the questionnaire and 3510 to Gainwell TPL Unit for final eligibility determination. Forms should be faxed or mailed to: Gainwell TPL Unit P.O. Box 7262 Indianapolis, IN 46207-7262 Fax: 866-667-6579

Note: DFR and member will receive system-generated approval or denial notice from the TPL unit.

1 IC 12-15-1-24(a) 2 42 CFR 435.919(f)(4)(iii)(B) 3 8 U.S.C. § 1613 4 501 (e) of the Refugee Education Assistance Act of 1980 5 8 CFR 320.2 6 42 CFR 435.956(b)(4) and 42 CFR 457.380(b)(1)(ii) 7 Section 5006(a), (b) and (c) of the American Recovery and Reinvestment Act 8 42 CFR 435.601(b) 9 Public Law 98-94 of the Per Capita Act and 45 CFR section 232.20(a)(4)(ii)(e) 10 Section 5006(c) of the American Recovery and Reinvestment Act 11 25CFR 290.2 12 Public Law 98-94 of the Per Capita Act and 45 CFR section 232.20(a)(4)(ii)(e) 13 42 CFR 435.601(b) 14 Section 5006 (b) of the American Recovery and Reinvestment Act 15 Section 5006(a) of the American Recovery and Reinvestment Act Recovery Act 16 8 U.S.C. § 1613(b)(1)(D) 17 42 U.S.C. § 1320b-7(d)(3) 18 8 U.S. Code § 1613 19 8 U.S. Code § 1612 20 8 U.S. Code § 1612 21 8 U.S. Code § 1101 and 8 U.S. Code § 1101(a)(27) 22 Department of Defense Appropriations Act of 2010 (Section 8120, P.L. 111-118) 23 8 U.S. Code § 1101 24 42 USC 1395dd(e)(1)

75

25 42 CFR 435.956(b)(4) and 42 CFR 457.380(b)(1)(ii)

26 42 USC 1395dd(e)(1)27 8 U.S. Code § 1101 and 8 U.S. Code § 1101(a)(27) 28 Section 401 of the Immigration and Nationality Act 29Additional Supplemental Appropriations Act, 2022 (Section 401 P.L. 117-128) (May 21, 2021) 30 Additional Supplemental Appropriations Act, 2022 31 U.S.C. 1611(a), 8 U.S.C. 1613, and 8 U.S.C. 1641 32 8 U.S.C. 1611(a), 8 U.S.C. 1613, and 8 U.S.C. 1641 33 HCFA Letter to State Officials, 10/6/99: Provisions On Access and Cost Sharing for American Indian/Alaska Native Children)” 34 42 CFR 435.910 35 42 CFR 435.910 36 42 CFR 435.910 37 42 CFR 435.910 38 42 CFR 435.910 39 42 CFR 435.910 40 42 CFR 435.403 41 42 CFR 435.403 42 42 CFR 435.403 43 42 CFR 435.403 44 42 CFR 435.403 45 42 CFR 435.403 46 42 CFR 435.403 47 405 IAC 2-2-1 48 SSA 1902(a)(10)(A)(ii)(XV) and 1902(a)(10)(A)(ii)(XVI) 49 405 IAC 2-2-2 50 42 CFR 435.531 51 42 CFR 435.531; 405 IAC 2-2-2 52 SSA 1902(a)(12); 42 CFR 435.531 53 405 IAC 2-2-2 54 42 CFR 440.270 55 405 IAC 2-2-2 56 405 IAC 2-2-4 57 405 IAC 2-2-4 58 405 IAC 2-2-2 59 470 IAC 2.1-1-2 60 470 IAC 2.1-1-2 61 42 CFR 435.541 62 42 CFR 435.831(1) and 42 CFR 435.603 63 405 IAC 2-2-3; 42 U.S.C. 1382c(a)(3) 64 470 IAC 2.1-1-2 65 42 CFR 435.541 66 405 IAC 2-2-4 67 470 IAC 2.1-1-2 68 470 IAC 2.1-1-2

76

69 42 U.S. Code § 1382 (e) (1) (G) 70 42 CFR §435.725 71 42 CFR 435.138 72 42 CFR 435.137 73 SSA 1902(a)(10)(E) 74 SSA 1905(p)(1) 75 SSA 1902(a)(10)(E) 76 SSA 1905(s)(4) as added by P.L. 101-239 77 SSA 1902(a)(10)(E)(iii) 78 SSA 1902(a)(10)(E) 79 IRS.gov 80 42 CFR 435.603 81 Section 1902 of Social Security Act and 42 U.S.C. 1396 82 42 CFR435.603(f)(5) and IRS.gov 83 45 CFR 233.90 84 42 CFR 435.1009 85 42 CFR 435.1009 86 SSA 1905(i) 87 SSA 1905(i) 88 42 CFR 441.151 59 42 CFR 435.831(1) and 42 CFR 435.603 89 45 CFR 400.211 and 90 FR 13370 90 42 CFR 435.831 and 45 CFR 400.102 91 SSA 2110(b)(2) 92 45 CFR 457.805 93 45 CFR 457.65 and 45 CFR 457.805 94 SSA 1912(a). 95 42 CFR 433.147 96 470 IAC 2.1-4-6 97 SSA 1906 (a)(1) 98 42 U.S Code 1396e

Indiana Health Coverage Program Policy Manual Chapter 2600 RESOURCES Sections 2600.00.00 – 2640.10.40 Contents 2600.00.00 RESOURCES............................................................................................................ 7

2605.00.00 PRINCIPLES OF RESOURCES .................................................................................... 7 2605.05.00 DEFINITION OF RESOURCES ................................................................................. 7 2605.10.00 OWNERSHIP OF RESOURCES ................................................................................ 8 2605.10.05 JOINT OWNERSHIP OF RESOURCES ...................................................................... 8 2605.10.10 JOINT OWNERSHIP OF VEHICLES .......................................................................... 9 2605.15.00 AVAILABILITY OF RESOURCES ............................................................................. 10 2605.20.00 RESOURCE ELIGIBILITY DATE .............................................................................. 10 2605.25.00 DETERMINING RESOURCE VALUE ....................................................................... 10

2605.25.05 VEHICLE VALUATIONS ........................................................................................ 11 2605.25.10 REAL PROPERTY VALUE ...................................................................................... 11 2605.25.10.05 LIFE ESTATE/REMAINDER VALUE ........................................................................ 12 2605.25.10.10 LIFE ESTATE/REMAINDER TABLES ...................................................................... 13 2605.25.10.15 MINERAL RIGHTS VALUE .................................................................................... 15 2605.30.00 CONVERSION OF RESOURCES ............................................................................. 15 2605.35.00 VERIFICATION OF RESOURCES ............................................................................ 16 2605.40.00 MONITORING OF RESOURCES ............................................................................ 16 2605.45.00 THEFT OF FUNDS ............................................................................................... 16 2610.00.00 RESOURCE LIMITS ................................................................................................ 17 2612.00.00 ASSET VERIFICATION SYSTEM (AVS) ...................................................................... 17

2612.05.00 AVS TIMEFRAMES .............................................................................................. 19 2612.10.00 AVS AND ANNUAL MEDICAID REDETERMINATION ............................................. 20 2612.15.00 THE AVS DISCREPANCY NOTICE AND REBUTTAL PROCESS .................................. 21 2615.00.00 TYPES AND VALUE OF PERSONAL PROPERTY RESOURCES ..................................... 22

2615.05.00 CASH ................................................................................................................. 22

2615.05.05 PRE-PAID DEBIT CARDS ...................................................................................... 23 2615.05.10 CROWDFUNDING ACCOUNTS ............................................................................ 23 2615.10.00 BANK AND OTHER ACCOUNTS ........................................................................... 25 2615.10.05 SAVINGS AND CHECKING ACCOUNTS ................................................................. 26 2615.10.05.05 BUSINESS ACCOUNTS (MED 1, 4) ....................................................................... 28 2615.10.05.10 DEDICATED ACCOUNTS FOR INDIVIDUALS UNDER 18 (MED 1, 4) ........................ 28 2615.10.05.15 VIRTUAL CURRENCY ........................................................................................... 28 2615.10.05.20 PAYMENT PROCESSING APPS ............................................................................. 29 2615.10.10 TIME DEPOSITS .................................................................................................. 29 2615.10.15 SAFETY DEPOSIT BOX ......................................................................................... 30

2615.10.20 COLLEGE SAVINGS ACCOUNTS ........................................................................... 30 2615.10.30 ABLE ACCOUNTS ................................................................................................ 30 2615.15.00 RETIREMENT ACCOUNTS ................................................................................... 30 2615.20.00 BURIAL RELATED RESOURCES ............................................................................ 32 2615.20.05 BURIAL ACCOUNTS (MED 1, 4) ........................................................................... 32

2615.20.10 FUNERAL PLANNING PROGRAMS (MED 1, 4) ...................................................... 32 2615.20.10.05 PREPAID FUNERAL AGREEMENTS (MED 2) ......................................................... 33 2615.20.15 FUNERAL TRUSTS ............................................................................................... 34 2615.20.21 DEATH BENEFITS (MED 1, 4) ............................................................................... 34 2615.20.20.05 BURIAL PLOTS (MED 2) ...................................................................................... 34 2615.20.20.10 BURIAL PLOTS OR SPACES (MED 1, 4) ................................................................. 34 2615.25.00 INSURANCE ....................................................................................................... 35 2615.25.05 LIFE INSURANCE ................................................................................................ 35

2615.25.05.10 LIFE INSURANCE VALUE ...................................................................................... 35 2615.25.05.15 LIFE INSURANCE EXEMPTION (MED 1) ............................................................... 36 2615.25.05.20 LIFE INSURANCE EXEMPTION (MED 4) ............................................................... 37 2615.25.10 INDEMNITY HEALTH INSURANCE, VA AID AND ATTENDANCE PAYMENTS, AND CASUALTY INSURANCE ....................................................................................... 37 2615.25.15 LONG TERM CARE PROGRAM-RESOURCE DISREGARD (MED 1, 4) ....................... 37 2615.30.00 HOUSEHOLD GOODS AND PERSONAL EFFECTS ................................................... 40

2615.35.00 INCOME-PRODUCING PERSONAL PROPERTY ...................................................... 40

2615.35.10 INCOME-PRODUCING PERSONAL PROPERTY (MED 2) ......................................... 41 2615.35.15 INCOME-PRODUCING PERSONAL PROPERTY (MED 1, 4) ..................................... 41 2615.40.00 PERSONAL PROPERTY USED TO PRODUCE FOOD ................................................ 41 2615.45.00 STOCKS, BONDS, AND MUTUAL FUND SHARES ................................................... 41 2615.50.00 MORTGAGES, LOANS, AND PROMISSORY NOTES ................................................ 42 2615.55.00 LAND SALES CONTRACT ..................................................................................... 42 2615.55.10 LAND SALES CONTRACT (MED 2) ........................................................................ 42 2615.55.15 LAND SALES CONTRACT (MED 1, 4) .................................................................... 43 2615.60.00 VEHICLES ........................................................................................................... 44 2615.60.05 DEFINITION OF VEHICLE ..................................................................................... 44

2615.60.15 TREATMENT OF VEHICLES (MED 2) ..................................................................... 44 2615.60.20 TREATMENT OF VEHICLES PRIOR TO JUNE 1, 2014 (MED 1, 4) ............................ 44 2615.60.25 RECREATIONAL VEHICLES AND EQUIPMENT ....................................................... 45 2615.65.00 NON-RECURRING LUMP SUM PAYMENTS .......................................................... 45 2615.70.00 LIFE CARE CONTRACT (MED 1, 4) ....................................................................... 45 2615.75.00 TRUST FUNDS .................................................................................................... 46 2615.75.05 TRUST FUNDS ESTABLISHED PRIOR TO AUGUST 11, 1993 ................................... 46 2615.75.10 TRUST FUNDS ESTABLISHED ON AND AFTER AUGUST 11, 1993 .......................... 46 2615.75.15 CERTAIN TRUSTS RECEIVING SPECIAL CONSIDERATION ...................................... 48

2615.75.20 OTHER TRUSTS NOT GOVERNED BY OBRA-93 ..................................................... 49 2615.80.00 LEGAL GUARDIANSHIP/REPRESENTATIVE PAYEE (MED) ...................................... 50 2615.90.00 PRORATED INCOME ........................................................................................... 50 2615.95.00 PRESUMPTION OF LIQUIDITY (MED 1) ................................................................ 50 2620.00.00 TYPES AND VALUE OF REAL PROPERTY RESOURCES .............................................. 51 2620.05.00 REAL PROPERTY OWNERSHIP ............................................................................. 51 2620.10.00 VERIFICATION OF REAL PROPERTY OWNERSHIP ................................................. 52

2620.15.00 EXEMPT REAL PROPERTY RESOURCES ................................................................ 52 2620.15.10 THE HOME (MED 1, 4) ........................................................................................ 52 2620.15.10.05 HOME REPLACEMENT (MED 1, 4) ....................................................................... 53 2620.15.20 INCOME-PRODUCING REAL PROPERTY (MED 1, 4) .............................................. 53

2620.15.25 FOOD-PRODUCING REAL PROPERTY (MED 1, 4) .................................................. 53

2620.15.30 REAL PROPERTY OWNED BY A COMMUNITY SPOUSE (MED 1) ............................ 53 2620.20.00 TREATMENT OF NON-EXEMPT REAL PROPERTY .................................................. 54 2620.20.10 OFFERING REAL PROPERTY FOR SALE OR RENT (MED 1) ..................................... 54 2620.20.10.05 OFFERING REAL PROPERTY FOR SALE OR RENT (MED 4) ..................................... 55 2625.00.00 PLAN FOR ACHIEVING SELF-SUPPORT ................................................................. 55 2625.10.00 PLAN FOR ACHIEVING SELF-SUPPORT (MED 1, 4) ............................................... 55 2626.00.00 INDEPENDENCE AND SELF-SUFFICIENCY ACCOUNTS (MED 1) ............................... 56 2627.00.00 HEALTH SAVINGS ACCOUNTS ............................................................................... 58 2630.00.00 RESOURCES EXEMPTED UNDER FEDERAL LAW ..................................................... 58 2630.05.00 BENEFITS UNDER FEDERAL NUTRITION PROGRAM ............................................. 58

2630.05.05 WIC BENEFITS .................................................................................................... 58 2630.05.10 OLDER AMERICANS ACT ..................................................................................... 58 2630.05.15 CHILD NUTRITION ACT ....................................................................................... 58 2630.05.20 NATIONAL SCHOOL LUNCH ACT ......................................................................... 58 2630.05.25 FOOD STAMPS/COMMODITIES .......................................................................... 59 2630.10.00 HUD ASSISTANCE ............................................................................................... 59 2630.15.00 RELOCATION ASSISTANCE ACT PAYMENTS ......................................................... 59 2630.20.00 HOME ENERGY ASSISTANCE PAYMENTS ............................................................. 59 2630.25.00 ASSISTANCE FOR CERTAIN INDIAN TRIBES/ALASKAN NATIVES ............................ 59

2630.30.05 COMPENSATION TO JAPANESE/ALEUTS (MED 1, 4) ............................................ 62 2630.35.00 GERMAN REPARATION PAYMENTS (MED 1, 4) .................................................... 62 2630.35.05 CRIME VICTIM PAYMENTS (MED 1, 4) ................................................................ 62 2630.40.00 DOMESTIC VOLUNTEER SERVICE ACT COMPENSATION ...................................... 63 2630.45.00 PAYMENTS TO STUDENTS .................................................................................. 63 2630.55.00 DISASTER ASSISTANCE PAYMENTS ..................................................................... 63 2630.60.00 RADIATION EXPOSURE ACT BENEFITS................................................................. 63 2630.65.00 AGENT ORANGE SETTLEMENT ACT PAYMENTS ................................................... 64

2630.70.00 FEDERAL TAX REFUND PAYMENTS ..................................................................... 64 2630.95.00 INDIVIDUAL DEVELOPMENT ACCOUNT .............................................................. 64 2635.00.00 RESOURCE ELIGIBILITY DETERMINATION .............................................................. 64

2635.10.00 RESOURCE ELIGIBILITY DETERMINATION (MED 1) ............................................... 65

2635.10.05 QMB, QDW, SLMB, AND QI RESOURCE DETERMINATIONS (MED 4) .................... 66 2635.10.10 RESOURCES/INSTITUTIONALIZED/COMMUNITY SPOUSE (MED 1) ....................... 66 2635.10.10.05 RESOURCE ASSESSMENT AND SPOUSAL SHARE (MED 1) .................................... 67 2635.10.10.10 RESOURCE ELIGIBILITY/INSTITUTIONALIZED SPOUSE (MED 1) ............................. 69 2635.10.10.15 POST ELIGIBILITY PROTECTED PERIOD (MED 1) ................................................... 70 2635.10.20 RESERVED .......................................................................................................... 71 2635.10.20.05 ENTITLEMENT TO RESOURCE SPEND-DOWN/SSI DETERMINATION ..................... 71 2635.10.20.10 RESOURCE SPEND-DOWN DETERMINATION ...................................................... 71 2635.10.20.15 ELIGIBILITY SYSTEM PROCEDURES WHEN RESOURCE SPEND-DOWN IS INVOLVED (MED 1) ............................................................................................................. 71 2640.00.00 TRANSFERS OF PROPERTY .................................................................................... 72

2640.10.00 TRANSFER OF PROPERTY LAW ............................................................................ 72 2640.10.05 GENERAL APPLICABILITY OF TRANSFER OF PROPERTY LAW ................................. 72 2640.10.10 DETERMINING THE TRANSFER REVIEW PERIOD .................................................. 74 2640.10.15 ALLOWABLE TRANSFERS OF PROPERTY .............................................................. 74 2640.10.15.05 TRANSFERS OF HOMES AND INCOME-PRODUCING REAL PROPERTY (MED) ........ 75 2640.10.15.06 HOME EQUITY RESTRICTION .............................................................................. 76 2640.10.15.10 DE MINIMIS TRANSFER OF PROPERTY ALLOWANCE ........................................... 78 2640.10.16 TRANSFERS OF PERSONAL EFFECTS AND HOUSEHOLD GOODS ........................... 80

2640.10.20 DETERMINING ADEQUACY OF CONSIDERATION ................................................. 80 2640.10.20.05 COMPENSATION IN CASH ................................................................................... 80 2640.10.20.10 COMPENSATION IN REAL OR PERSONAL PROPERTY ............................................ 81 2640.10.20.15 COMPENSATION BY SUPPORT/MAINTENANCE ................................................... 81 2640.10.20.20 COMPENSATION BY SERVICES AGREEMENT, PERSONAL NEEDS CONTRACT, PERSONAL CARE CONTRACT OR OTHER SIMILAR AGREEMENTS ......................... 81 2640.10.25 DETERMINING UNCOMPENSATED VALUE .......................................................... 83 2640.10.25.05 TRANSFERS INVOLVING LIFE ESTATES ................................................................ 83 2640.10.25.10 TRANSFERS INVOLVING ANNUITIES .................................................................... 84 2640.10.25.20 ESTABLISHING JOINT OWNERSHIP (MED) ........................................................... 92 2640.10.25.25 TRANSFERS OF INCOME ..................................................................................... 92

2640.10.25.30 LOANS, PROMISSORY NOTES AS TRANSFERS OF ASSETS ..................................... 93

2640.10.25.35 TREATMENT OF CONTINUING CARE RETIREMENT COMMUNITY ENTRANCE FEES 94 2640.10.25.40 TRANSFERS INVOLVING BURIAL PLOTS OR SPACES FOR IMMEDIATE FAMILY MEMBERS ......................................................................................................... 95 2640.10.30 PRESUMPTION OF INTENT IN TRANSFERRING PROPERTY ................................... 95 2640.10.35 DETERMINING THE TRANSFER PENALTY PERIOD BEGIN DATE ............................. 96 2640.10.35.05 CALCULATION OF THE PENALTY PERIOD ............................................................ 97 2640.10.35.10 MULTIPLE TRANSFERS OF PROPERTY.................................................................. 98 2640.10.35.15 TRANSFERRED PROPERTY IS RETURNED TO THE ORIGINAL OWNER .................... 99 2640.10.35.20 BUDGETING PROCEDURES DURING A TRANSFER PENALTY PERIOD ..................... 99 2640.10.40 TRANSFER PENALTY HARDSHIP EXCEPTION ........................................................ 99

2600.00.00 RESOURCES This chapter presents requirements for determining eligibility based on resources. The chapter contains the following main sections: • Principles of Resources (Section 2605) • Resource Limits (Section 2610) • Types and Value of Personal Property Resources (Section 2615) • Types and Value of Real Property Resources (Section 2620) • Plan for Achieving Self-Support (Section 2625) • Resources Exempted Under Federal Law (Section 2630) • Resource Eligibility Determination (Section 2635) • Transfer of Property (Section 2640) 2605.00.00 PRINCIPLES OF RESOURCES This entire chapter is inapplicable to MED 3 and TMA (MA F). The resources owned by specific individuals must be identified and evaluated according to the requirements of each program. A distinction between resources and income must always be made so that proper consideration is given to each. Section 2605 outlines principles which apply to the consideration of resources in the determination of eligibility for assistance. All property not specifically exempted in the following sections is countable as a resource. When there is an agreement to offer to dispose of real property, the agreement should be considered to be effective for the purposes of the application (see 2620.20.10). 2605.05.00 DEFINITION OF RESOURCES Resources are real or personal property that is owned solely or jointly by an individual. Real property is land, including buildings or immovable objects attached permanently to the land. Real property also includes life estates, remainder interests, and mineral rights. (Refer to Sections 2605.25.10 and 2620.00.00). Personal property includes all property that is not real property. The eligibility system resource screens identify the following types of personal property as liquid resources: • Cash on hand (including balances on a pay card) • Checking accounts • Savings accounts, including Christmas Club

• Savings certificates • Trust funds • Individual retirement accounts • Keogh plans • Credit union accounts • Prepaid funeral agreements • Stocks • Bonds • Virtual currency is also known as cryptocurrency, such as Bitcoin • Nursing home accounts 2605.10.00 OWNERSHIP OF RESOURCES The owner of a resource is any individual who has the ability to liquidate or dispose of the resource. A resource can be solely or jointly owned. 2605.10.05 JOINT OWNERSHIP OF RESOURCES Joint ownership of resources, consisting of real or personal property, exists when the right to liquidate or dispose of the property is shared by more than one individual. Joint ownership is indicated by entering "Y" on the Liquid Asset-Details page. The full amount is entered for each individual in the case who owns part of the resource. Then the joint ownership screen comes up for each joint owner. If the resource is jointly owned by a married couple, one-half of the resource is to be entered for each spouse on the jointly owned resources screen. Otherwise, the entry on the screen depends on the type of resource, as explained below. When any type of account held in a financial institution is jointly owned, the worker is to presume that all of the funds belong to each owner. The individuals are to be advised of this presumption and given the opportunity to rebut it. If an applicant/recipient rebuts, they are responsible for providing proof of ownership of the funds, which includes a record of deposits and withdrawals from the account. Following a successful rebuttal, the funds must be separated and placed in separate accounts. Only the funds actually belonging to the applicant/recipient will then be counted as a resource to them and entered on the Liquid Resources screen. This procedure applies whether or not the joint owners are all applying for or receiving assistance. If the funds are not separated, the balance is counted in its entirety by each joint owner. In addition to bank accounts, other real and personal property may be jointly owned. If an applicant/recipient owns real property or non-liquid personal property with another applicant/recipient of any assistance program, the real/personal property resources screen is to be completed for EACH owner. Then proportionate shares of the property are to be assigned to the joint owners on the Jointly Owned Resources screen. The percentage amount of the share owned by each individual is entered on

the screen. Refer to Section 2605.10.10 regarding the availability determination for jointly owned vehicles. When a non-recipient is one of the joint owners of real or personal property, the availability of the applicant's/recipient's proportionate share must be determined. If the individual has unrestricted right, authority, or legal ability to liquidate or dispose of the property, or their share of it, the proportionate share would be available to them. If the joint owners do not have unrestricted rights to sell their interest in real property according to the title or other legal document, statements must be obtained from all joint owners to determine if they are all willing to sell the property. If all joint owners are willing to sell, then the property will be considered available. The AV (available) question on the Real/Personal Property Resources screen is answered "Y”, and the Jointly Owned Resources screen will come up. The percentage amount of their share is to be entered on the screen. 2605.10.10 JOINT OWNERSHIP OF VEHICLES This section addresses the determination of "availability" of jointly owned vehicles. If a vehicle is found to be available, refer to Section 2605.10.05 to determine how to complete the Jointly Owned Resources screen. A jointly owned vehicle is considered an available resource to the Assistance Group (AG) when: It is jointly owned with another, (one or more) applicant/recipient who may or may not be in the same AG or living at the same address It is jointly owned by a non-recipient who lives with the AG and either owner has physical possession and/or use of the vehicle and the non-recipient owner agrees to sell the vehicle. It is jointly owned with a non-recipient who does not reside with the AG, but the AG has physical possession or use of the vehicle and the non-recipient owner agrees to sell the vehicle It is jointly owned with a non-recipient who does not live with the AG and the AG does not have physical possession or use of the vehicle but, the joint owner is willing to sell the vehicle, thus enabling the client to obtain his share of the vehicle's value. If the client cannot legally sell the vehicle or take action to remove their name from the title (for example a pending lawsuit prohibits this action) the vehicle will not be considered to be available even in the situations listed above. The client must provide proof that the vehicle is not legally available by presenting court or BMV documents. Therefore, when a vehicle is found to be jointly owned with a non-recipient, the AG must be asked if the non-recipient is willing to sell the vehicle. If the non-recipient is not willing to sell, verification of the

non-recipient's statement must be obtained. The recipient must cooperate in locating and obtaining verification from the non-recipient. 2605.15.00 AVAILABILITY OF RESOURCES Resources are available if the owner has unrestricted right, authority, or legal ability to liquidate or dispose of the property or his share of the property. Resources must be available in order to be counted in the eligibility determination.1 Refer to Section 2605.10.10 regarding the availability determination of jointly owned vehicles. Refer to Section 2615.45 regarding the availability determination of savings bonds for MED 1. 2605.20.00 RESOURCE ELIGIBILITY DATE The resource eligibility determination is based on resources owned as of the first day of a month. Ownership of excess resources on the first day of the month renders an applicant or recipient ineligible for medical assistance for the entire month. The first day of the month means the first moment of the first day. Therefore, a financial transaction occurring on the first day does not affect the first of the month resource amount. For applicants, resources must be verified as of the first day of each retroactive month and the month of application. For a redetermination or a resource review, verification of the most current value of resources must be obtained. The value is then used to project resource eligibility for the following month. For liquid resources, the worker must enter on the Liquid Resources screen the resource information for each retroactive month and the month of application, including a "begin date" and an "end date" if the amount differs on the first day of each of the months. Subsequent changes in the amounts during the application processing period must be entered accordingly. Income is considered income in the month received, and a resource the month following. All income received in the previous month that was intended for that month counts as a resource in the following month. The only exception to this is early payments. For example, social security deposited the check on 01/03, but then deposited the February check early on 01/31. The second social security check should be deducted from the 02/01 bank balance. If a member routinely gets income at the end of the month, it is considered income in the month received and a resource the month after. If there are questions, submit to PAL. 2605.25.00 DETERMINING RESOURCE VALUE The value of a resource must be determined in order to establish the amount that must be counted toward the resource limit. With a few exceptions, the amount of any resource to be counted is the equity value. Equity value is the current fair market value, minus the total amount of liens against the

property.2 The exceptions to this procedure are vehicles (Section 2605.25.05) and, in certain instances, real property. (See section 2605.25.10.) 2605.25.05 VEHICLE VALUATIONS The fair market value of a vehicle is the lowest "wholesale" value as listed in publications written for the purpose of providing guidance to automobile dealers and loan companies. The Kelly Blue Book vehicle value guide may be used. If the Kelly Blue Book vehicle value guide is not available, any vehicle value guide which provides guidance to automobile dealers and loan companies may be used provided they have been updated within the last six months. If the applicant/recipient disputes the value amount, a written statement must be obtained from a licensed automobile dealer. The AG should be asked to acquire verification of the value of antique, custom made, or classic vehicles, if the worker is unable to make an accurate appraisal. If a vehicle is especially equipped with apparatus for the handicapped, the book value is to be assigned as if the vehicle were not so equipped. If a vehicle is no longer listed in a book due to the age of the vehicle, the AG's estimate of the value of vehicle is to be accepted, unless there is reason to believe that the estimate is incorrect. A written statement must be obtained from a licensed automobile dealer. Vehicle verification must include verification of all of the following: Ownership License status Fair market value Amount owed, Workers must keep in mind that equity value will increase with each monthly loan payment. Also, the fair market value may decrease whenever the publication used to establish the value is published. For those recipients who are very close to the resource limit, the value of nonexempt vehicles may have to be verified monthly to ensure that the recipient does not have excess resources as of the first day of a month.3 2605.25.10 REAL PROPERTY VALUE Fair market value is the reasonable price that real property can be expected to sell for on the open market in the particular geographic area involved (see 2605.05.00). The fair market (FMV) value of real property can be obtained through tax records or from an estimate by a knowledgeable source. When tax records are used, the most recent property tax assessment must be obtained. The fair market value is the assessed value divided by the assessment ratio. The tax assessment cannot be used if: • It is more than one year old It is under appeal

• It is based on a fixed rate per acre method • The taxing authority does not provide an assessment ratio, or only provides a range, for example, between 50% and 75%. If the worker questions an estimate from a knowledgeable source, one or more additional estimates are to be obtained and averaged to establish fair market value. If the lesser value is accepted, it must be entered on the Real/Personal Property resources screen in the Equity field. Since the eligibility system calculates the equity based on the worker entered FMV of property, the equity override (EO) field must be answered "Y" to enable the lesser equity to be entered and used by the system in the eligibility determination. 2605.25.10.05 LIFE ESTATE/REMAINDER VALUE Life Estate: A life estate conveys to an individual certain rights in property for his lifetime. The owner of a life estate generally has the right of possession and use of the property, as well as the right to obtain profits from the property and to sell his life estate interest. Remainder Interest: When an individual conveys property to one person for life (life estate holder) and to a second person (the remainderman) upon the death of the life estate holder, both a life estate interest and a remainder interest are created in the property. A remainderman cannot sell his interest in the property while the life estate holder is alive unless otherwise specified in the deed. At the death of the life estate holder, the remainderman will hold full title. The fair market value of a life estate or remainder interest is calculated by: • Determining the fair market value of the property (2605.25.10) in the usual manner and refer to the Life Estate and Remainder Interest Tables in Section 2605.25.10.10. • Using the individual's age as of his last birthday, multiply the figure in the Life Estate or Remainder Interest column for that age by the fair market value of the property to obtain the value of the life estate or remainder interest. • Advise the individual or person acting on their behalf of the presumed value of the life estate obtained from the table and provide them the opportunity to submit documentation of a lesser value. Such documentation will be acceptable only if it is provided by a knowledgeable source based on an evaluation of the specific life estate in question. If the lesser value is accepted, it must be entered on the Real/Personal Property Resources screen in the Equity field. Since the eligibility system calculates the equity based on the worker entered FMV of property, the equity override (EO) field must be answered "Y" to enable the lesser equity to be entered and used by the system in the eligibility determination.

2605.25.10.10 LIFE ESTATE/REMAINDER TABLES AGE LIFE ESTATE REMAINDER

AGE LIFE ESTATE REMAINDER 0 0.97188 0.02812 1 0.98988 0.01012 2 0.99017 0.00983

3 0.99008 0.00992 4 0.98981 0.01019

5 0.98938 0.01062 6 0.98884 0.01116

7 0.98822 0.01178 8 0.98748 0.01252

9 0.98663 0.01337 10 0.98565 0.01435

11 0.98453 0.01547 12 0.98329 0.01671

13 0.98198 0.01802 14 0.98066 0.01934

15 0.97937 0.02063 16 0.97815 0.02185

17 0.977 0.023 18 0.9759 0.0241

19 0.9748 0.0252 20 0.97365 0.02635

21 0.97245 0.02755 22 0.9712 0.0288

23 0.96986 0.03014 24 0.96841 0.03159

25 0.96678 0.03322 26 0.96495 0.03505

27 0.9629 0.0371 28 0.96062 0.03938

29 0.95813 0.04187 30 0.95543 0.04457

31 0.95254 0.04746 32 0.94942 0.05058

33 0.94608 0.05392 34 0.9425 0.0575

35 0.93868 0.06132 36 0.9346 0.0654

37 0.93026 0.06974 38 0.92567 0.07433

39 0.92083 0.07917 40 0.91571 0.08429

41 0.90457 0.09543

42 0.90457 0.09543

43 0.89855 0.10145 44 0.89221 0.10779

45 0.88558 0.11442 46 0.87863 0.12137

47 0.87137 0.12863 48 0.86374 0.13626

49 0.85578 0.14422 50 0.84743 0.15257

51 0.83674 0.16126 52 0.82969 0.17031

53 0.82028 0.17972 54 0.81054 0.18946

55 0.80046 0.19954 56 0.79006 0.20994

57 0.77931 0.22069 58 0.76822 0.23178

59 0.75675 0.24325 60 0.74491 0.25509

61 0.73267 0.26733 62 0.72002 0.27998

63 0.70696 0.29304 64 0.69352 0.30648

65 0.6797 0.3203 66 0.66551 0.33449

67 0.65098 0.34902 68 0.6361 0.3639

69 0.62086 0.37914 70 0.60522 0.39478

71 0.58914 0.41086 72 0.57261 0.42739

73 0.55571 0.44429 74 0.53862 0.46138

75 0.52149 0.47851 76 0.50441 0.49559

77 0.48742 0.51258 78 0.47049 0.52951

79 0.45357 0.54643 80 0.43659 0.56341

81 0.41967 0.58033 82 0.40295 0.59705

83 0.38642 0.61358 84 0.36998 0.63002

85 0.35359 0.64641 86 0.33764 0.66236

87 0.32262 0.67738

88 0.30859 0.69141

89 0.29526 0.70474 90 0.28221 0.71779

91 0.26955 0.73045 92 0.25771 0.74229

93 0.24692 0.75308 94 0.23728 0.76272

95 0.22887 0.77113 96 0.22181 0.77819

97 0.2155 0.7845 98 0.21 0.79

99 0.20486 0.79514 100 0.19975 0.80025

101 0.19532 0.80468 102 0.80025 0.80946

103 0.18437 0.81563 104 0.17856 0.82144

105 0.16962 0.16962 106 0.15488 0.84512

107 0.13409 0.86591 108 0.10068 0.89932

109 0.04545 0.95455 2605.25.10.15 MINERAL RIGHTS VALUE A mineral right is an ownership interest in certain natural resources such as coal, Sulphur, petroleum, sand, natural gas, and others which are usually obtained from the ground. If the individual owns the land to which the mineral rights pertain, the fair market value of the land can be assumed to include the value of the mineral rights. If the individual does not own the land to which the mineral rights pertain, a fair market value must be obtained from a knowledgeable source such as, the Bureau of Land Management, the U. S. Geological Survey, or any mining company that holds leases. 2605.30.00 CONVERSION OF RESOURCES Whenever a resource is sold or converted from one form to another resource, the proceeds remain a resource rather than income.4 Verification concerning the new resource must be obtained. Example 1: An applicant/recipient has an IRA valued at $100,000. The applicant/recipient cashed in the policy and deposits the proceeds into a bank account. Because the IRA was converted to a bank account (from one resource to another resource), it is considered a conversion of resources and remains a countable resource.

Example 2: An applicant/recipient has an IRA valued at $100,000. The applicant/recipient annuitizes the IRA and payments in the amount of $500 a month. The resource has been converted to income. This is a conversion of a resource to income making the IRA no longer a countable resource but the distributions countable as income. The IRA should be updated in the eligibility system as not available and the payments of $500 are considered income. 2605.35.00 VERIFICATION OF RESOURCES All verification of resources must be obtained from the source (for example, by the bank where the account is held) or through a source document. Verification of resources is required in all programs; however, the individual's signed statement as to the amount of cash on hand is sufficient (Refer to Section 2615.05.00). When resources are jointly owned, the portion belonging to the individual must be identified and verified. 2605.40.00 MONITORING OF RESOURCES Each applicant/recipient must be advised of the resource limits of the assistance programs and their responsibility to report any changes in the resource amounts which may affect their eligibility for assistance. Resources are verified at each redetermination and must be monitored more frequently if changes are anticipated, or resources are close to the limit. When payments are being made on real property or vehicles, the equity value may require monitoring as each payment will increase the property's equity. Special emphasis must be placed on the need for the recipient to keep their resources within the program's limits in order for assistance to continue. Additionally, workers are responsible for monitoring resources between redeterminations. In cases where resources are close to the resource limits, the cases must be flagged to alert the workers to check resources frequently or on a monthly basis when necessary. The Expected Changes Screen should be used for this purpose. Monthly monitoring of the value of resources is not required. 2605.45.00 THEFT OF FUNDS When a member, or their authorized representative, claims that the member’s income or resources have been stolen or misused it must be sent to PAL for review. To avoid imposition of a transfer of property penalty when claiming stolen or misused funds, the following actions are required: • The member must cooperate in the filing of an official police report detailing the alleged theft or

misuse, and • The member must actively cooperate with law enforcement in the pursuit of charges against the alleged perpetrator. In situations where the member claims their authorized representative, power of attorney, legal guardian or other legal representative has misused or stolen their income or resources, the member must cooperate in the required actions outlined above and must also: • Remove the accused individual as their representative, and • Report the accused representative to Adult Protective Services (APS). In all cases involving a claim of stolen or misused assets, documentation verifying the member’s active cooperation in all required actions must be requested and sent to PAL for review. If funds are returned or restitution is paid to the member, then the resources should be reviewed to verify that the member meets the eligibility criteria. If a member claims that theft or misuse of assets has occurred but fails to cooperate with any of the requirements listed above, then a transfer of property penalty should be invoked. In the event of the member’s death, estate recovery will be pursued. 2610.00.00 RESOURCE LIMITS The resource limit is the maximum value of nonexempt resources that the AG may retain without affecting eligibility. It is dependent on the composition and living arrangement of the AG and the specific rules that govern each program. An AG with countable resources in excess of the applicable resource limit is ineligible for benefits. Refer to Section 3005.00 for the specific resource limits. 2612.00.00 ASSET VERIFICATION SYSTEM (AVS) Federal regulations require that all States have an AVS in place to verify the resources of individuals when determining Medicaid eligibility for categories that require an asset/resource test5. The AVS is an automated system that obtains electronic resource verification and includes all MED 1 and MED 4 categories. AVS also applies to those whose resources are counted for household members on a Medicaid resource category for new applications, redeterminations, and category change from a non- resource Medicaid category to a resource required category. Submissions for the AVS are processed through the Eligibility System and responses are received electronically in the case file. AVS completes a lookback period for gathering resources of the member and any other members that would be included in the resource test (such as a spouse). Depending on the application lifecycle, the below lookback occurs:

For new applications, including category changes from MAGI to non-MAGI categories, the AVS completes a 5 year look back period. At redetermination, AVS reviews resources for 1 month prior to redetermination date. For reapplications, AVS completes a 4-month lookback period. AVS requests can be made every 90 days, however, if an AVS exchange is required prior to the 90 days, this must be sent to PAL, and if determined necessary, PAL can request a new AVS ping. Unless necessary, AVS pings should not occur more than once a year. Resource verifications returned from the AVS are obtained from Experian, Bureau of Motor Vehicles, and real property searches. Matches are made using the members’ name and Social Security Number. If a member does not have an SSN, then an AVS data match can’t be completed. For liquid resources including bank accounts, a search within 65 miles of the members’ address listed in the case is completed. While the AVS ping will return verifications from most of the larger banks, some of the smaller banks may not return information. Some liquid resource that may return results includes: • Checking accounts • Savings accounts • Money markets • Stocks balances if affiliated with a bank account • IRA’s and retirement fund balances • Miller Trust balances • Trust fund amounts, but not the actual legal Trust document • Vehicles registered in the members’ name and listed address in the eligibility system Real property in the member’s name. When the worker completes the wrap-up in the Eligibility system, this will ping the AVS system, and AVS will return the electronic verification in 13 days. A 2032 Request for Verifications form must also be sent to the member with the 13-day deadline pending all unverified resources. If the member’s resources are verified via hard copy before the 13 days, the worker should not send it to SRED or authorize the case until the AVS electronic verification is returned or on the 13th day that the verifications are due. Unless the member is failing (such as being over income), no case action should be taken until the 13th day. With the exception of issuing continued benefits due to an appeal, workers should not override AVS pings prior to the 13th day without PAL approval. If an unreported or unverified resource by the member is found by AVS, then the AVS information should be entered to continue the eligibility determination process. At no time should a case be closed

or denied for failure to verify a resource if the resource has been verified by AVS. In the case that a member returns the verifications, and they do not match the AVS documentation, then the higher balance will be used as the verified resource amount. The only exception to this is if there is a successful rebuttal verified by a hard copy verification, then AVS will not be used. There is an option for certain DFR workers to override AVS if there is verification that hard copy verification is the lower resource amount. If this occurs, it must be thoroughly documented in case notes. Documenting AVS returns: • If after the due date, no hard copy verifications are received but AVS is returned, then AVS verification is to be used. • If the member fails for a Medicaid resource category due to AVS, an AVS discrepancy notice must be generated and sent to the member notifying them that the application is denied based on AVS data exchange. • The member can send a rebuttal to the AVS information, such as but not limited to: o Verification that the resource is jointly owned with another person, therefore a reduced countable value should be used. o Proof of the amount that is still owed. o Verification that the resource is no longer in their name (normal transfer of property rules apply). If the member has a reason to believe the AVS data is incorrect, they will need to dispute with the consumer reporting agency in writing or by calling the toll-free number and address located at the bottom of the AVS discrepancy notice. • Blue book value is used for vehicles. Default to the fair purchase price listed for a base model of the same make, model, and year, unless other verification is received. • If the 13 days have passed and the case has been authorized, then the AVS returns additional verifications, this should be treated as a case change and the verification should be updated accordingly. If the member fails for a Medicaid resource category (MA A, MA B, MA D, MADI, MADW, MA L, MA J, MA I, MA G, MA R) due to AVS resource data, an AVS discrepancy notice must be generated and sent out to the applicant member notifying them that the application is denied based on AVS data exchange. If the member has a reason to believe the AVS data is incorrect, they will need to contact the number at the bottom of the discrepancy notice. 2612.05.00 AVS TIMEFRAMES AVS completes a lookback period for gathering resources of the applicant/member and any other members that would be included in the resource test (such as a spouse). Depending on the application lifecycle, the following is the process for lookback occurs: • For new applications, including category changes from MAGI to non-MAGI categories, the AVS completes a five-year look back period

• At redetermination, AVS reviews resources for one month prior to redetermination processing date (90 days before redetermination is due) For reapplications, AVS completes a four-month lookback period. AVS requests can be made every 90 days, however, if another AVS exchange is required prior to the 90 days, this must be sent to PAL, and if determined necessary, PAL can request a new AVS ping. Unless necessary, AVS pings should not occur more than once a year. When the worker completes the wrap-up in the eligibility system, this will ping the AVS system, and AVS will return initial findings from electronic verification in 13 days. A 2032 Request for Verifications form must also be sent to the applicant member and authorized representative with the 13-day deadline pending all unverified resources. Even if the individual’s resources are verified via hard copy before the 13 days, the worker cannot authorize the case until the 13th day after AVS electronic verification was requested. Unless the applicant/member is failing (such as being over income or over resources based on information they provided), no case action should be taken until after the 13th day. If no AVS information is returned by the 13th day, the worker should process as normal based on what the applicant/member has verified or failed to verify. If an unreported or unverified resource by the applicant member is found by AVS, then the AVS information should be entered to continue the eligibility determination process. At no time should a case be closed or denied for failure to verify a resource if the resource has been verified by AVS. If AVS finds additional information between days 13 and 30, and the case has already been authorized, any changes based on the newer AVS information should be treated as verified change. (See 2215.00.00.) After 30 days, AVS will not return any further information. If an asset is returned by AVS but was not reported by the applicant/member, the AVS value should be used. In the case that an applicant/member or their authorized representative returns verifications and they do not match the AVS documentation, then the higher balance will be used as the verified resource amount. The only exception to this is if there is a successful rebuttal verified by a hard copy verification, then AVS will not be used. (See IHCPPM 2612.10.00.) 2612.10.00 AVS AND ANNUAL MEDICAID REDETERMINATION Ninety (90) days prior to the redetermination due date for individuals in categories that require a resource test, the AVS will be pinged for information. If no discrepant information or information which makes the member fail resources is returned, the member may qualify for autorenewal based on existing rules. However, if AVS returns discrepant information or shows the member is over resources, the member will receive a mailer which they will be required to return with needed verifications to determine ongoing eligibility.

For all members who are required to return a signed mailer and verifications, their AR will receive a full copy of the mailer and may complete and return it with verifications and signature on the member’s behalf, if desired. If after the mailer is returned the member for whom we pinged AVS is failing due to excess resources, a discrepancy notice will be mailed (see IHCPPM 2612.15.00). 2612.15.00 THE AVS DISCREPANCY NOTICE AND REBUTTAL PROCESS If AVS information was returned and the applicant/member fails for a Medicaid resource category (MA A, MA B, MA D, MADI, MADW, MA L, MA J, MA I, MA G, MA R), a discrepancy notice will be sent. The AVS discrepancy notice tells the applicant/member and AR that Medicaid is currently set to be denied or closed based on information provided fully or partially by the AVS data exchange. This notice will display both the resources reported by the applicant or member and/or their authorized representative and also the details on what AVS has returned. They will be given 13 days to return hard copy documentation to verify a reduction in the countable amount of the asset. The applicant or member and/or their authorized representative can send a rebuttal to the countable value returned by AVS, such as but not limited to: • Bank statements that show amounts that should be deducted from the first of the month balance. (See 2615.10.05.) • Verification that the resource is jointly owned with another person, therefore a reduced countable value should be used • Proof of the amount that is still owed on it which reduces the equity value • Verification that the resource is no longer in their name (normal transfer of property rules apply). If the applicant/member or authorized representative believes the AVS data is incorrect, they will need to dispute with the consumer reporting agency in writing or by contacting the toll-free number and address located at the bottom of the AVS discrepancy notice. This process would be external to the Medicaid determination and workers should continue to use the AVS or hard copy verified information, as appropriate. There is an option for certain DFR workers to override AVS if hard copy verification proves a lower countable amount for the resource/s. If this occurs, it must be thoroughly documented in case notes. NOTE ABOUT FIRST OF THE MONTH BANK BALANCES: The applicant/member will still be requested to provide monthly statements for bank accounts on a 2032 Request for Verifications. If bank statements are returned, use the existing policy to determine any allowable deductions from the first of the month balance. If the first of the month balance/s match what was returned by AVS (AVS only returns 1st of the month balance), the worker can consider this a successful rebuttal without sending a discrepancy notice

and use the lower hard copy value for that account. If no successful rebuttal is received: • For applicants, the application will be denied after the discrepancy notice due date, and a separate denial notice will be mailed with normal appeal rights. • For ongoing eligibility, Medicaid will be closed after the discrepancy notice due date (using normal adverse timing) and separate notice will be mailed with normal appeal rights. Documenting AVS returns: • If after the 2032 Request for Verifications due date, no hard copy verifications are received but AVS is returned, then AVS verification is to be used. • For items where AVS returns information but there are not enough details to determine countable value (for example, we learn about a trust but need the actual trust document for Policy review as to availability), the applicant/member will have to provide separate documentation with the needed details. • Assets which were disposed of during the lookback period should be reviewed for potential transfer penalties. • Blue book value is used for vehicles. Default to the fair purchase price listed for a base model of the same make, model, and year, unless other verification is received. If the 13 days have passed and the case has been authorized, then the AVS returns additional verifications, this should be treated as a case change and the verification should be updated accordingly. 2615.00.00 TYPES AND VALUE OF PERSONAL PROPERTY RESOURCES This section describes the policy for determining the value of personal property resources. The different types of such resources and their consideration are discussed. 2615.05.00 CASH Cash that is not part of a current month's income is counted as a resource. Cash includes money the individual owns, no matter where it is located.6 Cash on hand includes: • Amounts carried by the individual • Amounts the individual has at home • Amounts being held for the individual elsewhere. • A signed statement from the individual owning the cash is sufficient verification.

2615.05.05 PRE-PAID DEBIT CARDS Pre-paid debit cards, including Direct Express cards which only allow monthly benefit deposits from federal agencies such as the Social Security Administration, are considered an available resource and must be verified. Any balance remaining on a pre-paid debit card is considered a liquid asset beginning the month following the month the funds were deposited. The only exception to this rule is for debit cards issued by a government-sponsored medical benefit as rewards, incentives, or extra benefits from a Medicare Advantage or Medicaid Managed Care Program. Assistance provided in cash or in kind (including food or shelter) under a Federal, State, or local government program whose purpose is to provide medical care or medical services (including vocational rehabilitation) is not counted as income or a resource.7 2615.05.10 CROWDFUNDING ACCOUNTS Crowdfunding accounts are way to fundraise from multiple people to assist in paying for things such as medical bills, funeral costs, starting a new business or pet care. If a Medicaid applicant or member is the beneficiary of a crowdfunding account, such as GoFundMe or Kickstarter, it is considered a liquid asset and is a countable resource (minus fees) in the Medicaid budget. Withdrawals from the crowdfunding account are considered unearned income in the month received and a resource in the month following (IHCPPM 2605.20.00). Transfer of property rules apply (IHCPPM 2640.10.00-2640.10.25). Example 1: April 15th - Kathy was in a car accident and was hospitalized. On April 20th, her daughters created a GoFundMe account asking for donations to help pay for her health care. Her only other resource is a checking account with a balance of $125. May 1st – Her total available resources are $30,125 which includes the GoFundMe account and her bank balance (IHCPPM 2605.20.00). June 1st - The family cashes in the GoFundMe account and withdraws $30,000. The funds are deposited into Kathys bank account. $30,000 is counted as income in the month of June (because it is income in June, it is not considered a resource). July 1st - The $30,000 remains in the bank account and is a countable resource. Kathy is over the asset limit for July. July 15th - Kathy applied for disability Medicaid.

July 20th - The family submits verification that $30,000 was paid toward hospital bills. Paying medical debt is allowable as adequate consideration was given. Her remaining bank balance is $125. Eligibility: • May: Denied – over resources with a balance of $30,125 (GoFundMe + bank balance) • June: Denied – over income (GoFundMe account was cashed in) • July: Denied – over resources (bank balance $30,125) • August: Eligible for MA D

Example 2: 04/15 - Patrick is 70 years old and enters a nursing home. His only resource is a bank account with a balance of $3,000. 04/20 - His neighbor created Kickstarter account to help pay for the nursing home stay. 05/01 The Kickstarter account has successfully raised $10,000. This is an available resource for May. His bank account has a balance of $1,200 leaving total resources for May at $11,200. 06/01 - The account raised a total of $25,000; his bank balance is $1,200. 07/15 - Patrick applied for Medicaid. His countable resources are $26,200. Eligibility: • April: Denied – over resources with a balance of $3,000 • May: Denied – over resources with a balance of $11,200 • June: Denied – over resources with a balance of $26,200 • July: Denied – over resources with a balance of $26,200

Example 3: 04/01 - Sammy is disabled and is receiving SSDI; he is on MA D is has an HCBS waiver. His only resource is a bank account with a $1,000 balance. 04/02 - Sammys mother created a GoFundMe account with him listed as the beneficiary to assist with his daily living. The account raised $30,000. 04/10 - He cashes in the GoFundMe account and deposits it into his bank account leaving a bank balance of $31,000. Sammy gives his children $30,000. Adequate consideration was not received resulting in a transfer of property penalty. Eligibility: • 05/01 – A transfer of property penalty is imposed 05/01 ongoing (MED 3) Funds received through crowdfunding platforms may be excluded from gross income and MAGI calculation if they qualify as a personal gift.8

Funds are considered non-taxable gifts when they are provided without expectation of receiving goods, services, or any other benefit in return (e.g., medical expenses, funeral costs, or personal disasters). Funds are considered taxable if contributors expect to receive services, goods, or another benefit; campaign is for a business, startup, or capital contribution; or funds are provided by an employer for an employee. Funds are typically considered as income in the month funds are disbursed and available to the beneficiary. Remaining funds should be excluded for ongoing months. Funds contributed to launch a business, create a product, or as part of reward-based crowdfunding (i.e., Kickstarter) are generally considered taxable business income and normal business expense deductions may apply.9 If there are any questions, please send them to PAL for review. 2615.10.00 BANK AND OTHER ACCOUNTS Bank accounts refer to funds in a bank, credit union, savings and loan association, or any other financial institution that are usually payable on demand. Bank accounts may be solely or jointly owned. Joint ownership exists when the right to liquidate the account is shared by more than one individual. This section provides information on: • Checking and savings accounts

• Time deposits, including IRAs and Keogh Plans • Guardianship accounts. 2615.10.05 SAVINGS AND CHECKING ACCOUNTS It is assumed that all of the funds in a savings or checking account are owned by and available to the individual designated as owner in the account title. If the account is jointly owned, it is to be presumed that all of the funds belong to each owner.10 The individuals are to be advised of this presumption and given the opportunity to rebut it. If an applicant/recipient rebuts, they are responsible for providing proof of ownership of the funds, which includes a record of deposits and withdrawals from the account.11 Following a successful rebuttal, the funds must be separated and placed in separate accounts. Only the funds actually belonging to the applicant/recipient will then be counted as a resource to the applicant/recipient. The resource value of savings and checking accounts is the balance in the account as of the first moment of the first day in which eligibility is being determined (see IHCPPM 2605.20.00).When determining the balance of a checking account for resource eligibility purposes, any checks that have not cleared the bank as of the date on which eligibility is determined are to be subtracted from the balance. Income is considered income in the month received, and a resource the month following. All income received in the previous month that was intended for that month counts as a resource in the following month. The only exception to this is early payments. For example, social security deposited the check on 01/03, but then deposited the February check early on 01/31. The second social security check should be deducted from the 02/01 bank balance. If a member routinely gets income at the end of the month, it is considered income in the month received and a resource the month after. If there are questions, submit to PAL. Example 1: The RSDI (Social Security) check is deposited on May 31st, but this is a June payment. Because it was deposited a day early, then it is considered as income for the month of June and will not become a resource until July. The RSDI deposit should be subtracted from the June 1st bank balance.

Example 2: As of the first moment of the first of January, the bank balance is $3,800. The member received a deposit of $1,000 on 01/03. A second deposit from the same company is made on January 31st. The last payment was deposited early and is considered income in the month of February. No income can be deducted from the bank balance in January. The beginning bank balance did not

include the $1,000 deposit and the last deposit had no impact on the January budget. • 01/01 balance $3,800 • 01/31 deposit (early deposit) $1,000 January balance total $3,800 The member is over resources for the month of January.

Example 3: Using the same case example as above, the bank balance on February 1st is $2,300 (the member spent the other $1,500). The unearned income direct deposit was made on 01/31, so this should be subtracted from the February budget.

• 01/31 deposit $1,000 • 02/01 balance $2,300 • Subtract 01/31 deposit - $1,000 • 02/01 balance is $1,300 This member is resource eligible for Medicaid in February.

Example 4: On May 15th, a new application is submitted. On the February 1st bank statement (retro month), the first moment of the first day of the month has a bank balance of $10,000. The member/authorized representative included copies of checks that were dated/written on January 31st. The member receives Social Security income in the amount of $1,500. One deposit was made on January 3rd, and a second deposit was made on January 31st. The second deposit is an early deposit intended for the month of February. The second deposit of $1,500 should be subtracted from the February 1st budget as it is income for the month of February and is not considered a resource. The checks that are dated prior to February 1st but not yet cleared need subtracted from the February bank statement. The second and early Social Security check that was deposited on January 31st also needs subtracted from the February 1st bank balance. • 05/15 Application date • 02/01 First retro month with a bank balance of $10,000 Subtract checks written: • 01/31 $2,000 • 01/31 $5,500 • Total = $7,500 • 02/01 balance: $10,000-$7,500 = $2,500 • Subtract the early Social Security deposit of $1,500 Balance $2,500-$1,500 (SS) = $1,000 • The 02/01 bank balance is $1,000. The member is passing resource eligibility for the month of February.

The total value of all bank accounts must be verified at the time of application and at each redetermination. Bank accounts must be verified by documentation obtained directly from the financial institution. In addition to using a bank collateral form, monthly account statements can be utilized to verify bank account balances. 2615.10.05.05 BUSINESS ACCOUNTS (MED 1, 4) When funds are in a bank account that has been properly identified as a business account, it is assumed that the funds are being used for the operation of the business and are not counted as a resource. If a business account is not clearly distinguishable from personal resources, such funds must be considered personal resources when determining resource eligibility. 2615.10.05.10 DEDICATED ACCOUNTS FOR INDIVIDUALS UNDER 18 (MED 1, 4) When past-due SSI benefit payments are paid into a separate dedicated account established solely for the payment of past-due SSI benefits for an individual under 18, these benefits are to be excluded as a resource until all funds in the dedicated account are depleted or until the individual no longer receives benefits from the Social Security Administration (SSA), whichever occurs first. This exclusion continues in any of the following situations:12 • When the child turns 18 years of age and continues to receive benefit payments from the SSA • If the individual receives a new representative payee for the dedicated account • During periods when benefits from the SSA have been temporarily suspended. A dedicated account may be a checking, savings, or money market account. A dedicated account cannot be in the form of certificates of deposit, mutual funds, stocks, bonds, or trusts. However, if the lump sum(s) of past due benefits are deposited into either a Special Needs Trust or a Pooled Trust described in section 2615.75.15, the resources in that trust would be exempt. 2615.10.05.15 VIRTUAL CURRENCY For MED 1 and 4 budgeting, virtual currency, otherwise known as cryptocurrency, is a not exempt and is a countable resource in the Medicaid budget.13 While it is not considered legal tender, it can be used to purchase goods and services. Some virtual currency, such as Bitcoin or Litecoin, can be exchanged for real currency. The current market value (CMV) of the virtual currency is counted as a resource. For the purposes of determining Medicaid eligibility, at the time of the interview or redetermination, the applicant/member needs to provide a current account statement showing the number of virtual coins owned. All virtual currencies for which are listed on the exchange should be determined using that exchange. If the virtual currency is not held on an exchange, utilize “Coinbase” at the following web address: https:

www.coinbase.com to determine the value. The exchange website and the exact exchange rate at the time of verification must be documented in case notes. 2615.10.05.20 PAYMENT PROCESSING APPS Applications such as Venmo, Cash App and others of the same nature may be used as a pass through for the purpose of transferring funds from one account to another. If used solely for that purpose, it would not be considered its own resource. The account to which it is attached must be evaluated for resources and income just as any bank account. Some of these applications offer banking accounts within the application. In that case, the account(s) would be evaluated for resources and income just as any bank account. It would be important to take note of whether the account within the application is also attached to another bank account, which would also need to be evaluated for resources and income. Eligibility staff must determine how the account is being used at the time of the eligibility interview and identify the account accordingly. 2615.10.10 TIME DEPOSITS Time deposits held by financial institutions may be solely or jointly owned. If a time deposit is solely owned, the availability of funds is the deciding factor in determining if the time deposit is a resource. A time deposit such as a savings certificate or certificate of deposit usually is available to the individual and is counted as a resource.14 Verification is to be obtained from the financial institution involved. When a time deposit is jointly owned and available, the worker is to presume that all of the funds belong to each owner. The individuals are to be advised of this presumption and given the opportunity to rebut it. If an applicant/recipient rebuts, then the member is responsible for providing proof of ownership of the funds, which includes a record of deposits and withdrawals from the time deposit account. Immediately following a successful rebuttal, the funds must be separated and placed in separate accounts. Only the funds actually belonging to the applicant/recipient will then be counted as a resource. If funds are not separated, the balance is counted in its entirety by each joint owner. Any interest penalties imposed for withdrawing the time deposit funds prior to maturity are deducted from the total amount when determining the value of the time deposit resource. Interest penalties may involve a reduction in the interest rate and/or loss of interest for a short period of time. In rare instances time deposits cannot be withdrawn prior to maturity under any circumstances. Funds in this type of account are not included as an asset until they reach maturity and become available. Verification of a time deposit certificate from the financial institution must include information on when

the funds can be withdrawn and any penalties for early withdrawal. 2615.10.15 SAFETY DEPOSIT BOX The applicant/recipient must present to the worker a signed statement listing all of the contents of a safety deposit box. The contents must then be evaluated in terms of their count ability as a resource.15

2615.10.20 COLLEGE SAVINGS ACCOUNTS Effective 07/01/2017 College Savings Accounts, such as 529 College Savings Plans, are exempt as a resource. Student funds used for educational expenses are not counted as income.16 2615.10.30 ABLE ACCOUNTS ABLE (Achieving a Better Life Experience) accounts are tax-favored savings accounts established on behalf of designated beneficiaries. ABLE accounts are established to provide secure funding for disability-related expenses and are exempt as a resource for Medicaid. As if 01/01/2026, those who were deemed disabled before age 24, are eligible.17 Prior to 01/01/26, the age limit was 26. ABLE accounts are only recoverable under estate recovery at a member’s passing for those that meet the estate recovery criteria outlined in State rule and federal law.18 2615.15.00 RETIREMENT ACCOUNTS The below policy applies to new applications filed on or after 07/26/2024. Retirement accounts as defined in 405 IAC 2-1-1 (13) are financial plans for providing income when employment ends. They may be in the form of Individual Retirement Accounts (IRAs), Keogh Plans, 401K Plans, pensions, annuities, and work-related plans. Some profit-sharing plans may qualify as retirement accounts. Savings accounts, checking accounts and certificates of deposits held at banks or credit unions are not retirement accounts. Except in the three situations listed below, a retirement account is an available resource to an individual if there is an option of withdrawing an amount for any reason, even though the member is not yet eligible for periodic payments. However, a retirement account is NOT considered an available resource if an individual must terminate employment in order to obtain any payment. Exceptions: • Funds held in an Individual Retirement Account or work-related pension plan, including Keogh Plans, by an ineligible spouse are not counted as resources19. Ineligible spouse means someone who lives with you as your husband or wife and is not eligible for SSI benefits.20

• For M.E.D. Works (MADW and MADI), all retirement accounts are exempt including those owned by the M.E.D. Works applicant/recipient. This exemption applies to such funds held by the member as well as by the spouse. • When the Retirement Account has been annuitized and the member begins to receive regular, periodic payments are being received on a retirement account, the account is no longer a countable resource, and the payments are considered unearned income. If the IRA has sporadic withdrawals, then this is a conversion of resources and is not income but remains a resource.21

The value of a retirement account is the amount that the individual can currently withdraw less any penalty for early withdrawal. Taxes due are not deducted from the retirement account's value. Verification is to be obtained from the administrator of the retirement plan. If there is a delay in payment due to reasons beyond the individual’s control because of the financial organization processing timeframe, it would affect the availability of the resource. The retirement account is presumed available unless there is evidence showing the processing timeframe for a request to withdraw funds. If the timeframe is equal to or less than twenty working days, the account is considered available in all months. If the timeframe is more than twenty working days, the account is considered available after the individual agrees to withdraw the funds from the account and the documented timeframe has passed. If the individual refuses to withdraw the funds, the account is considered available upon the refusal. The value of the retirement account/s of both spouses will be used in the initial calculation of the resource assessment for MCCA (Medicare Catastrophic Coverage Act) budgeting. After the 90-day transfer period as outlined in IHCPPM 2635.10.10.15, an account which is only in the community spouse’s name will no longer be included in the eligibility or post-eligibility (liability calculation) budget. Retirement accounts of both spouses will count in regular budgeting. 22,23 For married couples where both spouses are in an institution, a PACE member or on an HCBS waiver, see IHCPPM 2635.10.10.05 and 2635.10.10.10 for budgeting rules. MCCA budgeting supersedes all other budgeting types.24 Retirement accounts are not counted in the MED 4 budget. Another type of retirement account is intended for self-employed individuals and is often referred to as a Keogh Plan. Funds on deposit in Keogh Plans are counted as resources if the plan does not involve a contractual obligation with anyone who is not an AG member. If the plan includes a contractual obligation with a non-AG member, the money may not be accessible to the AG member and, therefore, is an unavailable resource. The value is the total amount of Keogh, less any withdrawal penalty. If there are any questions regarding the retirement account, please send it to PAL for review.

2615.20.00 BURIAL RELATED RESOURCES Burial related resources include various methods for reserving funds for burial such as prepaid funeral agreements, funeral trusts, life insurance, and burial accounts on deposit in financial institutions. Each assistance program has specific requirements in regard to burial related resources. 2615.20.05 BURIAL ACCOUNTS (MED 1, 4) A burial account refers to a revocable account in which funds are identified to be used for burial purposes. In order for funds or assets to be considered set aside for burial, the account titling must indicate such, or there must be a signed statement by the owner or guardian of the purpose for the funds and the date on which they were set aside. This type of account is available to the owner. If a burial arrangement is irrevocable, it is not to be identified as a burial account. Refer to the following sections on funeral trusts and prepaid funeral agreements which are irrevocable. The policies contained in this paragraph apply to the MA A, MA B, and MA D categories of assistance, in the circumstance of an individual or an institutionalized spouse/community spouse. For each individual or spouse, up to $1,500 of any separately identifiable funds set aside and earmarked for burial in a revocable account are exempt, regardless of beneficiary designation.25 The $1,500 maximum must be reduced by the amount in an irrevocable burial trust or by the face value of any life insurance policies whose cash surrender value (CSV) has been exempted because the face value is $10,000 or less and the beneficiary is the estate or funeral home. Example: Mr. Jones is in a nursing facility. Mr. and Mrs. Jones each have a burial account valued at $1,500. Mrs. Jones also has a life insurance policy with a face value of $1,000. Only $500 of Mrs. Jones' burial account can be exempted. For QMB (MA L), QDW (MA G), SLMB (MA J), and QI (MA I) up to $1,500 of any separately identifiable funds in a burial account are exempt. The exemption applies to the applicant/recipient and to his spouse. The $1,500 maximum must be reduced by the amount in an irrevocable burial trust or any irrevocable prepaid funeral agreement. It must also be reduced by the face value of any life insurance policies whose cash surrender value has been exempted because the face value does not exceed $1,500 regardless of the beneficiary designation. 2615.20.10 FUNERAL PLANNING PROGRAMS (MED 1, 4) There are various methods by which an individual may reserve funds for burial, such as burial accounts, prepaid funeral agreements, funeral trusts, and life insurance. In evaluating any of these entities as resources, workers must carefully apply resource eligibility principles applicable to each program. In most situations, the determination of availability of funds reserved by any type of prepaid funeral arrangement will be based on whether the contract is revocable or irrevocable.

However, a prepaid funeral agreement does not become irrevocable until 30 days after the contract is signed by the purchaser and seller, unless the 30-day period is waived as described below. During the 30-day waiting period the contract can be revoked, and a revocable contract is a countable resource except in the circumstances explained in the previous section. If the funeral agreement was established on or after July 1, 1997, and includes a waiver of the 30-day waiting period or similar language making the trust immediately irrevocable, the funds in the trust are unavailable and exempt beginning on the date the agreement is signed. When necessary, an FSSA attorney should be consulted. Example: Client signs a prepaid funeral agreement on 7/12. The contract is revocable for 30 days, so the value of the agreement is a countable resource for 8/1. The contract becomes irrevocable 30 days after signing, so the value is unavailable and, therefore, not a countable resource for 9/1. When an irrevocable assignment of life insurance (an action which eliminates the owner's right to obtain the cash surrender value) is involved as a means of funding an irrevocable funeral trust, the worker must verify two dates: • The date of the assignment • The date the insurance company accepted the assignment. The date of a legally executed irrevocable assignment of a life insurance policy which will fund a funeral trust is the date that the cash surrender value is considered to be unavailable, provided that the home office of the insurance company subsequently accepts the assignment.26

2615.20.10.05 PREPAID FUNERAL AGREEMENTS (MED 2) The cash value of a prepaid funeral agreement with a funeral home is exempt as a resource, up to a maximum of $1,500. One such exemption is allowable for each member of the AG. The amount of cash value exceeding $1,500 must be counted as a resource.27 However, any prepaid funeral agreement must be reviewed to verify not only its value, but its terms. A determination must be made as to whether the agreement is revocable or irrevocable. Per Indiana statute, a prepaid funeral agreement does not become irrevocable until 30 days after the contract is signed by the purchaser and seller.28 During the 30-day waiting period the contract can be revoked. An FSSA attorney may be consulted in the determination of whether an agreement is revocable or irrevocable. The value of any type of prepaid funeral agreement is considered available to the individual if the contract is revocable, however, the $1,500 exemption explained above is applicable. Refer to Section 2615.20.15 for information regarding funeral trusts. Funds set aside in a financial institution and designated for burial are counted as a resource to the individual.

2615.20.15 FUNERAL TRUSTS A valid irrevocable Indiana funeral trust is an exempt resource regardless of the value of the trust. Indiana's funeral trust statute is found at I.C. 30-2-10 et seq. and applies to funeral trusts established on or after July 1, 1982. I.C. 30-2-9 et seq. is applicable to funeral trusts established after June 30, 1978, but before July 1, 1982. A funeral trust may be valid if there is written evidence of the terms of the trust bearing the signature of the settlor or the settlor’s authorized agent. All funeral trusts must be reviewed to determine that it is valid and irrevocable in accordance with the criteria specified in the applicable statute. The value of the trust must also be verified. If questionable, the funeral trusts can be submitted to PAL for review. If an irrevocable trust is created but is not exempt per policy, then it should be reviewed for a potential transfer of property penalty (see IHCPPM 2640.10.05). Interest earned on an irrevocable trust is also exempt if the interest accrues to the principal of the trust. A funeral trust established in a state other than Indiana must be evaluated in terms of that state's laws. 2615.20.21 DEATH BENEFITS (MED 1, 4) Death benefits, including gifts and inheritances, received by an individual, to the extent that they are not income because they are to be spent on costs resulting from the last illness and burial of the deceased, are not resources for the calendar month following the month of receipt. However, such death benefits retained until the first moment of the second calendar month following their receipt are resources at that time.29 2615.20.20.05 BURIAL PLOTS (MED 2) A burial plot for each participating member of the AG is exempt. This includes a conventional gravesite, crypt, mausoleum, or any other type of repository. 2615.20.20.10 BURIAL PLOTS OR SPACES (MED 1, 4) A burial space or agreement which represents the purchase of a burial space held for the burial of the individual, his or her spouse, or any other member of his or her immediate family is an exempt resource, regardless of value. This includes a conventional gravesite, crypt, mausoleum, urn, or any other type of repository.

2615.25.00 INSURANCE Insurance policies owned by an individual may affect his eligibility and must be identified and evaluated. Types of insurance that may be taken into consideration include: • Life insurance Casualty insurance • Indiana Long Term Care Insurance Sections 2615.25.05.05 through 2615.25.15 discuss how these types of insurance are treated in the eligibility determinations for the different assistance programs. 2615.25.05 LIFE INSURANCE The following definitions are pertinent in the consideration of life insurance as a resource: • The insured is the individual whose life is covered by the policy. • The beneficiary is the individual or entity named in the contract to receive the proceeds of the policy upon the death of the insured. • The owner is the individual who has all rights and privileges of the contract and has the absolute right to liquidate the policy, exercise policy loans, change beneficiary, elect settlement options, determine the manner in which dividends will be treated, or any other rights and privileges granted in the policy. • The face value is the amount stated as such on the face of the policy. • The cash surrender value (CSV) is the amount which the insurer will pay upon cancellation of the policy before death or maturity. This value usually increases as more premiums are paid toward the policy. There are various types of life insurance. However, not all types of life insurance have cash value (for example, term insurance). Policies which have no cash value prior to payment of the death benefit, do not count in the resource determination. The presumption is that the cash value of a life insurance policy is a liquid resource.30 The CSV of insurance is available to the owner unless assigned or in some other manner transferred on the records of the insurance company to the insured or another person. Therefore, insurance is to be considered a resource to the owner and not to the insured if the specific assistance program takes the CSV into consideration. 2615.25.05.10 LIFE INSURANCE VALUE The CSV of a life insurance policy is counted as a resource if the owner is the applicant/recipient or a person whose resources are deemed to the AG.

The owner of a life insurance policy may be indicated on the policy; however, verification of the CSV must be obtained from the insurance company. As this will usually take several weeks, workers must be sure to follow up and, whenever possible, should enlist the assistance of the applicant/recipient and the local insurance office or agent. Awaiting verification of the cash surrender value is a valid extenuating circumstance for pending a case beyond the time standard. If there is no possibility that the CSV will cause excess resources (for example, the policy has been in force a short time and the person's other resources are minimal), the application can be approved prior to receipt of verification of the CSV. Efforts to obtain the CSV, however, must be continued. The CSV must be verified at each redetermination. In cases where resources are close to the resource limits, the cases must be flagged to alert the worker to check resources frequently, at a minimum, on a monthly basis. The Expected Changes screen should be used for this purpose. It is recommended that, at the time of application, workers request that the insurance company verify future cash surrender values as well as the current CSV. 2615.25.05.15 LIFE INSURANCE EXEMPTION (MED 1) The cash surrender value (CSV) of life insurance is exempt when the total face value (FV) of all policies owned by the applicant/member and their spouse (except term insurance and burial insurance) does not exceed $1,500, regardless of the beneficiary designation. If the total face value of any or all polices exceeds $1,500, the CSV is a countable resource. The spouse of the member/recipient is also entitled to have the CSV of life insurance exempted under this provision.31 In order for a trust, an escrow, or a life insurance policy, with a FV that exceeds $1,500 to be exempt as a resource in determining an applicant's or a recipient's eligibility for Medicaid, the applicant or recipient must: • Irrevocably assign the asset to a funeral trust or prepaid funeral agreement, and • Designate to the State of Indiana or the applicant's or recipient's estate to receive any remaining amounts after delivery of all services and merchandise under the contract as reimbursement for Medicaid assistance provided to the applicant or recipient after fifty-five (55) years of age. Once the life insurance policy has been irrevocably assigned to funeral planning (i.e., irrevocable funeral trust or an irrevocable prepaid funeral agreement), only then can it be exempted if it designates the state or the applicant’s/recipient’s estate is to receive any remaining amounts after the goods and services are paid for. If questionable, send it to PAL for review. Example1: Sally has a life insurance policy with a face value of $30,000. The policy was properly transferred over to the funeral home and created an irrevocable funeral agreement which designates the state or Sally’s estate to receive any remaining funds after all services and merchandise have been paid. The life insurance cash surrender would be exempt on the date the funeral agreement is irrevocable

Example 2: A member has a life insurance policy with a face value of $20,000. The policy was transferred over to the funeral home and created an irrevocable funeral agreement which did not designate the State or the estate to receive any remaining funds after all services have been paid. Because the life insurance was transferred to an irrevocable funeral agreement, then it is no longer an available resource. However, the funeral agreement did not designate the State or estate to receive remaining funds after the services have been paid, therefore a violative transfer has occurred. A transfer of property penalty should be imposed. Before the CSV over $1,500 can be exempt, the worker must verify the face value, the owner, the beneficiary, and the insured. Policies which ensure the non-recipient spouse or parent of the applicant/recipient cannot be exempt under this provision. 2615.25.05.20 LIFE INSURANCE EXEMPTION (MED 4) The CSV of life insurance is exempt when the total face value (FV) of all policies (except term policies) does not exceed $1,500, regardless of the beneficiary designation. If the total face value exceeds $1,500, the CSV is a countable resource. Both spouses are entitled to have the CSV of life insurance exempted under this provision, whether or not they are both applicants/recipients. 2615.25.10 INDEMNITY HEALTH INSURANCE, VA AID AND ATTENDANCE PAYMENTS, AND CASUALTY INSURANCE Payments made to covered persons under an indemnity health insurance plan intended to cover costs associated with health care costs incurred by the applicant/recipient are exempt as resources the month the payments are received and the following month. Any payments from the insurance policy that are not spent on health services during the exempted timeframe are deemed countable once this timeframe has passed. This resource exclusion applies to income received for VA Aid and Attendance payments made to the applicant/recipient. The proceeds (including interest earned) of casualty insurance received as a result of damage, destruction, loss, or theft of exempt real or personal property are not to be counted as a resource if the applicant/recipient demonstrates that the proceeds are being used to repair or replace the property. For MED 1 and 4 only, the resource is exempt for a period not to exceed nine months from the date of receipt. If the proceeds from casualty insurance are retained by the applicant/recipient or his spouse or parent after the nine-month period, they must be counted as a resource.32 2615.25.15 LONG TERM CARE PROGRAM-RESOURCE DISREGARD (MED 1, 4) This section applies to all MED 1. Within MED 4, it applies only to QMB (MA L).

The Indiana Long Term Care Program (ILTCP) is jointly administered by the Family and Social Services Administration and the Department of Insurance. An applicant/member and their spouse, who purchases a long-term care policy that is a qualifying policy under the ILTCP, as determined by the Department of Insurance, is allowed a special resource disregard in his Medicaid eligibility determination once policy benefits have been utilized. The amount of the disregard for the applicant and their spouse depends on the type of “asset protection” earned by the qualifying policy. There are two types of disregards depending on the policy: 1) total asset protection; and 2) dollar-for-dollar asset protection. The available policy disregard is in effect for the lifetime of the member and their spouse. Total Asset Protection is available to the individual who purchased a policy or certificate that includes a maximum benefit equal to or greater than the State-Set dollar amount in force on the original effective date of the policy (i.e., when there was a policy agreement). To view the State Set dollar amounts for certain years, please, see the Total Asset Chart here: http://www.in.gov/iltcp/2358.htm. Dollar-for-Dollar Protection is available when the individual does not have Total Asset Protection. The amount of the resource disregard is applicable up to the limit on the policy. Policy benefits are payable for long-term care services provided in a long-term care facility or in the home. Not all long-term care insurance policies qualify for this "asset protection". Workers must verify that a policy is qualified under the ILTCP. Insurance companies who sell qualified ILTCP policies are responsible for documenting the number of benefits paid on behalf of their clients. The first page of the policy will have boxed language stating the policy qualifies for Medicaid asset protection. The insurer must provide a quarterly report to the insured individual summarizing the amount of benefits paid during the quarter and cumulatively since benefits were first paid under the policy, as well as the amount of asset protection earned.33 When an insured individual applies for Medicaid, the insurance company is required to provide the client with a service summary report.34 This service summary is the required documentation that workers will need in order to verify that a policy is qualified under the ILTCP and the amount of the resource disregard to be applied in the Medicaid eligibility determination of an applicant/recipient.

Example 1 - Dollar for Dollar Policy: An individual purchases a dollar-for-dollar ILTCP policy which provides initial policy benefits of 100,000. She enters a nursing facility, and the policy pays out a total of $109,000 (benefits increase due to inflation provision). She then applies to Medicaid and her resources are as follows: • Irrevocable funeral trust $4,000 (exempt) • Certificate of deposit $50,000 • Life insurance cash value $15,000 • Stocks $25,500 • Mutual Funds $20,000 • Total Resources $110,500 • ILTCP disregard $109,000 Countable resources $1,500 Resource Limit $2,000 The applicant is resource eligible.

Example 2 - Dollar for Dollar Policy: An individual purchases a dollar-for-dollar ILTCP policy which provides initial policy benefits of $100,000. She enters a nursing facility, and the policy pays out a total of $109,000 (benefits increase due to Inflation provision). She then applies to Medicaid and her resources are as follows: • Irrevocable funeral trust $ 4,000 (exempt) • Certificate of deposit $50,000 • Life insurance cash value $18,000 • Stocks $25,500 • Mutual Funds $20,000 • Total Resources $113,500 • ILTCP disregard $109,000 Countable resources $4,500 Resource Limit $2,000 The applicant has excess resources, so the application is denied.

Example 3 -Total Asset Policy: An Individual purchased a total asset ILTCP which provides an initial policy benefit of $200,000 in 2005. Thereafter, she enters a nursing facility, and the insurance pays out the maximum benefits, which will be more than the initial benefits depending on when she entered the facility. She then applies to Medicaid and her resources are as follows: • Irrevocable funeral trust $4,000 (exempt) • Certificate of deposit $120,000a • Life insurance cash value $15,000 • Stocks $25,5000 • Mutual Funds $120,000 • Total Resources $280,500 • ILTPC disregard $225,000 Countable resources $55,5000 Resource Limit $2,000 The applicant has excess resources, but all excess resources are disregarded with a total asset policy, because $200,000 is greater than the State-Set amount in 2005, which was $196,994. 2615.30.00 HOUSEHOLD GOODS AND PERSONAL EFFECTS Household goods and personal effects are exempt as resources.35 Household goods are items of personal property customarily found in the home and used in connection with the maintenance and occupancy of the home. They include (but are not limited to) furniture, appliances, kitchen utensils, linens, and television sets. Personal effects are those items of personal property which are worn or carried by an individual. Some examples are clothing, jewelry, and hobby items. 2615.35.00 INCOME-PRODUCING PERSONAL PROPERTY Income-producing personal property consists of items such as farm machinery, livestock, tools, equipment, a vehicle used in a business, business inventory, and furnishings and appliances included with a rental unit. Such personal property may be solely or jointly owned. If an applicant/recipient jointly owns personal property with another applicant/recipient of any assistance group (AG), for any program, proportionate shares of the property are to be assigned to the joint owners and considered as a resource in accordance with the program requirements. (Refer to Section 2605.10.05).

When a non-recipient is one of the joint owners of real or personal property, the availability of the applicant's/recipient's proportionate share must be determined. If the applicant's/recipient's proportionate share is available to them, it is to be considered a resource as required by the specific assistance category, as discussed in the following sections. 2615.35.10 INCOME-PRODUCING PERSONAL PROPERTY (MED 2) The equity value of farm or business equipment is a countable resource. 2615.35.15 INCOME-PRODUCING PERSONAL PROPERTY (MED 1, 4) Items of personal property utilized in the production of income are exempt resources.36 Examples of such are farm machinery, livestock, tools, equipment, a vehicle used in a business inventory, furnishings, and appliances included with a rental unit. This exemption does not, however, include income- producing financial assets such as certificates of deposit, other interest-bearing bank accounts, stocks, bonds, IRA’s and so forth. 2615.40.00 PERSONAL PROPERTY USED TO PRODUCE FOOD Personal property necessary for the production of food for home consumption is also exempt as a resource.37 This would include such things as garden equipment, farm implements, chickens, and livestock. 2615.45.00 STOCKS, BONDS, AND MUTUAL FUND SHARES Stocks, mutual fund shares, and bonds may be solely or jointly owned. If jointly owned, refer to Section 2605.10.05 for instructions regarding jointly owned real or personal property. Stocks, mutual fund shares, and bonds are considered in the eligibility determination as follows: • Stocks and Mutual Fund Shares: The current market value of shares of stock and mutual fund shares can be verified by reviewing the closing or "bid" price listed in the financial section of the newspaper, or by contacting a brokerage firm. The value to be considered as a resource is the current market value less the legitimate expenses related to the sale of the shares. • Municipal, Corporate, and Government Bonds: A bond is a written obligation to pay a sum of money at a future specified date. It is a negotiable instrument and is transferable. The worker must verify the current market value of bonds by contacting a securities dealer. As with stocks and mutual fund shares, expenses related to the sale of a bond must be deducted from the current market value in order to determine the cash value to be counted as a resource. • United States Savings Bonds: A United States Savings Bond is an obligation of the federal government but, unlike other government bonds, it is not transferable in that it can only be sold back to the government.

Although many bonds have a table of values on the reverse side of the bond, it is often inaccurate because the interest rate may have changed since the bond was issued. Therefore, the worker should contact a bank to verify the current value. Also, the Department of Treasury's website can be used to calculate the value of bonds. www.publicdebt.treas.gov/. For determining eligibility under a MED 1 category for a month prior to June 1, 2014, savings bonds are considered immediately available if purchased on or after November 9, 2002.38 This includes, but is not limited to, Series I and Series EE bonds. During the 6-month period following the date of issuance, bonds issued for face value are counted as a resource in the amount of the face value. Bonds issued at face value include Series I and Series HH bonds. Bonds such as Series EE which are issued at less than face value count as a resource in the amount of the purchase price. Bonds which were purchased prior to November 9, 2002, and are in the 6-month post-issuance period, become a countable resource in the sixth month after purchase. For example, a bond with an issue date in August becomes a countable resource in February; if the value of the bond causes excess resources for the recipient, the worker would discontinue Medicaid effective February 1. Series EE U.S. Savings Bonds and I Bonds purchased after February 1, 2003, are not deemed to be available until the 13th month after the date of purchase.39 2615.50.00 MORTGAGES, LOANS, AND PROMISSORY NOTES A negotiable mortgage, loan, or promissory note held by an individual is a countable resource. Such items are negotiable when they can be sold (there is no legal barrier to the transfer of ownership). The value counted as a resource is the amount of the outstanding principal balance. Also, any payment received from the principal is a resource. The interest portion of any such payment is unearned income. If the mortgage loan or note is non-negotiable, it is not a resource. In that case, only the interest payments received are counted as unearned income. A mortgage, loan, or promissory note should be reviewed by FSSA Legal to resolve questions of negotiability. All promissory notes must be sent to PAL for review. 2615.55.00 LAND SALES CONTRACT A land contract must be evaluated according to the requirements of each assistance category. Property which is being sold on contract is to be entered on the real/personal property resource screen. 2615.55.10 LAND SALES CONTRACT (MED 2) When an applicant/recipient is the owner of a contract for the sale of real property, the equity value of the contract is counted toward the resource limit of the AG.

The equity value is equal to the principal balance remaining to be paid on the contract, which is referred to as a land contract or installment contract. Example: A Refugee applicant contracted to sell a piece of real estate for $15,000. To date, $8700 has been paid on the principal. The remainder, $6300, is considered a resource to the applicant. The equity value of a contract is to be considered a resource. Except when the contract contains a clause that prohibits the owner from selling or transferring the contract. In such an instance, the equity value is exempt. However, the portion of the periodic payment that represents payment toward the principal is counted as a resource. 2615.55.15 LAND SALES CONTRACT (MED 1, 4) Land contracts or property agreements must meet the following criteria: • The repayment term must be actuarially sound (it cannot be set up in terms which exceed the applicant/recipient’s life expectancy). See the Life Expectancy Table included at the end of section 2640.10.25.10. • Payments must be made in equal amounts during the term with no deferral of payments and no balloon payments. • 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. If the criteria above are not met, the land contract or property agreement must be treated as a prohibited transfer of resources. Ineligibility periods must be determined and applied. The value of the contract to be considered an improper transfer will be the outstanding balance due as of the date of the individual’s application for Medicaid or date of LTC admission, whichever is later. In the case of HCBS, the balance to be used is the amount as of the date of the waiver approval. Income and resources in the Medicaid budget for the seller should be handled as below. For all land contracts and property agreements: • The down payment is counted as a resource • Only the interest portion of the payment/s is counted as income40 • It is considered a conversion of resources (see IHCPPM 2605.30.00). For land contracts or property agreements meeting the criteria listed in this section: • The principal portion of payments/s is not income

• Amounts paid towards the principle are therefore a countable resource as soon as received • Principal amounts should not be deducted from bank balances or reports of cash on hand or put into a Miller Trust • Excess accumulation of these amounts could make the member over resources and may need to be monitored by the worker as explained in 2605.40.00 • The property itself is not a countable resource because the seller cannot legally convert it to cash while it is encumbered by the non-negotiable agreement. The property agreement or promissory note has an assumed resource value based on the outstanding principal balance unless the individual furnishes evidence that it has a lower cash value. For land contracts which do not meet the criteria in this section, the outstanding principal on the negotiable agreement is considered a countable resource. 2615.60.00 VEHICLES MED 1 & 4 have different requirements for considering vehicles than MED 2. Requirements may differ between the Medicaid categories. The following sections describe how to determine the resource value of vehicles. 2615.60.05 DEFINITION OF VEHICLE A vehicle is any conveyance that provides transportation of persons or goods from place to place. Automobiles, trucks, vans, motorcycles, mopeds, boats, snowmobiles, and so forth are classified as vehicles.41 2615.60.15 TREATMENT OF VEHICLES (MED 2) Each AG is allowed an exclusion of $5000 of the equity in one vehicle. Equity is the vehicle's fair market value less any liens. If more than one vehicle is owned, the equity in each vehicle is to be determined. Since the $5000 disregard can be applied to only one vehicle, it is to be applied to the vehicle with the highest equity value. No amount is excluded from the equity value of the remaining vehicle even if the value of the first vehicle is less than the $5000 disregard. 2615.60.20 TREATMENT OF VEHICLES PRIOR TO JUNE 1, 2014 (MED 1, 4) As of June 1, 2014, this section no longer applies. 2615.60.20.05 TREATMENT OF VEHICLES This section explains the treatment of vehicles.

One vehicle is exempt regardless of its value if it’s used for transportation of the applicant/member or a member of their household.42 If the applicant/member transfers a vehicle out of their name and it is not considered an allowable transfer of property, then it should be evaluated for a transfer penalty (see IHCPPM 2640.10.15). If there is more than one vehicle, the one with the highest equity should always be the one that is exempt. The equity value of other vehicles is counted as a resource. If the other vehicle is being used for production of self-employment income, and there is question if it is an available resource, please contact PAL. The equity value is the fair market value minus total liens. 2615.60.25 RECREATIONAL VEHICLES AND EQUIPMENT Recreational vehicles such as campers, trailers, and boats must be counted according to their current equity value. If the recreational or other vehicle serves as the AG's home, it should be evaluated according to the guidelines in IHCPPM 2620.15.10. 2615.65.00 NON-RECURRING LUMP SUM PAYMENTS A lump sum payment may include retroactive benefits such as SSI, Social Security, and VA benefits. A lump sum may also be a refund of Medicare Part B premiums, an insurance settlement, an inheritance, a 13th PERF check or other such non-recurring payment. Retroactive lump sum payments from Social Security (i.e., SSI, RSDI, or SSDI) are exempt as resources for nine (9) months.43 2615.70.00 LIFE CARE CONTRACT (MED 1, 4) An individual may have entered into an agreement with an institution in which the individual transferred their available assets to the institution in exchange for full maintenance and medical care in the institution for life. Such individual would normally be ineligible for assistance, as the institution has a legal responsibility to provide care even if the individual's resources are exhausted. However, in the event the facility claims that the conditions of the contract are no longer applicable because the facility is financially unable to fulfill its legal responsibilities under the contract, the facility must prove this allegation. The DFR must require an accounting from the facility as to: • The amount of income and resources the individual assigned to the facility upon admission • The cost of the individual's care as paid by the facility

• Amount of assets refunded to the individual Amount of assets retained by the individual. If such documentation proves the facility's allegation that the individual's funds have been expended on their care, then the individual can be eligible for Medicaid.44

2615.75.00 TRUST FUNDS All trusts which involve a member of the AG must be carefully evaluated to determine whether or not the trust principal will be counted as a resource. 2615.75.05 TRUST FUNDS ESTABLISHED PRIOR TO AUGUST 11, 1993 The date on which a trust fund was established is a determining factor as to how the trust will be treated for Medicaid eligibility purposes. A change in federal law (OBRA-93) governs the treatment of trusts established on and after August 11, 1993, and is explained in next Section 2615.75.20. A trust which was established prior to 8-11-93 by the applicant/recipient or his/her spouse as grantor with the applicant/recipient or spouse as the beneficiary is referred to as a "Medicaid qualifying trust". Unless such a trust was created in a will (i.e., a testamentary trust) or was created prior to 4-7-86 solely for the benefit of an intellectually disabled individual residing in an ICF/IID, the principal of the trust is a countable resource. The amount to be counted as a resource is the maximum amount available to the beneficiary if the trustee were to exercise full discretion for distribution of the funds according to the terms of the trust. The trust is counted as a resource regardless of whether it is revocable or irrevocable, and whether or not the trustee actually exercises their full discretionary authority as allowed by the trust. A trust established by the individual's guardian or legal representative, who is acting on behalf of the individual, falls under the definition of a Medicaid qualifying trust. In reviewing trust funds established prior to August 11, 1993, which do not meet the definition of a Medicaid qualifying trust, including testamentary trusts and those created prior to 4-7-86 for an intellectually disabled individual residing in an ICF/IID, the DFR must determine the "availability" of the trust. Refer to Section 2605.15.00 for the definition of availability. 2615.75.10 TRUST FUNDS ESTABLISHED ON AND AFTER AUGUST 11, 1993 The policies in this section are applicable to trust funds established, other than by a will, on and after August 11, 1993, and are effective October 1, 1993.45 A trust fund is subject to the provision in this section if the trust is funded with assets of the applicant/recipient or spouse and is established by: • The applicant/recipient • The spouse of the applicant/recipient

• Anyone, including a court or administrative body, with legal authority to act on behalf of the applicant/recipient or spouse Anyone, including a court or administrative body, who is acting at the direction or request of the applicant/recipient or spouse. Refer to Section 2615.75.15 which explains the types of trust funds which are exempt from these provisions. These provisions apply if assets of the applicant/recipient were used to fund all or part of the trust. If other person(s)' assets are included, the portion of the trust representing the individual's assets will be evaluated for resource eligibility purposes. A revocable trust is considered as follows: • The entire trust principal is an available countable resource • Any payments made from the trust to or for the benefit of the individual are counted as income • Any payments from the trust which are not made to or for the benefit of the individual must be evaluated as a transfer of property. The look-back period for a transfer in this circumstance is 60 months. An irrevocable trust is considered in the following manner. If the terms of the trust allow for payments to or for the benefit of the individual, under any circumstances, the following rules apply to that portion of the trust: • Payments from trust income or principal are treated as income • Trust income which could be paid (but isn't being paid) is treated as an available resource • The portion of the trust principal which could be paid (but isn't being paid) is treated as an available resource • Payments made from the trust income or principal to another individual (and not for the benefit of the applicant/recipient or spouse) must be evaluated as a transfer of property. The look-back period for a transfer in this circumstance is 60 months • If the terms of the trust do not allow part or all of the trust income or principal to be paid to or for the benefit of the individual under any circumstance, the value of that portion of the trust must be evaluated as a transfer of property. The look-back period in this situation is 60 months. Payments made from revocable or irrevocable trusts are considered as being paid to the individual if such payments are paid directly to the individual or to someone acting on their behalf such as a guardian. A payment for the benefit of the individual is one from which the individual derives a distinguishable benefit. Some examples include the purchase of clothing and items for personal use such as a radio or television, and payment of the individual's utilities or rent. These payments are counted as income to the extent that they would ordinarily be counted as income for eligibility purposes. For example, if a

trust pays the individual's medical expenses, the payment made directly to the medical provider is not countable income. Similarly, a payment to a utility company is income-in-kind, but only countable income-in-kind in accordance with Section 2815.15.00. 2615.75.15 CERTAIN TRUSTS RECEIVING SPECIAL CONSIDERATION The trust provisions explained in the preceding Section 2615.75.10 do not apply to certain special needs trusts and pooled trusts as well as Miller trusts defined below. The following trusts should not be considered countable resources. Special Needs Trust: This is a trust containing the assets of a disabled applicant/recipient under age 65, which is set up by the applicant's/recipient's parent, grandparent, legal guardian or by a court, and is established for the sole benefit of the applicant/recipient. A trust established on or after December 13, 2016, by an individual with a disability under age 65 for his or her own benefit can qualify as a special needs trust, conferring the same benefits as a special needs trust set up by a parent, grandparent, legal guardian, or court.46 The individual must be disabled according to SSI criteria. Such a trust must contain a provision specifying that, upon the death of the individual, the State will receive all amounts remaining in the trust up to the total amount of Medicaid benefits paid on the individual's behalf.47

Pooled Trusts: A pooled trust is a trust containing the assets of a disabled applicant/recipient (disabled according to SSI criteria) which meets the following conditions:48 • The trust is established and maintained by a non-profit association • A separate account is maintained for each of the beneficiaries, but for investment and management purposes the funds are commingled • The trust account is established by the applicant/recipient or their parent, grandparent, legal guardian or by a court for the sole benefit of the applicant/recipient • There is a provision which specifies that upon the death of the beneficiary, any funds not retained by the trust will be paid to the State up to the total amount of Medicaid benefits paid on the individual's behalf. Miller Trust (Qualified Income Trusts): A Miller Trust (or Qualified Income Trust (QIT)) is a unique trust that allows persons residing in long-term care facilities, PACE members or receiving home-and- community-based-services through a 1915(c) waiver (see IHCPPM sections 3305.00.00 and 3320.10.00) who have personal income above the Special Income Level (SIL) (see IHCPPM sections 3455.14.00 and 3010.20.15) to be considered Medicaid eligible. A Miller Trust may be established for a Medicaid applicant/recipient who is a beneficiary of the trust by the applicant/recipient’s Authorized Representative for Medicaid eligibility purposes, legal guardian, power-of-attorney (POA), or family member if the applicant/recipient is incapacitated as shown with documentation from a licensed physician.49 A Miller Trust is one that:

• Is funded only by the income of the beneficiary including accumulated interest on that income. The trust will not be funded with the beneficiary’s resources, nor income or resources of other people. • Upon the death of the beneficiary, the State of Indiana will receive all remaining funds in the trust up to the amount of Medicaid expenditures paid on the individual’s behalf. A transfer of resource penalty does not apply to a Miller trust if the trust is: • Established for the benefit of an individual; and • Funded solely by the income of an individual, including accumulated interest. The Miller trust described in this subsection can be revocable or irrevocable. Under 42 U.S.C. 1396p(d)(4)(B)(ii), upon the death of a beneficiary, the state of Indiana receives the remaining funds in a Miller trust up to the amount of Medicaid expenditures paid on the member's behalf. Allowable distributions from a Miller Trust may include the following: • A monthly personal needs allowance for a primary beneficiary if they are depositing their entire income into the trust • A monthly amount to the spouse of a primary beneficiary sufficient to provide but not exceed the minimum monthly maintenance needs allowance for the spouse, as provided by Title XIX of the Social Security Act • Incurred medical expenses of a primary beneficiary • The cost of medical assistance provided to a primary beneficiary, such as the patient liability. A Miller trust must be funded at least each month in the amount of the beneficiary's monthly income exceeding the SIL. Funds in a Miller trust must: • Be maintained in a separate account from any other account; and • Not be commingled with other accounts.50 With the exception of funeral trusts and Miller trusts, trusts should be sent to OMPP through the PAL system to make a determination of validity and exemption. 2615.75.20 OTHER TRUSTS NOT GOVERNED BY OBRA-93 Trusts established on or after August 11, 1993, that are not governed by OBRA-93 must be reviewed for the purpose of determining the "availability" of the trust. Some examples are trusts created by a will

(testamentary trust) or by a third party other than a spouse or someone acting on behalf of the applicant/recipient and funded with the assets of another person(s). 2615.80.00 LEGAL GUARDIANSHIP/REPRESENTATIVE PAYEE (MED) An individual who serves as legal guardian/representative payee for another person is responsible for administering that person's funds and will be listed in bank records as having access to their bank accounts. Resources that are managed by an individual's legal guardian, representative payee, or other person acting as an agent on behalf of the applicant/recipient are counted as resources to the individual. The resources are not counted as being available to the guardian/payee for their own use. However, the resources must be held in a form that clearly shows they belong to another individual. For example, a bank account that is held by the guardian/payee must be clearly designated as being administered by the guardian/payee on another person's behalf. 2615.90.00 PRORATED INCOME Income that is prorated (educational income, self-employment income) cannot be counted as a resource for any month during the prorated period. 2615.95.00 PRESUMPTION OF LIQUIDITY (MED 1) Resources are explained as real property or personal property that is owned solely or jointly by an individual (refer to Section 2605.05.00). These property types are generally broken down into two categories: liquid and non-liquid. Liquid resources consist of personal property which can be converted to cash within 20 working days. See Section 2605.05.00 for examples of resources which are ordinarily liquid. Liquid resources, other than cash, are evaluated according to the individual's equity in the resources. 51 Non-liquid resources consist of all real property and some personal properties which cannot be converted to cash within 20 working days. For treatment of non-exempt real property, refer to Section 2620.20.00. For purposes of this section, it is assumed that the following types of personal property are non-liquid: loan agreements automobiles, machinery, livestock, noncash business property. It is presumed that all other types of personal property not contained in the list are liquid, can be converted to cash within 20 workdays and are countable as resources.

A person may overcome this presumption with documentary evidence. For example, if a presumed liquid asset cannot be converted to cash within 20 working days from the date the person requests the funds from the account, there must be documentary evidence, from the financial institution, showing that the request has been received and at what point such funds will be available to the individual. Such requests must be submitted to PAL for review. Once the funds are withdrawn, if retained, they will be considered countable upon the first moment of the first day of the following month. In this situation, if verification from the financial institution is received clearly displaying that a member is unable to liquidate a resource within 20 days, send to PAL for review. 2620.00.00 TYPES AND VALUE OF REAL PROPERTY RESOURCES Real property consisting of land, which includes buildings or immovable objects attached permanently to the land, is to be evaluated as a resource according to the requirements of each assistance category. 2620.05.00 REAL PROPERTY OWNERSHIP Real property is to be considered as a resource according to the requirements of each assistance category and the type of ownership of the property. (Refer to Sections 2605.05.00 and 2605.25.10.) Ownership of real property can consist of an interest in the title as follows: • Sole Ownership: When property is solely owned by one individual, only the individual or their legal guardian may sell the ownership interest without conditions imposed by others. The individual is legally entitled to all income which may be generated from the property. • Joint Ownership: Joint ownership is the holding of property by two or more people who have an equal interest in the whole property. At the death of one of two joint owners, the survivor usually becomes the sole owner. At the death of one of three or more joint owners, the survivors become joint owners. o If an applicant/recipient jointly owns real property with another applicant/recipient of any assistance program, proportionate shares of the property are to be assigned to the joint owners and considered as a resource in accordance with the program requirements. o When a non-recipient is one of the joint owners of real property, the availability of the applicant's/recipient's proportionate share must be determined. (Refer to Section 2605.15.00.) If the applicant's/recipient's proportionate share is available to them, it is to be considered a resource as required by the specific assistance program. If the applicant's/recipient's proportionate share is not available to them, the resource is exempt. • Ownership in Common: An ownership in common is the holding by two or more persons of separate titles in the same real estate. Each owner has a divided interest in the whole property. There is no right of survivorship to ownership in common. It is not joint ownership. • Ownership by Entirety: Ownership by the entirety refers to property owned by a husband and

wife whereby each member has ownership interest in the whole property which is indivisible. Upon the death of one, the survivor becomes sole owner. When a marriage has been legally dissolved, the former spouses become owners in common of the property. o Ownership of real property can also consist of a legal right to the use of property without having title to it. • Life Estate: A life estate conveys to an individual certain rights in property for their lifetime. The owner of a life estate generally has the right of possession and use the property, as well as the right to obtain profits from the property, and to sell their life estate interest. However, the deed establishing the life estate may restrict one or more rights of the individual. Ownership of a life estate interest may affect eligibility for certain assistance programs. (Refer to Section 2605.25.10.05.) • Remainder Interest: When an individual conveys property to one person for life (life estate holder) and to a second person (the remainderman) upon the death of the life estate holder, both a life estate interest and a remainder interest are created in the property. A remainderman cannot sell their interest in the property while the life estate holder is alive, unless otherwise specified in the deed. At the death of the life estate holder, the remainderman will hold full title. (Refer to Section 2605.25.10.05.) • Reversion Interest: When an individual owner conveys property to another person for life (life estate holder) and to themselves (the reversioner) upon the death of the life estate holder, both a life estate interest and a reversion interest are created in the property. A reversioner cannot sell the property while the life estate holder is alive. At the death of the life estate holder, the reversioner would hold full title. (Refer to Section 2605.25.10.05.) 2620.10.00 VERIFICATION OF REAL PROPERTY OWNERSHIP Ownership of real property can be verified from one or more of the following sources: • Deed • Mortgage • Property tax receipts (current only) County treasurer's records, or Title search. 2620.15.00 EXEMPT REAL PROPERTY RESOURCES Certain real property is exempt from being considered as a resource. This determination is program specific so that the exemption or non-exemption of real property must be in accordance with program requirements as explained in the following passages. 2620.15.10 THE HOME (MED 1, 4) A home is exempt when it is the principal residence of any of the following: • The applicant/recipient

• The spouse of the applicant/recipient • The parent of an applicant/recipient under age 18 • The biological or adoptive child under age 18 of the applicant/recipient • The biological or adoptive disabled or blind child age 18 or older of the applicant/recipient.52 The home is defined as the shelter in which the individual resides, the land on which the shelter is located, and related outbuildings. In order to be considered part of the home, the surrounding land must adjoin the plot on which the home is located and not be separated from it by intervening real property owned by others. (A road does not separate land). Such property remains exempt until it is verified that none of the people listed above intends to reside there or is physically able to reside there.53 Whenever there is a conflict between an individual's stated intent to return home and their apparent physical capability to do so, the worker is to obtain documentation from the individual's physician. 2620.15.10.05 HOME REPLACEMENT (MED 1, 4) The proceeds from the sale of an exempt home can also be exempt from consideration under certain conditions. If, within a specified time period, the proceeds are used (or obligated to be used) to purchase a replacement home and cover the costs incurred in occupying it, the proceeds can be disregarded. The individual must be committed to the transactions within the "home replacement period", the time period beginning with the date of the receipt of the proceeds and ending on the last day of the third full month following receipt of the funds. 2620.15.20 INCOME-PRODUCING REAL PROPERTY (MED 1, 4) Income-producing property is exempt if the income from it is greater than the expenses of ownership. This exemption also applies to property being sold on land contract. The ownership of income-producing property must be verified to determine who is legally entitled to the income from the property. 2620.15.25 FOOD-PRODUCING REAL PROPERTY (MED 1, 4) Real property used for producing food for home consumption is exempt.54 An example of such property would be a garden plot. 2620.15.30 REAL PROPERTY OWNED BY A COMMUNITY SPOUSE (MED 1) For purposes of Medicaid eligibility, when the resources of an institutionalized spouse and a community spouse are assessed to establish the amount of combined resources for spousal share determination, the equity value of real property owned solely by the community spouse (or jointly with someone other than the institutionalized spouse) is not included. Additionally, such property is not considered in the resource eligibility determination of the institutionalized spouse.

2620.20.00 TREATMENT OF NON-EXEMPT REAL PROPERTY Real property that is not classified as exempt is taken into consideration in the resource eligibility determination. Nonexempt real property must be considered under the requirements of each assistance program as explained in the following passages. 2620.20.10 OFFERING REAL PROPERTY FOR SALE OR RENT (MED 1) If non-exempt real property causes an applicant/recipient to be over resources for Medicaid and it is available, it must be offered for sale or rent at fair market value (FMV), unless the applicant/recipient is in a long-term care facility and has a community spouse.55 (For the definition of real property, see 2605.05.00.) This requirement is also applied to ownership of a life or remainder interest in the property and to a life or remainder interest in mineral rights. For policy regarding exempt real property, see 2620.15.10. When it is determined that the applicant/recipient or their financially responsible relative’s own property which is not exempt and is available, the owner of the property must sign the form, FI 0118, Agreement to Offer Property for Sale or Rent and Repayment Agreement. If the owner of the property refuses to sign the form, the applicant/recipient is ineligible for Medicaid. If the property owner complies and signs the form, FI 0118, they have 30 days from the date they signed the form or from the date the notice of eligibility is mailed, whichever is later, to offer the property for sale or rent at CMV. When the form is signed, it is effective “for the purposes of the application”, that is, inclusive of retroactive months for that application date. To be considered offered for sale or rent, a sign must be placed at a conspicuous location on the property, stating clearly that the property is for sale (or for rent) and giving the individual's name and address (or telephone number), or listing the property with a realtor. When the AG owns property that is not exempt and is available, enter a "?" on screen real/personal property resource in the "agree to sell" and "agree to rent" fields, unless the nonexempt property is currently for sale or rent. If the eligibility system determines that it must be offered for sale or rent, the case will be pended and indicated on the Resource Eligibility Determination/Transfer Results screen. When the property owner is contacted and signs the Form 0118, Agreement to Offer Property for Sale or Rent and Repayment Agreement, access the Real/Personal Property Resources screen, change the "?" to "Y" and enter the date it was signed. (If the owner refuses to sign it, enter "N" in the appropriate fields.) If "Y" was entered, the resource eligibility determination/transfer results screen will then indicate the client has passed resource eligibility. The eligibility system will monitor the 30-day period that is allowed to offer the property for sale or rent, and the system will generate an alert. When the property owner signs the Form 0118A, Report on Property for Sale or Rent, access the real/personal property resource screen and enter "Y" in the appropriate field. If the owner does not offer the property for sale or rent, enter "N" in the appropriate

field and assistance will be discontinued.56 2620.20.10.05 OFFERING REAL PROPERTY FOR SALE OR RENT (MED 4) The provision requiring nonexempt real property to be offered for sale or rent as is explained in the preceding passage, 2620.20.10, can be invoked only if the equity value of the real property causes excess resources. If the applicant/recipient is within the applicable resource limitation when the equity value of nonexempt real property is counted, the property owner is not required to agree to offer it for sale or rent. If the equity value does cause excess resources, the agreement to offer the real property for sale or rent must be signed. When the AG owns nonexempt real property, enter it as unverified on the real/personal property resource screen in the "agree to sell" and "agree to rent" fields, unless the nonexempt property is currently for sale or rent. If the eligibility system determines that it must be offered for sale or rent, the resource eligibility determination/transfer results screen will display the number of excess resources in the "sale/rent" field, and the case will be pended. Follow instructions in Section 2620.20.10 regarding compliance with the requirement to offer the property for sale or rent. 2625.00.00 PLAN FOR ACHIEVING SELF-SUPPORT There are two kinds of Plans for Achieving Self-Support (PASS). One is an SSI PASS which is approved by the Social Security Administration for SSI eligibility purposes. The other is a Medicaid PASS which is approved by the Division of Family and Resources, Central Office, for Medicaid eligibility purposes. MED 1 and MED 4 have provisions to exempt resources specified in a PASS under certain circumstances as explained in the following two sections. Med 2 has no provisions to exempt a PASS. 2625.10.00 PLAN FOR ACHIEVING SELF-SUPPORT (MED 1, 4) The policies explained in this section apply only to the MA B, MA G, MA L, SLMB (MA J), and QI (MA I) categories of assistance. A PASS can be developed for an individual who needs to set aside a part of their resources for a specified period of time necessary to achieve an occupational objective. The resources could be used for current expenditures or saved for a later planned expenditure to achieve a work-related goal such as education, vocational training, starting a business, or purchasing work-related equipment. For individuals in the MA B category (SSI recipients and non-SSI recipients) as well as non-SSI recipients in the MA L, MA G, MA J, and MA I categories, a PASS must be approved by the Office of Medicaid Policy and Planning (OMPP).57 In order for a PASS to be approved, the DFR must submit a letter to the OMPP containing: • The description and objectives of the plan as discussed with the applicant/recipient

• The source and amount of all income and/or resources and the amounts of each that are to be used in the plan • The length of time the plan is to operate • Any other pertinent information including documentation from the Social Security Administration of an SSI recipient's approved PASS. This letter is to be recorded in the case record with one copy being given to the applicant/recipient, one copy being sent to the OMPP Eligibility Unit at 402 W. Washington Street, MS 07, W374, Indianapolis, IN, 46204, and one copy being retained in the case record. The OMPP will forward a copy to the Blind and Visually Impaired Section of the DMHA for their recommendation. OMPP will then review the self- support plan and recommendation from the Blind and Visually Impaired Section of the Division of DMHA and notify the DFR by letter of approval or disapproval. The DFR will then notify the applicant/recipient. If the plan is approved, the amount of income and resources disregarded and time period for the disregard, must be documented in the case record. A Medicaid approved PASS is coded in the eligibility system as PM. In the QMB, QDW, SLMB, and QI eligibility determinations of SSI recipients who have a PASS approved by the Social Security Administration, a separate approval from the Central Office is not required. A copy of SSA's documentation should be obtained and filed in the case record. An SSI PASS is coded in the eligibility system as PS. A PASS under the MA B category can be approved for a period not to exceed 12 months. For MA L, MA G, MA J, and MA I the PASS exemption will be for at least 18 months and may be extended up to 36 months. 2626.00.00 INDEPENDENCE AND SELF-SUFFICIENCY ACCOUNTS (MED 1) This section applies to MADW and MADI. Funds that have been set aside by the applicant/recipient for “independence and self-sufficiency” are disregarded as resources in an amount up to $20,000 as approved by the Central Office of the Family and Social Services Administration.58 The purpose of an Independence and Self-Sufficiency Account (ISSA) is to allow the MEDWorks member to save money in order to purchase goods or services that will increase or maintain their employability or independence. An ISSA will not be approved for any item or service that the person is entitled to receive under Medicaid or any other public program. Accounts for general savings or personal recreation will not be approved. State Form 50929, MEDWorks Request for Independence and Self-sufficiency Account, is to be provided to any Medicaid applicant or recipient in MADW/I who answers “Y” to the question on the Disabled Worker Information screen. A 30-day due date is to be specified; however, a denial of an

application or discontinuance of benefits for failure to turn in the ISSA form i.e., “failure to cooperate” is not appropriate. If the form is not submitted by the individual within 30 days, the response to the question must be changed from “Yes” to “No”. The applicant can submit the form at any time while the application remains pending. Workers should provide the State Form 50929 to any applicant/recipient who asks for it or who indicates the possibility of saving for an ISSA. However, a “yes “response should be entered on the Disabled Worker Information screen only when the applicant/recipient answers the question definitively, or at some time after the interview submits a completed form. Example 1: Applicant #1 states in their application interview that they are saving money on a down payment for a car and they do want consideration for this as an ISSA. The worker completes the top portion of the form, enters the 30-day due date, signs and dates it, and gives it to the client. A determination of excess resources cannot be made on #1’s application during the 30-day time frame or while the Central Office is reviewing the ISSA request.

Example 2: During Recipient #2’s redetermination interview, the applicant/recipient says they are thinking about how they might use an ISSA to help themselves get a better job. They don’t have definitive plans and do not have excess resources at the time. The worker completes the top portion of the form but does not give a due date and enters “No” on AEDWI. Recipient #2 is determined to remain eligible and MADW is authorized. Several weeks later, the worker receives the completed Form 50929. The worker signs it, enters “yes” on the Disabled Worker Information screen, and forwards the form to Central Office. The Central Office will review the request in accordance with state law and regulations, make a decision, and enter it on the Disabled Worker Information screen. The decision will be sent to the applicant/recipient and a copy to the worker. The eligibility system will send an alert. An ISSA does not have to be a separate account in order to be disregarded. The disregard will be applied to the person’s total liquid assets. It is applied only to resources owned by the applicant/recipient or owned jointly with the applicant’s/recipient’s spouse. The disregard cannot be applied to resources owned solely by the spouse. An approved ISSA must be reviewed by the worker at each redetermination. If the estimated date that the items/services were to be purchased has passed and the item/service has not been purchased, the recipient must submit an updated request Form 50929. If the recipient does not do so within 30 days, the worker is to send an e-mail to the PAL Mailbox on Outlook. It is not necessary for these e-mails to PAL to go through the Policy Contact Person at the local DFR office. The worker can send them directly by entering in the subject field “ISSA UPDATE”. Do not include the recipient’s name or case number in the subject field. The Central Office will then end date the ISSA, and it will no longer be an allowable resource disregard. MEDWorks members have an obligation to report any changes in their ISSA. If their plans or goals change, they must report this to the DFR. If a request for an ISSA is disapproved or the amount is

reduced, the individual has the right to appeal this determination. The letter of decision that Central Office issues will explain these obligations and appeal rights. 2627.00.00 HEALTH SAVINGS ACCOUNTS Health Savings Accounts are exempt as a resource if the account is restricted to use for qualified medical expenses only. The terms of the Health Savings Account are required to be verified to determine if the account can be used for purposes other than qualified medical expenses. 2630.00.00 RESOURCES EXEMPTED UNDER FEDERAL LAW Each program has specific resources which are exempt by federal law. These exemptions are discussed in the following sections. 2630.05.00 BENEFITS UNDER FEDERAL NUTRITION PROGRAM Certain benefits which are intended to meet the nutritional needs of low-income individuals are exempt.59 2630.05.05 WIC BENEFITS Benefits received through the Women's, Infant's, and Children's (WIC) Program is exempt. These payments are usually made through vouchers and can be used to purchase specific items for pregnant or nursing women and young children. 2630.05.10 OLDER AMERICANS ACT Benefits received under Title VII, Nutrition Program for the Elderly of the Older Americans Act of 1965, as amended, are exempt. 2630.05.15 CHILD NUTRITION ACT The value of supplemental food assistance received under the Child Nutrition Act of 1966, as amended, is exempt.60

2630.05.20 NATIONAL SCHOOL LUNCH ACT The special food service program for children under the National School Lunch Act, as amended, is exempt.61

2630.05.25 FOOD STAMPS/COMMODITIES The value of food stamps and the value of United States Department of Agriculture donated foods (surplus commodities), are exempt.62

2630.10.00 HUD ASSISTANCE Housing assistance paid directly or indirectly by HUD under the following is exempt: • The Housing Authorization Act of 1976 with respect to a dwelling unit under the United States Housing Act of 1937, as amended (Sections 8, 10, and 23 and the Experimental Housing Allowance Program) • The National Housing Act (loans for housing renovation, mortgage insurance, and investment insurance) • Title V of the Housing Act of 1949 (loans to elderly individuals, farmers, and developers for the construction, improvement, or replacement of farm homes and other buildings) • Section 101 of the Housing and Urban Development Act of 1965 (payments to certain mortgagors on behalf of tenants with low income who are displaced by government action, age 62 or over, physically handicapped, living in substandard housing, present or past tenants of dwellings damaged or destroyed by disaster, or whose head of the household is on active duty with the armed forces).63 2630.15.00 RELOCATION ASSISTANCE ACT PAYMENTS Relocation assistance provided under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 is exempt.64 2630.20.00 HOME ENERGY ASSISTANCE PAYMENTS Payments received through the Home Energy Assistance Program (EAP) are exempt.65 2630.25.00 ASSISTANCE FOR CERTAIN INDIAN TRIBES/ALASKAN NATIVES The following Section discusses federal law pertaining to Indian tribes and Alaska natives. • P.L. 92-203, section 29, dated 1/2/76, the Alaska Native Claims Settlement Act, and Section 15 of • P.L. 100-241, 2/3/88, the Alaska Native Claims Settlement Act Amendments of 1987 - All • compensation (including cash, stock, partnership interest, land, interest in land, and other benefits) received under this Act are excluded from income and resources. • P.L. 93-134, the Judgment Award Authorization Act, as amended by P.L. 97-458, Section 1407, 11/12/83 and P.L. 98-64, 8/2/83, the Per Capita Distribution Act. P.L. 97-458 required the

exclusion of per capita payments under the Indian Judgment Fund Act (judgment awards) of • $2,000 or less from income and resources. The exclusion applies to each payment made to each individual. Initial purchases made with exempt payments distributed between 1/1/82 and 1/12/83 are excluded from resources to the extent that excluded funds were used. P.L. 98-64 extended the exclusion to cover per capita payments from funds which are held in trust by the Secretary of Interior (trust fund distributions). • P.L. 93-531, Section 22 - Relocation assistance payments to members of the Navajo and Hopi Tribes are excluded from income and resources. • P.L. 94-114, Section 6 - Income derived from certain sub-marginal land held in trust for certain Indian tribes is excluded from income and resources. The tribes that may benefit are: • Bad River Band of the Lake Superior Tribe of Chippewa Indians of Wisconsin • Blackfeet Tribe • Cherokee Nation of Oklahoma • Cheyenne River • Sioux Tribe Crow Creek Sioux Tribe • Lower Brule Sioux Tribe • Devils Lake Sioux Tribe • Fort Belknap Indian Community • Assiniboine and Sioux Tribes • Lac Courte Oreilles Band of Lake Superior Chippewa Indians • Keweenaw Bay Indian Community • Minnesota Chippewa Tribe • Navajo Tribe • P.L. 94-189, Section 6, 12/31/75 - Funds distributed per capita to the Sac and Fox Indians or held in trust are excluded from income and resources. The funds are divided between members of the Sac and Fox Tribe of the Mississippi in Iowa. The judgments were awarded in Indian Claims Commission dockets numbered 219, 153, 135, 158, 231, 83, and 95. • P.L. 94-540 - Payments from the disposition of funds to the Grand River Band of Ottawa Indians are excluded from income and resources. • P.L. 95-433, Section 2 - Indian Claims Commission payments made pursuant to this Public Law to the Confederated Tribes and Bands of the Yakima Indian Nation, and the Apache Tribe of the Mescalero Reservation are excluded from income and resources. • P.L. 96-420, Section 9(c), 10/10/80, Maine Indian Claims Settlement Act of 1980 - Payments made to the Passamaquoddy Tribe, the Penobscot Nation, and the Houlton Band of Maliseet are excluded from income and resources. • P.L. 97-403 - Payments to the Turtle Mountain Band of Chippewas, Arizona are excluded from income and resources. • P.L. 97-408 - Payments to the Blackfeet, Grosventre, and Assiniboine tribes, Montana, and the Papago, Arizona, are excluded from income and resources. • P.L. 98-123, Section 3, 10/13/83 - Funds distributed under this Act to members of the Red Lake Band of Chippewa Indians are excluded from income and resources. Funds were awarded in docket number 15-72 of the United States Court of Claims.

• P.L. 98-124, Section 5 - Per capita and interest payments made to members of the Assiniboine Tribe of the Fort Belknap Indian Community, Montana, and the Assiniboine Tribe of the Fort Peck Indian Reservation, Montana, under this Act are excluded from income and resources. Funds were awarded in docket 10-81L. • P.L. 98-500, Section 8, 10/17/84, Old Age Assistance Claims Settlement Act, provides that funds made to heirs of deceased Indians under this Act shall not be considered as income or resources. • P.L. 99-146, Section 6(b), 11/11/85 - Funds distributed per capita or held in trust for members of the Chippewas of Lake Superior are excluded from income and resources. Judgments were awarded in Dockets numbered 18-S, 18-U, 18-C and 18-T. Dockets 18-S and 18-U are divided among the following reservations: Wisconsin ▪ Bad River Reservation ▪ Lac du Flambeau Reservation ▪ Lac Courte Oreilles Reservation ▪ Sokaogon Chippewa Community ▪ Red Cliff Reservation ▪ St. Croix Reservation. Michigan ▪ Keweenaw Bay Indian Community (L'Anse, Lac Vieux Desert, and Ontonagon Bands)

Minnesota ▪ Fond du Lac Reservation ▪ Grand Portage Reservation ▪ Nett Lake Reservation (including Vermillion Lake and Deer Creek)

▪ White Earth Reservation. • Under Dockets 18-C and 18-T funds are given to the Lac Courte Oreilles Band of the Lake Superior Bands of Chippewa Indians of the Lac Courte Oreilles Reservation of Wisconsin, the Bad River Band of the Lake Superior Tribe of Chippewa Indians of the Bad River Reservation, the Sokaogon Chippewa Community of the Mole Lake Band of Chippewa Indians, and the St. Croix Chippewa Indians of Wisconsin. • P.L. 99-264, White Earth Reservation Land Settlement Act of 1985, 3/24/86, Section 16 excludes money paid under this Act from income and resources. This Act involves members of the White Earth Band of Chippewa Indians in Minnesota. • P.L. 99-346, Section 6(b) (2) - Payments to the Saginaw Chippewa Indian Tribe of Michigan are excluded from income and resources. • P.L. 99-377, Section 4(b), 8/8/86 - Funds distributed per capita to the Chippewa of the Mississippi or held in trust under this Act are excluded from income and resources. The judgments were awarded in Docket Number 18-S. The funds are divided by reservation affiliation

for the Mille Lac Reservation, Minnesota; White Earth Reservation, Minnesota; and Leech Lake Reservation, Minnesota. • P.L. 101-41, 6/21/89, the Puyallup Tribe of Indians Settlement Act of 1989, Section 10(b) provides that nothing in this Act shall affect the eligibility of the Tribe or any of its members for any Federal program. Section 10(c) provides that none of the funds, assets or income from the trust fund established in Section 6(b) shall at any time be used as a basis for denying or reducing funds to the Tribe or its members under any Federal, State, or local program. (The Puyallup Tribe is located in the State of Washington.) • P.L. 101-277, 4/30/90, funds appropriated in satisfaction of judgments awarded to the Seminole Indians in Dockets 73, 151 and 73-A of the Indian Claims Commission are excluded from income and resources except for per capita payments in excess of $2,000. Payments were allocated to the Seminole Nation of Oklahoma, the Seminole Tribe of Florida, the Miccosukee Tribe of Indians of Florida, and the independent Seminole Indians of Florida. • P.L. 101-503, Section 8(b), Seneca Nation Settlement Act of 1990, dated 11/3/90, provides that none of the payments, funds or distributions authorized, established, or directed by this Act, and none of the income derived therefrom, shall affect the eligibility of the Seneca Nation or its members for, or be used as a basis for denying or reducing funds under, any Federal program. • P.L. 93-134, Section 8, 10/19/73, the Indian Tribal Judgment Fund Use or Distribution Act, as amended by P.L. 103-66, Section 13736, 10/7/93, provides that interest of individual Indians in trust or restricted lands shall not be considered a resource and up to $2,000 per year of income received by individual Indians that is derived from such interests shall not be considered income in determining eligibility for assistance under the Social Security Act or any other Federal or federally assisted program. If other types, not on this list, are encountered, contact the Policy Answer Line for guidance. 2630.30.05 COMPENSATION TO JAPANESE/ALEUTS (MED 1, 4) Restitution payments by the U.S. Government to individual Japanese Americans (or, if deceased, to their survivors) and Aleuts who were interned or relocated during World War II are exempt from income and resources. Also, restitution payments from the Canadian government to individual Japanese Canadians who were interned or relocated during World War II are exempt resources.66

2630.35.00 GERMAN REPARATION PAYMENTS (MED 1, 4) German reparation payments are payments made by the Republic of Germany to certain survivors of the Holocaust and may be received periodically or in a lump sum. They are exempt from resources by federal law.67 2630.35.05 CRIME VICTIM PAYMENTS (MED 1, 4) Any amount of assistance received from federal funds administered by any state or local government

program established to aid victims of crime is excluded from resources for a period of 9 months beginning with the month following the month of receipt. To be excluded from resources under this section, the individual (or spouse) must demonstrate that any amount received was compensation for expenses incurred or losses suffered as the result of a crime.68

2630.40.00 DOMESTIC VOLUNTEER SERVICE ACT COMPENSATION The following is exempt as a resource by federal law: • Compensation of any kind (including stipends, supportive services, remuneration for out-of- pocket expenses, and so forth) provided to individuals who are volunteers in programs administered directly or through sponsoring agencies by the United States action Agency under Titles I, II, and III of the Domestic Volunteer Service Act of 1973, is exempt. These programs include the Foster Grandparents Program, Retired Senior Volunteer Program (RSVP), Service Corps of Retired Executives (SCORE), Active Corps of Executives (ACE), Action Cooperative Volunteer Program • (ACV), Senior Companion Program, Volunteers in Service to America (VISTA), and University Year for Action (UYA).69 2630.45.00 PAYMENTS TO STUDENTS Education grants and loans received under Title IV of the Higher Education Act, or the Bureau of Indian Affairs (BIA) programs are exempt for undergraduate students’ Medicaid.70 These exclusions are allowed for students in high school and GED programs as well as post-secondary education. Examples include: • Basic Educational Opportunity Grants (BEOG) • Supplemental Educational Opportunity Grants (SEOG) • College Work Study • National Direct Student Loans (NDSL) • Guaranteed Student Loans • Pell Grants, and • Federal Perkins Loans Refer to Section 2860.05 for comprehensive listing. 2630.55.00 DISASTER ASSISTANCE PAYMENTS Assistance received under the Disaster and Emergency Assistance Act of 197471 or another federal statute because of a presidentially declared major disaster is permanently exempted as a resource. 2630.60.00 RADIATION EXPOSURE ACT BENEFITS Payments made from the Radiation Exposure Compensation Trust Fund established under the Radiation

Exposure Compensation Act are exempt resources.72

2630.65.00 AGENT ORANGE SETTLEMENT ACT PAYMENTS Payments made from the Agent Orange settlement fund, or any fund established as a result of the Agent Orange product liability litigation, are exempt from resource consideration.73 2630.70.00 FEDERAL TAX REFUND PAYMENTS For non-MAGI (MED 1, 2, 4) AGs, federal tax refunds received after December 31, 2009, are disregarded as a resource for a period of 12 months after the month of receipt for all federal means-tested programs including Medicaid. The resource exclusion lasts for 12 months If properly transferred within the 12- month protected period, transfer of the federal tax refund would be allowable and would not incur a transfer penalty for the member. Example: Sam is institutionalized in a psychiatric facility and receives a federal tax return in the amount of $8000.00. The tax refund was transferred to her brother 3 months after the receipt date. Because the transfer occurred within the 12-month period of receipt, this is allowable, and Sam would not incur a transfer penalty. The federal tax refund is to be excluded as a resource by subtracting any tax refund received by the AG in the last 12 months from the AG’s resources. If the difference between the resources and the amount of the federal tax refund is less than the resource limit, the AG meets the resource limit. Example: AG applies today and has total resources of $4000. AG verified receipt of a federal refund in the amount of $3287 received in January of this year. This federal refund amount would need to be deducted from the total resources and the difference of $713 would be countable as a resource. 2630.95.00 INDIVIDUAL DEVELOPMENT ACCOUNT Individual Development Accounts (IDA) operated under the Assets for Independence Act (AFIA), Public Law 106-554, are established by or on behalf of eligible TANF recipients for the purpose of purchasing a home, attending post-secondary education, or purchasing a business.74 Eligible individuals75 may receive matching funds for their IDA through a community development corporation (CDC). Any funds deposited in an IDA are exempt from being counted as a resource. (See IPPM 2850.05.00) 2635.00.00 RESOURCE ELIGIBILITY DETERMINATION Resource eligibility requirements for MED 1, 2, or 4 categories must be met for eligibility to be established. The worker is responsible for obtaining and verifying all pertinent information regarding the

resources of the appropriate AG members. The consideration of resources will vary according to the age, marital status, and living arrangement of the AG members. The following sections explain the methods used in determining resource eligibility. 2635.10.00 RESOURCE ELIGIBILITY DETERMINATION (MED 1) In addition to eligibility requirements discussed in the preceding passages of this chapter, the following principles apply to the consideration of resources in the resource eligibility determination of all persons except institutionalized individuals who entered long term care facilities on or after September 30, 1989, and who have a community spouse. All available resources owned by the applicant/recipient and their responsible relatives must be considered regarding the resource limitations listed in Section 3005.15.00. Persons who qualify as "responsible relatives" are as follows: • The spouse of the applicant/recipient if the couple is living together or separated only for medical reasons such as nursing home placement • For those in an institution, a PACE member or on an HCBS waiver, MCCA rules apply (see section 2635.10.10 – 2635.10.10.15).76

• The biological or adoptive parent(s) and stepparents living with an applicant/recipient under age 1877, unless the child is receiving Home and Community-Based Services under any of Indiana's waivers. If the applicant/recipient child is institutionalized (including hospitalization) the parent(s)' resources are not considered in the month following the month of admission. If the non-recipient parent of the applicant/recipient child owns resources more than the resource limit, the excess is to be counted as a resource of the child However, excess resources of the child applicant/recipient cannot be counted as a resource to the parent. Also, excess resources of the recipient parent cannot be counted as a resource to the child. • Parent’s resources are considered through the month in which the child applicant/recipient reaches age 18 unless the child turns 18 on the first of the month. When the applicant/recipient is a student between the ages of 18 and 21, the parent's resources are not counted. Resources owned solely by the following individuals are exempt: • Non-recipient children or siblings of the applicant/recipient, The stepparent of an applicant/recipient • Parents of an institutionalized applicant/recipient beginning in the month following the month of admission, or beginning in the month of birth if the child remains institutionalized/hospitalized in the following month78 • Parents of a child who has been determined eligible for Home and Community-Based Services (HCBS) Waiver.79 See Chapter 3300.

2635.10.05 QMB, QDW, SLMB, AND QI RESOURCE DETERMINATIONS (MED 4) In addition to the eligibility requirements discussed in the preceding sections of this chapter, the following principles apply to the consideration of resources in the Qualified Medicare Beneficiary (QMB), Qualified Disabled Worker (QDW), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) eligibility determination: • Resources owned by the following individuals must be considered: o The applicant/recipient o The spouse of the applicant/recipient if the couple is living together. • Resources owned solely by the spouse of the applicant/recipient who does not live with them are not considered. • Resource limitations listed in Section 3005.25.00 must be met before resource eligibility can be established. 2635.10.10 RESOURCES/INSTITUTIONALIZED/COMMUNITY SPOUSE (MED 1) The policies stated in this section apply only to the MA A, MA B, MA D, MADW, and MADI categories of assistance. Special resource provisions apply to married individuals who are institutionalized, PACE participants or HCBS waiver members; the provisions are explained further in Sections 2635.10.10.05, 2635.10.10.10, and 2635.10.10.15 Special resource provisions apply to an institutionalized individual who has a community spouse or to a waiver applicant/recipient who has a community spouse, and are explained further in Sections 2635.10.10.05, 2635.10.10.10, and 2635.10.10.15. To qualify for consideration under these special provisions, an institutionalized spouse must be in a hospital, nursing facility, ICF/IID, or psychiatric facility for 30 consecutive days, or be likely to remain in such a facility for that period or longer. If an individual dies before the 30th consecutive day, the individual should be treated as though they would have resided in the institution for 30 consecutive days. The "community" spouse must be living in a setting other than one of the aforementioned facilities. The special resource provisions apply only to individuals who are legally married to community spouses and who begin continuous periods of institutionalization on or after September 30, 1989. An individual is in a "continuous period of institutionalization" until such continuity is broken by the absence from a hospital, nursing facility, ICF/IID, or psychiatric facility for at least 30 consecutive days. These special resource provisions no longer apply beginning the month following the month in which circumstances change so that the couple no longer meets the criteria.

An individual living in a residential facility, such as one participating in the Room and Board Assistance (RBA) program, is not entitled to have eligibility determined under the special provisions. A resident of an RBA facility qualifies as a community spouse when the other spouse is institutionalized in a hospital, nursing facility, ICF/IID, or psychiatric facility. 2635.10.10.05 RESOURCE ASSESSMENT AND SPOUSAL SHARE (MED 1) The policies stated in this section apply only to the MA A, MA B, MA D, MADW, and MADI categories of assistance. Institutionalized individuals who are married to community spouses and who meet the specific criteria in Section 2635.10.10 must have a resource assessment completed. The resource assessment is a very important process whereby the combined countable resources of the couple are determined as of the beginning (date of admission) of the institutionalized spouse's first continuous period of institutionalization which began on or after September 30, 1989.80 From this information, a "spousal share" for the community spouse, equaling one-half of the couple's combined countable resources, is then established for use in determining the institutionalized spouse's resource eligibility. Countable resources for assessment purposes are determined in the same manner as in regular situations with the following exceptions: • Up to $2,000 of any separately identifiable funds or assets which have been set aside for burial can be excluded. This exemption can be given to both spouses if applicable; however, the $2,000 maximum must be reduced by the face value of any life insurance policy whose cash surrender value has been exempted, or by the amount in any irrevocable burial trust. [Please, note the exempted value prior to June 1, 2014, was $1,500]. In order for funds or assets to be considered set aside for burial, the account titling must indicate such, or there must be a signed statement by the owner or guardian of the purpose for the funds and the date on which they were set aside. • One motor vehicle of any value is exempt. • The equity value of nonexempt real property owned solely or jointly by the institutionalized spouse is a countable resource. (The "agree to sell" rule is applied only to eligibility determinations, not for purposes of calculating the spousal share.) The equity value of real property owned solely by the community spouse (or jointly with someone other than the institutionalized spouse) is not included when determining the amount of combined assets for spousal share purposes. The resource assessment can be requested independently of an application for assistance by either spouse or their authorized representative. In that situation, the assessment request should occur promptly upon admission to the facility. DFR Offices are to provide Form 2060, Resource Assessment Notice and Request, to interested people upon request and should provide a supply to facilities in the county. A completed Form 2060 can be mailed to FSSA Document Center or the local DFR office.

When a request for an independent resource assessment is received, the screener is to access the independent resource assessment screen, complete the screens, and schedule an appointment for the assessment interview. The interview can be conducted in person or by telephone. During the interview the worker is to complete Form 2061, Resource Assessment for Medical Assistance to the Aged, Blind and Disabled. The responsibility for providing the required documentation and verification rests entirely with the couple and any representative. The Form 2060 explains this fact and also lists the type of documentation which must be provided to the DFR. Workers are to give advice and guidance to the individual as to the most effective means of obtaining verification but are not required to obtain verifications directly, although it is not prohibited when a properly signed consent has been obtained. If the necessary documentation is not received by the DFR within 20 days of the date of the assessment request, the worker will receive an alert and is to send a reminder letter to both spouses and their representative listing the necessary documentation and asking for an update on the status of their verification process. At the end of 30 days, a second letter should be sent stating that the assessment cannot be completed until the verification is submitted. When the necessary documentation is received, the DFR is to proceed in an expedient manner to complete the assessment and determine the spousal share. Once completed, copies of the Form 2061 and the verifications must be provided to both spouses. If a representative has acted on behalf of either spouse, the DFR must provide client with a copy also. The worker is to access the independent resource assessment screen and enter the amount of the spousal share. A copy of all complete or incomplete assessments, as well as the documentation and any correspondence, must be retained by the DFR as the spousal share, or the inability to establish one, is crucial information in the determination of the institutionalized spouse's eligibility when an application is filed. Copies of the independent resource assessments are to be retained indefinitely. The spousal share cannot be appealed until an application for Medicaid is filed and the eligibility determination is completed. If a mathematical or keying error is made by the worker, the independent resource assessment screen can be accessed by the supervisor who can enter the correct spousal share. If an individual not entitled to an independent resource assessment under the special resource provisions requests an assessment via the Form 2060, the DFR must advise the individual in writing of the reason the assessment will not be completed. If the institutionalized spouse is applying for Medicaid, the resource assessment will be an integral part of the eligibility study. Do not complete the independent resource assessment screen. When a person is applying for Medicaid and needs a resource assessment as part of member’s eligibility determination, that individual will be entered into the system just like any other application. When the application is processed in AE, the resource assessment and the resource assessment-continued screens are to be completed with the resource data necessary to determine the spousal share. When resources are jointly owned by the spouses, they are to be entered once on the Resources Assessment screen and the Resource Assessment-Continued screen in the institutionalized spouse's name. Then the spousal share can be correctly calculated. Resource values for assessment purposes must be verified as of the first

date of continuous institutionalization, whether it is in a hospital or a nursing facility. When an assessment is being completed in conjunction with an application for assistance, the securing of necessary resource verification is a joint applicant/worker effort conducted in the usual manner. 2635.10.10.10 RESOURCE ELIGIBILITY/INSTITUTIONALIZED SPOUSE (MED 1) The policies stated in this section apply only to MA A, MA B, MA D, MADW, and MADI categories of assistance and are applicable to institutionalized individuals who meet the specific criteria in Section 2635.10.10. The community spouse resource limit is the greatest of the following (Refer to Section 3005.10.00 for current amounts.):81 • The minimum current state standard • The spousal share not exceeding the current maximum • Any number of resources ordered to be transferred by a court against the institutionalized spouse for the support of the community spouse, or • The amount established by an Administrative Law Judge as the result of an appeal. The first of the month resource eligibility rule (refer to Section 2605.20.10) is applicable to resource eligibility determinations made under the special resource provisions for an institutionalized spouse with a community spouse. The special provisions are applicable beginning with the first month of institutionalization included in the possible Medicaid covered period (that is the three-month retro period). The institutionalized spouse's resource eligibility for any month in which the special resource provision does not apply (for example, the month before institutionalization) is to be determined using all of the regular resource methodologies and the resource limitation for a couple. Beginning with the first month in which the special resource provisions apply, the procedure outlined below is required. This procedure establishes the initial month of eligibility, which is the point at which the community spouse's resources are no longer considered. The couple's combined countable resources are determined by applying all of the regular resource methodologies, except as follows: • Up to $1,500 of separately identifiable burial funds is disregarded.82 This exemption can be given to both spouses if applicable. However, the $1,500 maximum must be reduced by the amount in an irrevocable burial trust or by the face value of any life insurance policies whose cash surrender value has been exempted because the face value is $1,500 or less and the beneficiary is the estate or funeral home • One motor vehicle is exempt regardless of value or purpose • The equity value of real property owned solely by the community spouse (or jointly with someone other than the institutionalized spouse) is exempt

• Nonexempt real property owned solely or jointly by the institutionalized spouse is not subject to the requirement to offer it for sale or rent, unless the total value of the couple's countable resources, including the real property, exceeds their combined resource standards. The total value of the couple's non-exempt resources, including real property owned by the institutionalized spouse, is compared to their combined resource limit (the community spouse limit plus the standard for a single individual). If countable resources are equal to or less than the current standard, the institutionalized spouse is eligible for assistance for that month, which is the initial month of special resource eligibility for the institutionalized spouse. For subsequent months during the continuous period of institutionalization, resources owned solely by the community spouse are exempt. If the countable resources exceed the current standard, and ownership of real property is not involved, the institutionalized spouse is ineligible for that month. The process is repeated for subsequent months. If a month of eligibility does not occur, the application is to be denied. If the countable resources, including non-exempt real property, are greater than the current standard, the next step is to subtract the equity value of the real property. If there still are excess resources in personal property, the applicant is ineligible. If not, the applicant must agree to offer the real property for sale or rent as a condition of eligibility. If, for the initial month of eligibility under this provision, resources in the name of the institutionalized spouse exceed the single individual standard, a post-eligibility transfer of resources will be required within a specified time limit as explained in Section 2635.10.10.15. If the institutionalized spouse assigns to the State of Indiana his rights for support from the community spouse, the institutionalized spouse cannot be determined ineligible due to resources under this section. 2635.10.10.15 POST ELIGIBILITY PROTECTED PERIOD (MED 1) The policies stated in this section apply only to the MA A, MA B, MA D, MADW, and MADI categories of assistance and are applicable only to individuals who meet the specific criteria in Section 2635.10.10. Once initial resource eligibility has been established, any amount of the community spouse resource standard spousal share which is not already solely in the community spouse's name, can be transferred to them by the institutionalized spouse and not be counted in determining the institutionalized spouse's continuing resource eligibility.83 The institutionalized spouse must indicate a willingness to transfer resources into the community spouse's name sufficient to reduce their resources to the allowable single individual standard. They will have a period of 90 days in which to complete this transfer. This protected period begins with

the date of the notice of eligibility which approves assistance. The worker must enter on the expected changes screen the expected date of the end of the 90-day period. During this protected period, the amount subject to transfer (the difference between the community spouse resource standard and the actual number of resources solely owned by the community spouse) will not be counted as a resource of the institutionalized spouse. Once the DFR determines that an institutionalized spouse/applicant is resource eligible for an initial month, but that the community spouse does not actually own resources equal to the community spouse resource standard, the institutionalized spouse, community spouse, and any representative must be advised in writing of the amount to be transferred to the community spouse and the deadline for doing so. This letter will be a part of the eligibility system-generated approval notice. The DFR must monitor the couple's resources monthly through the end of the protected period to ensure that the transfer actually takes place. When it does, this is to be documented in the case record. Should the transferor need more time than the 90-day protected period to complete the transfer, the individual should contact the DFR and report this. More time must be granted by the DFR if the transfer is being pursued but has been delayed in whole or part by circumstances beyond the institutionalized spouse's control, such as a court order requirement, uncooperative insurance company, and so forth. If the protected period is extended by the DFR, access the expected changes screen, and change the expected date of the end of the 90-day protected period. Monthly resource monitoring must continue until the transfer is completed. If there is no extension and the 90-day period ends without the transfer having occurred, the DFR must contact the institutionalized spouse or his representative relative to the status of transfer activity. If the transfer is not being pursued or there is no good cause for an extension, the protected assets immediately become countable again as resources of the institutionalized spouse and assistance will be discontinued. 2635.10.20 RESERVED 2635.10.20.05 ENTITLEMENT TO RESOURCE SPEND-DOWN/SSI DETERMINATION As of June 1, 2014, this no longer applies. 2635.10.20.10 RESOURCE SPEND-DOWN DETERMINATION As of June 1, 2014, this no longer applies. 2635.10.20.15 ELIGIBILITY SYSTEM PROCEDURES WHEN RESOURCE SPEND-DOWN IS INVOLVED (MED 1) As of June 1, 2014, this no longer applies.

2640.00.00 TRANSFERS OF PROPERTY The transfers of certain real or personal property to another individual must be considered in relation to the law and/or regulations in effect on the date that the transfer occurred. The specific policy for transfers of property varies by program and is explained in Sections 2640.10.00 through 2640.10.35.05. The Resource Questions screen contains the transfer of property question. When the answer is "yes", the Resource Transfer screen must be completed with the transfer information. 2640.10.00 TRANSFER OF PROPERTY LAW The Medicaid eligibility of an individual who transfers property on or after August 11, 1993, is governed by federal law. Section 1917(c) of the Social Security Act (42 U.S.C. 1396 p-C), as amended by OBRA-93 requires a penalty period of reduced Medicaid coverage for persons found to have made a property transfer for less than fair market value and for the purpose of becoming eligible for Medicaid. The following sections explain the procedures for consideration of transfers of property occurring on or after August 11, 1993. State regulations, as amended, at 405 IAC 2-3-1.1 and 405 IAC 2-3-1.2 are applicable to certain transfers effective June 1, 2002, regarding annuities, income transfers, and failure to take action to receive assets. Additional provisions are effective July 1, 2003, regarding the start of a transfer penalty, penalty periods for successive transfers, and transfers of income producing real property. 2640.10.05 GENERAL APPLICABILITY OF TRANSFER OF PROPERTY LAW The transfer of property provision is applicable to applicants/recipients who are: • Inpatients of nursing facilities or other medical institutions in which they are receiving equivalent nursing facility services, or • PACE participants, or • Receiving Home and Community-Based Services (HCBS). If an applicant/recipient does not meet one of the above conditions a transfer penalty is not invoked. If such an individual has transferred property, the worker is to record the occurrence but will not require verifications nor attempt to determine whether the transfer was violative. However, if the individual later enters a nursing facility or begins receiving HCBS, the worker would then be required to determine whether the transfer was violative. When a spouse transfers an asset that results in a penalty for the client, the penalty period must be apportioned between the spouses. Both spouses must be eligible for Medicaid Institutional service or home/community-based waiver services during the same time for apportionment to occur. When one spouse is no longer subject to a penalty (for example, the spouse no longer receives institutional or

waiver services or the spouse dies), the remaining penalty period applicable to both spouses must be served by the remaining spouse.84

If the applicant/recipient claims that a theft of funds has occurred, see 2605.45.00. Transfers are potentially violative made by the following:85 • Applicant/recipient • The spouse of the applicant/recipient • Anyone with legal authority to act on behalf of the applicant/recipient or spouse, such as a parent or legal guardian (including a court or administrative body) • Anyone acting at the direction or request of the applicant/recipient or spouse (including a court or administrative body). Federal law defines assets as both income and resources (real and personal property) owned by the applicant/recipient and spouse. Refer to Section 2640.10.15.05 regarding transfers of homes and income-producing real property. Also included as an asset are income and resources, which the applicant/recipient is entitled to receive but doesn't because of their actions or those of their spouse, a person with legal authority to act on the applicant or their spouse's behalf, including a court or administrative body, or any other person, court or administrative body acting at the direction or request of the individual. Examples of actions which would cause income or resources not to be received are: • Irrevocably waiving pension income • Waiving the right to receive, or failing to take the necessary action to receive an inheritance • Not accepting injury settlements. Each individual circumstance of an individual failing to take an action to obtain assets must be carefully examined, as this may not always be considered a violative transfer. A transfer of property penalty will not be imposed in the following circumstances: • The applicant/recipient, or the person with the legal authority to act on behalf of the applicant/recipient is unaware of the right to receive assets or becomes aware after the deadline for taking action has passed. If the DFR or other division of FSSA informs the individual of their right to receive assets prior to the deadline for taking action, the individual will be presumed to be aware of his rights. • A physician who is knowledgeable of the medical condition of the applicant/recipient provides a written statement that the applicant/recipient is not capable of taking the necessary action to receive the asset. A physician’s statement can only be used for this purpose if the applicant or recipient has no legal guardian or other person who has the authority to act on the individual’s behalf in whatever action is needed to receive the assets. • The expense of collecting the assets would exceed the value of the assets. In the case of a

surviving spouse who fails to take a statutory share of a deceased spouse’s estate, a penalty is not imposed if the deceased spouse made other equivalent arrangements to provide for the surviving spouse’s needs, including but not limited to setting up a trust. 2640.10.10 DETERMINING THE TRANSFER REVIEW PERIOD As stated in the preceding section, the transfer of property law is made an active consideration only by the applicant/recipient being or becoming institutionalized in a nursing facility (or receiving Home and Community-Based Services). When this factor is present in a case situation, the worker must then determine the time period that must be reviewed during which transfers made could be violative. This time period is the "review period", or “look-back” period. The review period for looking at a transfer involving non-trust property prior to November 1, 2009, is 36 months prior to the first date when the individual was institutionalized and had applied for Medicaid and continues indefinitely thereafter. Upon November 1, 2014, the review period for looking at a transfer involving non-trust property is 60 months prior to the first date when the individual was institutionalized and had applied for Medicaid and continues indefinitely thereafter (referred to as the baseline date). The review period for looking at a transfer involving non-trust property between November 1, 2009, and November 1, 2014, extends back to November 1, 2009, when the individual was institutionalized and had applied for Medicaid, and continue indefinitely thereafter. The review period for transfers involving trust funds in the circumstances explained in Section 2615.75.15 is 60 months prior to the baseline date defined above and continues indefinitely thereafter. When a Medicaid recipient becomes institutionalized, is a PACE member or begins receiving Home and Community-Based (HCBS) waiver services, the baseline date is the date when both conditions, i.e., an application and institutionalization, an application and PACE, or HCBS, are met. This would be the date of institutionalization or effective date of waiver services. Example: Individual living at home transfers property on January 10, 1995. She applies for Medicaid on April 7, 1995, and enters a nursing facility on September 11, 1995. The baseline date is September 11. Therefore, the transfer took place within the review period. 2640.10.15 ALLOWABLE TRANSFERS OF PROPERTY If it is determined that a transfer occurred within the review period, the next step is to determine whether the transfer automatically qualifies as allowable. No transfer of property penalty can be invoked when an individual makes a transfer to:

• The applicant/recipient’s spouse (or to another for the sole benefit of the spouse), or • The applicant's/recipient's child who is blind or disabled, according to SSI criteria, or to a trust fund for such a child • The assets were transferred to a trust established solely for the benefit of an individual under sixty-five (65) years of age who is disabled.86 Additionally, the transfer of a home to certain individuals as explained in Section 2640.10.15.05 is allowable. Transfers on and after 8-11-93, to certain types of trust funds, as defined in section 2615.75.15, for disabled individuals are allowable. 2640.10.15.05 TRANSFERS OF HOMES AND INCOME-PRODUCING REAL PROPERTY (MED) There is no transfer of property penalty if a home, as defined in section 2620.15.10, is transferred to any of the following: • A spouse • Children under age 21 of the applicant/recipient • Blind or disabled (according to SSI criteria) children of the applicant/recipient • A sibling of the applicant/recipient who has equity interest in the home and who was residing in the home for at least one year prior to the individual's nursing facility admission • A child of the applicant/recipient who was living in the home at least two years prior to the individual's admission to the nursing facility and who provided care that was necessary to permit the individual to remain at home rather than be institutionalized. In these situations, documentation of the individual's condition and the extent of care provided by the child is required in the case record. An individual who transfers their home to a person not specified above remains subject to a transfer of property penalty. For transfers of income-producing real property on and after 7-1-03, the following rules apply: • $6,000 of the equity value can be transferred without penalty if the property produces at least $360 a year in income.87 The uncompensated value is the equity over $6,000. If the property does not produce at least $360 per year in income, the entire equity is the uncompensated value. The transfer of the income must be evaluated based on the fair market value of the income in accordance with Section 2640.10.25.20. • If the real property has equity of less than $6,000, the property can be transferred without penalty if it produces income that is at least 6% of the equity value. If it produces income that is less than 6% of the equity, the entire equity is the uncompensated value. Refer to Section 2640.10.25.20 regarding transfer of the income. The $6,000 transfer exemption is a single, one- time exemption that applies to the total value of all income-producing real property transferred

by the individual during the individual’s lifetime. • Income producing real property that is used in a trade or business can be transferred without application of the $6,000/6% limitation. In order to qualify as a trade or business, the property must be actively managed or operated by the applicant/recipient. • Income-producing real property for which the individual owns a government permit or license, or other governmental authority to engage in income-producing activity is not subject to the • $6,000/6% limitation. Examples of this are commercial fishing permits and tobacco crop allotments issued by the USDA. (This does not include crop subsidies and soil banks.) Both of these circumstances are very uncommon in Indiana, therefore, if DFR is processing a case in which the individual claims to own such property, the Policy Answer Line must be contacted. When contacting PAL, be sure to explain what type of license or permit the individual submitted as verification. Example 1: A Medicaid applicant in nursing facility owned rental property with an equity value of $50,000. The applicant/recipient received $2,400 per year in rent. The month before applying for Medicaid, they gave it away to a relative with no consideration received and did not show that the transfer was made for any purpose other than qualifying for Medicaid. The uncompensated value is $44,000 plus the amount of income that was transferred based on the applicant/recipient’s life expectancy at the time of the transfer.

Example 2: A Medicaid applicant in nursing home owned farmland with an equity value of $100,000 which they cash rented to their child who paid all of the expenses and gave the member $100 a year income. The uncompensated value is $100,000 (plus the amount of income that was also transferred) because the property did not produce at least $360 annual income for member.

Example 3: A Medicaid recipient in a nursing facility owns a 25% share as tenancy in common, in rental property valued at $200,000. Their share is $50,000 and they receive FMV rent of $2,100 per year. The applicant/recipient gave their share of the property away to their child and received no consideration. The uncompensated value is $44,000 plus the amount of income that was transferred. 2640.10.15.06 HOME EQUITY RESTRICTION A penalty consisting of ineligibility for LTC services is invoked due to the ownership of the home if the applicant’s equity interest or share of equity interest, in his or her home is greater than the home equity limit: • 11-01-09 $500,000 • 01-01-11 $506,000 • 01-01-12 $525,000 • 01-01-13 $536,000

• 01-01-14 $543,000 The penalty starts on the date that the applicant is otherwise eligible for Medicaid and would be receiving LTC services under Medicaid were it not for the equity restriction provision, but not before 11- 01-09. The penalty continues as long as the equity value remains over the home equity limit. The home is the applicant’s principal place of residence prior to requiring LTC services. A hospitalization, visit with friends or family, or other absence from the home does not change the home designation for the purpose of this provision. Income-producing home property is subject to the equity restriction. This restriction does not apply if the individual’s spouse, dependent child under the age of twenty-one (21), or blind or disabled (per SSI standards) child of any age, is lawfully residing in the home. Additionally, the amount of equity that would fall under the asset protection of a long-term care partnership policy reduces the amount of equity in excess of the limitation. The equity value of a home is the current fair market value (FMV) minus any encumbrance against the property. An encumbrance is a legally binding debt against the home. This can be a mortgage, reverse mortgage, home equity loan, or other debt secured by the home. The current property tax assessment must be obtained as verification of the FMV. Any such assessment other than the most current one is unacceptable. If the individual disputes the property tax assessment, a current arm’s length, independent professional appraisal can be submitted and will be used in lieu of the assessment. Arm’s length means that there can be no special relationship, directly or indirectly, between the appraiser and the applicant/recipient so that the interests of both are independent of each other. If there is an encumbrance against the property such as a mortgage, home equity loan, reverses mortgage, etc., the date that the encumbrance was established must be verified for the purposes of eligibility and whether or not an improper transfer occurred. If, for example, a home equity loan was taken out within the review period, the loan transaction in and of itself may not be a violative transfer. However, any subsequent transaction involving the proceeds from the loan must be evaluated for determination of whether an improper transfer occurred. The equity restriction works in conjunction with the existing eligibility provisions regarding the treatment of real property, not in lieu of them. Even if all other eligibility provisions are met, the home equity restriction may still be a factor in whether or not LTC services will be paid for on the individual’s behalf. Example: A single individual entered a nursing facility on 10-15-13 and listed their home for sale with a realtor. They apply for Medicaid on 11-11-13. The home is valued at $800,000. For resource eligibility purposes, the value of the home which is up for sale at fair market value is exempt. However, the applicant is subject to the home equity restriction penalty beginning the first of the month in which she or he is otherwise eligible for LTC services under Medicaid. The first retro month is 07-13. All other eligibility requirements are met, and the application is approved with Medicaid effective 07-01- 13. The LTC penalty starts 10-01-13, the month in which the applicant was otherwise eligible for LTC.

This provision applies to individuals who apply for Medicaid on and after November 1, 2009, and for these individuals, any subsequent redeterminations that occur as the result of seeking LTC services as well as the annual scheduled redeterminations. 2640.10.15.10 DE MINIMIS TRANSFER OF PROPERTY ALLOWANCE An annual transfer amount is allowed that will not invoke a transfer penalty and will be excluded from the total uncompensated value of an improper transfer under the circumstances explained below. This is referred to as the de minimis transfer allowance; the annual amount allowed per year is $1200. The de minimis transfer allowance is applicable if the gift is made by the applicant/recipient, during the review period directly to: • A family member who is related to the applicant by blood, adoption, or existing marriage, or • A nonprofit organization qualified under Section 501(c) of the Internal Revenue Code as amended, which gives the organization tax-exempt status, and the de minimis allowance is subtracted after any and all transfers have been evaluated. Up to $1200 per year is deducted from the uncompensated value of transfers that are otherwise improper. Example 1: A member residing in a nursing facility applies for Medicaid on 10-15-09 and reports the following transfers:

• $10,000 to an irrevocable funeral trust • $1,200 to the applicant’s child The purchase of the funeral trust is allowable without penalty. The gift to the child does not invoke a transfer penalty because it did not exceed the de minimis allowance and was given to a family member. No penalty is imposed. The de minimis allowance is an annual total for all otherwise improper transfers, regardless of how many individuals received gifts from the member.

Example 2: • Gift 1: $800 is given to member’s grandchild • Gift 2: $900 is given to a non-profit charity The 2 gifts are combined for a total of $1,700. $1,200 is subtracted from the total gifted amount, resulting in an improper transfer amount of $500. The de minimis transfer allowance does not apply to transfers made by the member’s spouse. Example 3: • Gift 1: The member gives $400 to their son. • Gift 2: The individual’s spouse gives $600 to their sister. The de minimis transfer allowance is $400, because the de minimis allowance does not apply to the transfer made by the individual’s spouse. The year of calculation for de minimis gifting is based upon the established baseline date and each calendar year of the review period. Any excess over $1,200 in a calendar year does not carry over to a subsequent year. The de minimis allowance can be applied to more than one qualifying individual or non-profit organization each year, however, not more than $1,200 in any one calendar year is allowed. To allow a de minimis transfer allowance, the member is required to establish the relationship of the individual being claimed to be a family member and the tax-exempt status of any organization to which a gift was made. Required Documentation in the Case File includes: • The name, date of birth, and relationship lineage of a family member must be provided by the member. Signed statements from the member and family member(s) will suffice unless contradicting information is known to the worker, in which case clarifying information must be provided. • For example, documentation of a gift to a grandchild would include a statement that the grandchild is the child of the member’s child, giving the child’s birth date, and the names of the child, parent, and grandparent. • Collateral documentation of the 501(c) tax exempt status of an organization must be provided by the member. It is customary practice for these organizations to give receipts for gifts so that donors will have documentation for their own tax purposes. This type of receipt is sufficient documentation. Information about the organization should reveal its status as well, if the receipt is not available, such as brochures, websites, etc. In addition, proof of payment to the organization whose status is being documented must be provided. • For example, if a gift is reported to Charity #1 and a cancelled check to Organization #2 is provided, the de minimis allowance cannot be applied until the discrepancy is reconciled. Documentation of the proof necessary to apply a de minimis transfer allowance is the responsibility of the applicant/recipient. It is the agency’s responsibility to explain what type of documentation is

required and follow existing procedures for obtaining documentation. 2640.10.16 TRANSFERS OF PERSONAL EFFECTS AND HOUSEHOLD GOODS The following items can be transferred without receipt of adequate consideration and without imposition of a transfer penalty: • Household goods and personal effects88 • One wedding ring of the applicant/recipient and spouse • One engagement ring of the applicant/recipient and spouse • Medical equipment required due to the applicant’s/recipient/s physical condition, and which is not used extensively or primarily by others. Wedding rings and engagement rings are those purchased by one spouse for the other spouse (or intended spouse in the case of engagement ring). If a ring is purchased by someone after marriage and labeled an engagement or wedding ring upon giving it away, a violative transfer has occurred. 2640.10.20 DETERMINING ADEQUACY OF CONSIDERATION If a transfer cannot be determined automatically non-violative in accordance with the preceding sections, the DFR must proceed to determine whether or not adequate consideration was received. Consideration is whatever compensation the individual received in return for the transferred property. In order to determine a transfer as non-violative, the individual must have received adequate consideration. Consideration is adequate when the fair market value minus loans, mortgages, or other encumbrances, of the transferred property is equal to the consideration received. Fair market value is the current market value of the property at the time of the transfer. The applicant/recipient is required to supply any necessary records, documentation and information which verify the fair market value and consideration received. The value of the consideration received is based on the agreement and expectation of the parties at the time of the transfer. The value of consideration is the gross amount paid by the purchaser, and it may be paid in one or more forms such as those discussed in the following sections. (Other forms of consideration may also be possible.) The compensation received for an asset must be in a tangible form with intrinsic value. For example, love and affection does not constitute adequate consideration because there is no dollar value attributable to love and affection. 2640.10.20.05 COMPENSATION IN CASH Compensation in the form of cash is the total amount of cash paid or agreed to be paid in exchange for the property.89

2640.10.20.10 COMPENSATION IN REAL OR PERSONAL PROPERTY Compensation in the form of real or personal property is valued according to the fair market value of that property at the time of the property transfer. 2640.10.20.15 COMPENSATION BY SUPPORT/MAINTENANCE The value of compensation in the form of support and/or maintenance provided, or agreed to be provided, is based on the fair market value and duration of the support and/or maintenance. Example: The applicant/recipient has transferred a sum of money to a retirement community with the expectation that they will be provided with support and maintenance for a period of time. 2640.10.20.20 COMPENSATION BY SERVICES AGREEMENT, PERSONAL NEEDS CONTRACT, PERSONAL CARE CONTRACT OR OTHER SIMILAR AGREEMENTS The policy below applies to new applications filed on or after July 26, 2024. For purposes of this section, “agreement” refers to a service agreement, personal needs contact, a personal care agreement, or other similar agreement where services are provided in return for compensation. All agreements must be sent to PAL for review. If there is an agreement in place, even if it has not been paid, it must be provided at the time of application for review. The agreement and logs must clearly display the services provided, the dates and hours of services, the names of the caregiver/s, proof that the value of services is commensurate with fair market value, verification of payments made, and the total amount paid to each caregiver. To be considered an allowable transfer of assets, an agreement must90: 1. Be in writing 2. List the services provided to an applicant or member 3. List the payment rate of the services provided to the applicant or member 4. List the care provider or providers 5. Be signed by each party 6. Be notarized at the time the agreement is made 7. The requirements in the above sections 1-6 are not required when documentation is submitted to the office stating payments for services were made at the time the services were rendered (such as cash checks or bank statements). The fair market value of the services provided, and the payment made will still be reviewed for a potential transfer of property penalty. Lump sum payments or rolling credit accounts for services previously provided are not considered payments at the time of the service.

The rate of pay for care provided to an applicant or a member in an agreement must be commensurate with a reasonable wage, based on fair market value, frequency, and duration of the services. A detailed log of the services provided to an applicant or a member in an agreement must be maintained and include the following: • The monetary value • Frequency and duration of the services • Description of the services provided An agreement must provide for services for the benefit of an applicant or a member and cannot be retroactively dated or applied before the date the contract was notarized. Lump sum payments for past or future services are not valid and may result in a transfer of property penalty. An individual care provider under an agreement cannot provide services to an applicant or a member for more than sixteen (16) hours a day. Duplicate services cannot be provided by multiple care providers to the same applicant or member. Valid services do not include being on call or available to provide potential services to an applicant or a member. Services provided under an agreement for an applicant or a member may include the following: • Preparing meals • Managing medication • Housekeeping • Paying household bills • Transportation to medical appointments. For ongoing Medicaid members, an agreement cannot duplicate services already provided or allowable under the Medicaid program.91 The approval process will occur more efficiently if the logs are provided with the details below: • Name of the caregiver and the total amount paid to the caregiver/s • Date services provided • A detailed breakdown of the services provided total hours • Checks written are in order by date with clear documentation that the checks were written for caregiver services • Verification from the member or authorized representative that the services provided are commemorate with fair market value

• Verification of payments made (such as canceled checks) If any of the required information is missing or not clear and concise, the agreement may result in a transfer of property penalty. 2640.10.25 DETERMINING UNCOMPENSATED VALUE If inadequate consideration is received, the DFR must determine the uncompensated value. The uncompensated value is the difference between the fair market value, minus loans, mortgages, or other encumbrances, and the consideration received by the individual.92 When the transferred property was jointly owned, the uncompensated value is the difference between the individual's share of the fair market value and the consideration received by the individual. 2640.10.25.05 TRANSFERS INVOLVING LIFE ESTATES When an individual who owns real property transfers ownership of the property to another person and retains a life estate, the uncompensated value must be determined. The uncompensated value is the fair market value of the property, less the amount of loans, mortgages, or other encumbrance, minus the value of the life estate and minus any other consideration received. The value of the life estate is determined in accordance with Section 2605.25.10.05. Example: The applicant, age 66, owned a home valued at $235,000. The applicant transferred the title to the child for $20,000 and retained a life estate. Using the Table in Section 2605.25.10.10, the life estate value is $156,394.85 ($235,000 x .66551). The total compensation received is $176,394.85 ($156,394.85 + $20,000). The uncompensated value is $58,605.15. When an individual purchases a life estate interest in real property in the home of another person, a transfer penalty is imposed, using the full amount of the purchase price, when an individual purchases a life estate interest in another individual’s home and does not reside in that home for at least one full year after the date of the purchase.93 The year of residence in the home begins with the month after the documented purchase and continues for 12 consecutive months. This 12-month period is not a waiting period. The individual must establish and provide documentation of residence in the property and live there for a one-year period. Otherwise, a transfer penalty will be imposed. The penalty cannot be prorated or shortened in any fashion based on fewer months of residence. The start date of the penalty and length of the penalty period is determined the same as described previously for post-11/1/09 transfers. In addition, under the resource eligibility policy, if the purchased life estate is not producing income and is no longer the person’s home, then the life estate interest will have to be offered for sale or rent at FMV as a condition of Medicaid eligibility. Any transfer or otherwise disposal of the life estate must be evaluated as a transfer of property. This provision applies to individuals who purchase a life estate in another individual’s home on and after November 1, 2009.

2640.10.25.10 TRANSFERS INVOLVING ANNUITIES An annuity is an investment product, policy, certificate, contract, or other arrangement between two or more parties. One party pays a sum of money or other valuable consideration to the94 other party in return for the right to receive future payments. The term “annuity” includes any financial instrument that claims to be an annuity, as well as any instrument that meets the definition of an annuity. Annuities are generally purchased by individuals from financial institutions, insurance companies, or non-profit organizations. However, “private annuities" exist that are arrangements between non-commercial, non-organizational entities such as family members, friends, or other individuals. Different companies may use slightly varied terminology for their products. However, there are basic and common definitions that apply to annuities in general: • A deferred annuity allows interest to accumulate until the purchaser elects monthly payments to begin • Income payments often start many years after purchase • With an immediate annuity, payments start no later than one year after the premium is paid • The annuitant is the person on whose life expectancy the annuity payments will be calculated • Annuitize is when the accumulated value of the annuity is converted into a guaranteed stream of income. At this point, the annuitant decides how the payments will be received. The individual could choose monthly fixed or variable payments, or a balloon payment at the end of the term, for example. The purchase of an annuity is a transfer of property and, therefore, it is necessary to determine whether adequate consideration was (will be) received. For annuities purchased on or after June 1, 2002, or annuitized on or after June 1, 2002, regardless of the purchase date, adequate consideration (will be) received if all the following criteria are met: • The annuity is purchased from an insurance company or other commercial company that sells annuities as part of the normal course of business, or from a tax-exempt non-profit organization • The annuity provides monthly payments of interest and principal so that, for a specific year, the total payments for the year do not differ by more than five percent from the total paid in the previous year, and • The annuity must return the full purchase price to the purchaser or the purchaser’s spouse within the annuitant’s life expectancy using the Life Expectancy Tables that appear later in this section. If the individual does not (will not) receive compensation in the amount of the full purchase price within their lifetime (or within the contract’s specified time period if shorter than the life expectancy), the uncompensated amount is the difference between the purchase price and the amount that the annuity will pay out to the individual within the individual’s life expectancy, or term of the contract if shorter than life expectancy.

If an annuity is not purchased from a company that regularly sells such financial products or not purchased from a non-profit organization, the uncompensated amount is the entire purchase price. An example is the purchase of a private annuity from a family member. The purchase of a private annuity is a violative transfer of property. If the annuity pays/will pay a lump sum balloon payment or if the total annual payments vary by more than five percent, then the uncompensated amount is the entire amount of the purchase price. If an annuity does not meet any of the criteria that render it automatically a violative transfer of property, then a determination of whether adequate consideration will be received must be made by the DFR. The value of the expected income is determined by multiplying the monthly income by the individual's life expectancy (or term of the annuity, if shorter). Convert years to months using the figure for the person's age at the time of purchase. The uncompensated value is the difference between the purchase price of the annuity and the amount of income expected to be received by the purchaser or their spouse, during the lifetime of the annuitant, or term of the annuity if shorter. Example 1: A female applicant, age 85, purchases a $50,000 immediate annuity from a life insurance company. She elects to receive income payments of $375 per month. Per the Life Expectancy Table for females, her life expectancy is 6.63 years or 79.56 months. $375 x 79.56 = $29,835. The applicant is not expected to receive in payments what she transferred in principle. The uncompensated value is $20,165.

Example 2: Male applicant, age 60, purchases a $100,000 annuity on June 1, 2002, from an insurance company and will receive equal income payments of $500 per month. Per the Life Expectancy Table for males, his life expectancy is 18.42 years or 221.04 months. $500 x 221.04 = $110,520. The applicant is expected to receive income greater than the purchase price. Adequate consideration will be received.

Example 3: Male applicant, age 90, purchases a $20,000 annuity from an insurance company on July 1, 2002, and will receive 45 payments of $250 per month. Since the annuity was purchased after June 1, 2002, and the individual will receive a balloon payment, the uncompensated amount is $20,000 – the full purchase price of the annuity. For annuities that have been annuitized prior to June 1, 2002, adequate consideration was (will be) received if the annuity will return to the individual the full purchase price within the individual’s life expectancy (or within the contract’s specified time period if shorter than the life expectancy). These annuities do not have to be purchased from a commercial company or a non-profit organization. The total annual payments do not have to be equal and lump sum or deferred payments toward the end of the individual’s life expectancy may be made. The uncompensated amount is the difference between the purchase price and the amount that the annuity will return within the annuitant’s life expectancy. For annuities purchased, annuitized, or where certain specified changes were made on or after

November 1, 2009, the following provisions apply: The new provisions require disclosure of annuities, specify the circumstances in which a purchase or transaction involving an annuity will be treated as an improper transfer, and require the State to be beneficiary. The new provisions apply to purchases and certain transactions as described below occurring on and after November 1, 2009. Transactions that are subject to the new provisions include any action taken by the individual that changes the course of payment to be made by the annuity, or the treatment of the income or principal of the annuity, including such actions taken on annuities purchased before November 1, 2009. These actions include: • Additions of principal Elective withdrawals • Requests to change the distribution of the annuity Elections to annuitize the contract • A change in ownership, or • Any other non-routine action. The following types of changes and events would not subject an annuity purchased prior to November 1, 2009, to treatment under the new rules: • Routine transactions such as notification of an address change, notification of death or divorce of a remainder beneficiary, and other similar circumstances • Changes that occur based on terms of the annuity which existed prior to November 1, 2009, and which do not require a decision, election, or action to take effect, or • Changes beyond the control of the individual, such as a change in law, a change in the policy of the issuer, or a change in the terms based on other factors, such as the issuer’s economic condition. Any interest in an annuity must be reported. The requirement to disclose all resources when applying for Medicaid has always been in effect for LTC applicants/recipients. These new provisions specifically require disclosure of any interest that the LTC applicant/recipient and or spouse have in annuities. The failure to disclose and provide all necessary documentation will result in denial or closure due to failure to cooperate. At minimum, the applicant/recipient must provide a copy of the complete annuity contract and documentation of transactions that occur after the purchase. The application and redetermination forms have been revised to allow for annuity disclosure as required by federal law. The State must be beneficiary. Annuities purchased and transactions made on annuities owned by the applicant/recipient and spouse must name the State as a remainder beneficiary in accordance with the rules that follow below. If these rules regarding the beneficiary assignment in the correct position are not met, the full purchase price of the annuity is considered an improper transfer, and a penalty must be imposed. • An annuity must name the State as the remainder beneficiary in the first position unless there is a community spouse and/or a minor or disabled child. A disabled child is one who meets the SSI

or SSDI disability criteria • If there is a community spouse and/or minor or disabled child, the State must be named as the remainder beneficiary in the second position after the community spouse or minor or disabled child • If the State has been named as a remainder beneficiary after a community spouse and/or a minor or disabled child, and any of those individuals or their representatives dispose of any of the remainder of the annuity for less than fair market value, the State must then be named beneficiary in the first position • The requirement is waived if the individual has purchased a long-term care insurance policy that protects the annuity as approved by the Indiana Long-Term Care Partnership (ILTCP). As remainder beneficiary, the State is entitled to receive the total amount of medical assistance paid on behalf of the applicant for medical assistance. Additional Criteria Applicable ONLY to the person in LTC: The rules explained below do not apply to annuities owned by or transactions made by community spouses. There are 2 separate sets of criteria that, if met by the terms of the annuity, will not result in a transfer penalty. The first set will be referred to as “soundness” criteria. The second set will be referred to as “class exceptions”. The annuity does not have to meet both sets of criteria – it must meet the criteria from either set. The purchase of an annuity or transactions completed will not result in a transfer of property penalty if the following conditions, referred to as soundness criteria, are met: • The annuity is irrevocable and non-assignable in that it cannot be cashed in, nor ownership transferred to another individual or entity, and • The annuity is actuarially sound in that it is expected to return full principal and interest within the institutionalized individual’s life expectancy, and • The annuity provides payments in approximately equal amounts with no deferred or balloon payments. To determine actuarial soundness for promissory notes, loans and annuities use the Life Expectancy Table at the end of this document. If the individual does not (will not) receive compensation in the amount of the full purchase price within lifetime (or within the contract’s specified time period if shorter than the life expectancy), the uncompensated amount is the difference between the purchase price and the amount that the annuity will pay out to the individual within the individual’s life expectancy, or term of the contract if shorter than life expectancy. Ownership of an annuity in one of the following classes of retirement annuities will not result in a transfer of property penalty: • An individual retirement annuity (according to Sec. 408(b)) of the Internal Revenue Code of 1986 (IRC), or

• A deemed Individual Retirement Account (IRA) under a qualified employer plan (according to Sec. 408 (q) of the IRC), or • The annuity is purchased with proceeds from a traditional IRA (IRC Sec. 408a), or • The annuity is purchased with proceeds from certain accounts or trusts which are treated as traditional IRAs (IRC Sec. 408 §(c)), or • The annuity is purchased with proceeds from a simplified retirement account (IRC Sec. 408 § (p)), • The annuity is purchased with proceeds from simplified employee pension (IRC Sec 408 § (k)) • The annuity is purchased with proceeds from a Roth IRA (IRC Sec. 408A). To determine that an annuity is established under any of the various provisions of the Internal Revenue Code that are referenced above, rely on verification from the financial institution, the employer or the employer association that issued the annuity. The burden of proof is on the applicant or recipient (or his/her authorized representative) to produce this documentation. The life expectancy tables for males and females are listed below and are effective for annuities purchased on or after August 1, 2023. Life expectancy is provided in years. LIFE EXPECTANCY TABLES

TABLE 1 - MALE TABLE 2 - FEMALE Average Number of Years Age of Life Remaining Age of Life Remaining 55 24.27 27.86 56 23.48 27.01 57 22.71 26.16 58 21.95 25.32 59 21.21 24.49 60 20.47 23.67 61 19.74 22.85 62 19.03 22.04

63 18.32 21.24 64 17.63 20.45 65 16.94 19.66 66 16.26 18.88 67 15.58 18.10 68 14.91 17.34 69 14.24 16.58 70 13.59 15.82 71 12.94 15.08 72 12.30 14.36 73 11.67 13.64 74 11.05 12.94 75 10.46 12.26 76 9.88 11.60 77 9.32 10.95 78 8.77 10.31 79 8.25 9.70 80 7.74 9.10 81 7.25 8.53

82 6.77 7.98 83 6.31 7.44 84 5.88 6.93 85 5.47 6.44 86 5.07 5.99 87 4.70 5.55 88 4.35 5.15 89 4.02 4.76 90 3.72 4.41 91 3.44 4.08 92 3.18 3.78 93 2.96 3.51 94 2.75 3.27 95 2.57 3.05 96 2.42 2.85 97 2.28 2.68 98 2.15 2.52 99 2.04 2.37 100 1.93 2.23

101 1.83 2.09 102 1.73 1.96 103 1.63 1.84 104 1.54 1.72 105 1.45 1.61 106 1.36 1.50 107 1.28 1.40 108 1.20 1.30 109 1.13 1.21 110 1.05 1.12 111 0.98 1.03 112 0.92 0.95 113 0.85 0.88 114 0.79 0.80 115 0.74 0.74 116 0.68 0.68 117 0.63 0.63 118 0.58 0.58 119 0.53 0.53

2640.10.25.20 ESTABLISHING JOINT OWNERSHIP (MED) When property is converted from individual ownership to joint ownership on or after July 1, 1996, a transfer of property has occurred. The amount considered to be transferred is the proportionate value of the new owner(s) share of the property. When evaluating this kind of transfer workers should keep in mind that the joint interests might not all be equal. The deed or contract should specify the proportionate interests of each owner, but if it is not clear or if the worker has questions, an FSSA attorney should be consulted for assistance. Example 1: Property value = $60,000. One equal joint owner is added. $30,000 was transferred.

Example 2: Property value = $80,000. Two joint owners are added and all 3 have equal interests. $53,333.34 was transferred. (The 2 new owners' value of the property.) If property is jointly owned and additional new owners are added, the amount transferred is the difference between individual's interest before the transfer and after the transfer.

Example 3: Property valued at $90,000 is jointly owned by the applicant and his son. His interest is $45,000. He adds his daughter as another joint owner, and all 3 have equal shares. His interest is now $30,000, so the amount transferred is $15,000. ($45,000 - $30,000). If the property which has been converted to joint ownership has a lien or mortgage, the amount transferred is the proportionate equity value. 2640.10.25.25 TRANSFERS OF INCOME This section applies to transfers of income that occur on and after June 1, 2002.95 When an individual transfers a stream of income or the right to receive income, the uncompensated value is the difference between the actual amount of income received, and the fair market value (FMV) of income that should be received. The FMV of the income that should be received is determined by multiplying the FMV by the life expectancy of the individual based on the Tables in Section 2640.10.25.10. Any income that the property was producing, or was capable of producing, is included in the definition of assets for purposes of the transfer law. The resource that was transferred may have been exempt or non-exempt. In the situation of a transfer of income-producing, non-home real property, the value of the property in excess of $6,000 is considered an uncompensated transfer. See Section 2640.10.15.05 for instructions on calculating the uncompensated value of income-producing real property. In addition, the value of the income that the property was producing or was capable of producing is a transfer. The uncompensated

value is the fair market value of the income that the property could reasonably be expected to produce multiplied by the person’s life expectancy at the time of the transfer. If an individual rents real property for less than FMV, the uncompensated amount is the difference between the FMV of the rent and the amount of rent being received, based on the person’s life expectancy. Example 1: A 75-year-old recipient in a nursing home owns rental property with an equity value of $50,000 and is receiving $500 a month in rent. This rental amount is consistent with other similar properties in the neighborhood and is therefore considered the fair market value. After subtracting allowable rental expenses, he has $400 rental income in his Medicaid budget. Their legal guardian transfers full title of the property to member. The uncompensated value of the transfer of income is $400 x 110.88 months (9.24 years obtained from the life expectancy tables, $44,352. This is added to the uncompensated value of the property in excess of $6,000 for a total uncompensated value of $88,352. ($44,000 real property plus $44,352 income.).

Example 2:

A 70-year-old Medicaid recipient moves into a nursing home and signs the agreement to put their home up for sale or rent at fair market value. They hire a realtor who assesses the value at $95,000 with a rental value of $800 per month. Two months later, they rent the property to their child for $10 dollars a month. The child will pay the allowable expenses which amount to $150 per month. The uncompensated value is $640 ($800 - $150 - $10) x 184.20 months (15.35 years), $117,888. 2640.10.25.30 LOANS, PROMISSORY NOTES AS TRANSFERS OF ASSETS This provision applies to loans established on and after November 1, 2009. It applies to individuals who loan money directly to another as well as those who may purchase a loan or promissory note that was originally entered into between 2 other people. The likelihood of the latter may be small, however given the concern that many private loans are merely gifts appearing to be loans, it is important to understand the possible transactions that may occur by someone trying to shelter assets to become eligible for Medicaid. All promissory notes should be sent to PAL for review. Whenever an individual has a promissory note, loan agreement, or mortgage as presumed evidence that a transfer of money was not a gift but was made with the expectation of full repayment, the arrangement will be considered an improper transfer unless all the following criteria are met96: • The repayment term is actuarially sound in accordance with the Life Expectancy Table included at the end section 2640.10.25.10 • The agreement provides for payments to be made in equal amounts during the term of the loan, with no deferral of payments and no balloon payments, and

• The promissory note, loan, or mortgage prohibits the cancellation of the balance upon the death of the lender.95 In the case of a promissory note, loan, or mortgage, that does not satisfy the requirements above and is established on or after 11-1-09, the value of such contract considered as an improper transfer will be the outstanding balance due as of the date of the individual’s application for Medicaid or date of LTC admission, whichever is later. In the case of HCBS, the balance to be used is the amount as of the date of the Cost Comparison Budget approval. When determining if the loan is actuarially sound, refer to the person’s age on the Life Expectancy Table as of the date the loan is established. If the loan cannot be repaid within the person’s life expectancy, it is not actuarially sound and is therefore an improper transfer. The interest amount of the loan payments is countable income. 2640.10.25.35 TREATMENT OF CONTINUING CARE RETIREMENT COMMUNITY ENTRANCE FEES A Continuing Care Retirement Community (CCRC) or similar life care community typically provides a variety of living arrangements, from independent living through skilled nursing care. In many cases, potential residents must provide extensive information about their finances, including their assets and income, before being accepted for admission. In addition, they must pay substantial entrance fees and sign detailed contracts before moving to the community. Effective with contracts entered into on and after November 1, 2009, entrance fees paid by an individual to a CCRC, or similar life care community, are counted as an available non-exempt resource of the individual for Medicaid eligibility determinations when all of the following 3 conditions apply97: 1. The person has the ability to use the entrance fee, or the contract provides that the entrance fee may be used, even in part, to pay for care if the person’s other resources or income are insufficient to pay for their care. It is not necessary for the CCRC to provide a full, lump sum refund of the entrance fee to the residents. If even a portion of the fee can be refunded or applied to pay for care as required, this condition would be met. 2. The person is eligible for a refund of any remaining entrance fee when the person dies or terminates the contract and leaves the community. In order to meet this second condition, it is not necessary for the residents to receive a refund of the entrance fee or deposit. This second condition is met if the resident could receive a refund were the contract to be terminated or if the resident dies. 3. The entrance fee does not confer an ownership interest in the continuing care retirement community or life care community. Ownership interest generally means the right to possess and convey property. Therefore, the residents will be required to verify whether or not they have an ownership interest in a CCRC or life care community by presenting documentation from the facility to that effect. If the CCRC or life care

community confirms that the entrance fee does not confer an ownership interest to the residents, then the third condition described above is met. For Medicaid eligibility determinations, all spousal impoverishment protection rules regarding income and asset allocations for a community spouse are applicable when one spouse resides in the skilled nursing care section of the facility, and the other spouse (the community spouse) resides in an independent living setting. CCRC and similar life care community contracts are required by federal law to account for spousal impoverishment income and asset allocations to a community spouse before determining the number of resources that a resident must spend on his or her own care. 2640.10.25.40 TRANSFERS INVOLVING BURIAL PLOTS OR SPACES FOR IMMEDIATE FAMILY MEMBERS Pursuant to FSSA v. Culley, irrevocable burial trusts, plots or spaces purchased with assets owned by applicants or recipients that name an immediate family member as the beneficiary of the burial plots or spaces are not considered improper transfers that invoke a penalty period. See IHCPPM 2615.20.20.10. For purposes of this section immediate family means an individual's minor and adult children, including adopted children and stepchildren, an individual's brothers, sisters, parents, adoptive parents, and the spouses of those individuals. Neither dependency nor living-in-the-same-household will be a factor in determining whether a person is an immediate family member. For purposes of this section “burial spaces” include burial plots, gravesites, crypts, mausoleums, urns, niches, and other customary and traditional repositories for the deceased's bodily remains provided such spaces are owned by the individual or are held for his or her use. Additionally, the term includes necessary and reasonable improvements or additions to or upon such burial spaces including, but not limited to, vaults, headstones, markers, plaques, or burial containers and arrangements for opening and closing the gravesite for burial of the deceased.98 2640.10.30 PRESUMPTION OF INTENT IN TRANSFERRING PROPERTY Once the uncompensated value for a transfer of property has been established, this figure will be used to determine a penalty period. DFR will presume Medicaid eligibility to be the motive unless a satisfactory showing is made to the DFR that the property was transferred exclusively for a purpose other than to qualify for Medicaid, or that the individual intended to transfer the property at fair market value. If the individual wishes to rebut this presumption, they are responsible for presenting convincing evidence to the DFR in support of their contention that the property was transferred exclusively for some other purpose or that they intended to transfer the property at fair market value. If the individual chooses to rebut the presumption, they must provide a statement concerning the circumstances of the transfer. The statement should cover, but need not be limited to the following:

• Purpose for transferring the property • Attempts to dispose of the property at fair market value • Reason for accepting less than fair market value for the property Means of or plans for supporting himself after the transfer • Relationship (for example: familial or business) to the person to whom the property was transferred. In addition, the individual must submit any and all pertinent documentary evidence such as legal documents, realtor listing agreements, relevant correspondence, and so forth, to the DFR. An allegation by the individual that the property transfer was done to avoid Medicaid estate recovery will not be accepted as a satisfactory showing that the property was transferred exclusively for a purpose other than to become eligible for Medicaid. Clearly, an individual who makes this claim has the intention of becoming eligible for Medicaid, or estate recovery would not even be an issue. Furthermore, a simple statement made by or on behalf of a recipient who has transferred property, that the transfer did not affect eligibility and is therefore allowable, does not constitute a satisfactory showing. The individual may be trying to protect all future eligibility. Again, the avoidance of estate recovery may be the intent and will not suffice. If the DFR finds the individual has made a satisfactory showing that the resource was not transferred to attain Medicaid eligibility, or that they intended to transfer it for fair market value, a penalty period will not be established. 2640.10.35 DETERMINING THE TRANSFER PENALTY PERIOD BEGIN DATE An unsuccessful rebuttal of the presumption of intent combined with a determination of inadequate consideration will result in the DFR invoking a penalty period. During a transfer of property penalty period, the recipient is ineligible for nursing facility services and home and community-based services. For transfers on and after 8-11-93 but prior to July 1, 2003, the penalty period will begin with the month of the transfer (if that month is not a part of another penalty period) and continues for the full number of penalty months determined by dividing the uncompensated value by the nursing facility private pay rate in effect as of the application month. (Refer to Section 3006.00.00 for the private pay rate). The process of rounding down the number of penalty months is no longer valid policy, and the procedure is now prohibited. The penalty start date for transfers of property will begin on the later of: • The date on which the individual would be otherwise eligible for Long Term Care Services under Medicaid based on an approved application were it not for the imposition of the penalty period, or • The first day of a month during which assets have been transferred for less than fair market value (FMV), and

• The penalty does not occur during any other transfer of property penalty. NOTE: Advance notice of an adverse action is applicable for individuals who have been determined eligible for Medicaid. IHCPPM 2232.00.00. Therefore, if the calculation of the penalty period based on the criteria previous stated in this section would have any portion of the penalty period cover month(s) where the individual was previously determined eligible for and received Medicaid long-term care services, a claim for benefit recovery must be initiated to recover the portion of the nursing home per diem paid for by Medicaid during the calculated penalty period the individual incorrectly received. Please, refer to IHCPPM Chapter 4600 for Benefit Recovery. The notice of the benefit recovery action serves as the notice for advanced notice of adverse action in this instance. If the individual residing in a long-term care facility is a new applicant whose eligibility requires a transfer penalty period, the begin date will most often be the first month the person is otherwise eligible. Example: • 10/15 Individual entered LTC facility • 12/05 Gifted Money • 05/10 Apply for Medicaid The months covered by the application are February, March April and continuing. During the eligibility process it is determined that the gifting was an improper transfer, and that the applicant had excess resources for the months of February and March. Therefore, Medicaid is effective 04/01 and a transfer penalty is imposed starting the same date, 04/01. Assume the penalty period is 5 full months. The penalty begins on 04/01 and ends on 08/31. Under the old rules, the transfer penalty would have begun on 01/01, the month after the month of transfer and ended on 05/31. 2640.10.35.05 CALCULATION OF THE PENALTY PERIOD All improper transfers occurring on and after 11-01-09 are accumulated into one total amount to determine the penalty period. The facility rate as of the date of application, not the date of transfer, is used in the calculation. Refer to IPPM 3006.00. The uncompensated value determination must take into consideration the de minimis transfer allowance as explained in IPPM 2640.10.15.10. Transfer penalties using the specific method explained below may end on any date in a month not just the last day of a month. Two standard values are used in the penalty period calculation: • Monthly Standard of days in a month - 30.42 days. (365 days divided by 12) • Average Monthly Facility Private Rate - Refer to IPPM 3006.00 for the applicable rate to use

based on the date of an application. Once the final uncompensated value (UV) of all improper transfers made on and after 11-01-09 has been determined, the steps below are to be followed to determine the length of the penalty period: 1. Divide the UV by the facility rate as of the date of application. Round up at 2 decimal places. (For example, 2.26216807 are 2.27 months.) This result is the length of the penalty period. 2. If the above division happens to result in whole months, the calculation of the penalty is complete. 3. If the length of the penalty period as calculated above includes a fractional month, the next step is to convert the fractional month into days. Multiply the partial month by 30.42 and round up to determine the number of days in last month of the penalty period. Example: UV = 10,129.24 Private Rate = $4,611 $10,129.24 divided by $4,611 = 2.1967555 2.20 months Partial month .20 x 30.42 Standard of days = 6.084 7 days Penalty period is 2 months, 7 days. 2640.10.35.10 MULTIPLE TRANSFERS OF PROPERTY For transfers occurring on or after November 1, 2009, if multiple transfers occurred during a person’s look-back review period that require a transfer of property penalty period, there is to be one overall penalty period that is a cumulative total of all the improper transfers. of all the improper transfers. Example: • An individual admitted to Long Term Care facility on 10/08/09 • Application filed 11/20/2010 • Facility Private Rate is $4,826 (see IHCPPM 3006.00.00) The first month of eligibility is 10/2010. (The applicant is ineligible for August and September due to excess resources). Transfers: • 11/03/2009: $10,000 cash gift to sister • 11/09/2010: $800 cash gift to son • 11/14/2010: $20,000 cash to best friend Evaluation: All transfers are determined to be improper and subject to penalty. Because the application was filed after 10/01/2009, the $1,200 de minimis transfer allowance rule applies to each year of transfers. The $10,000 transfer is reduced to $8,800 because the gift was to a family member. $8,800 divided by

$4826 = 1.823 = 1.83 months. Convert. The partial .23 months to days: 30.42 x .83 = 24.2486 days = 25 days. The penalty begins 11/01/2010 and ends 12/25/2010. The uncompensated value of the transfer in 2010 = $20,800. Only the $800 gift to a family member is subject to the de minimis; the gift to the friend is not reduced. The uncompensated value subject to penalty is $20,000. $20,000 divided by $4,826 = 4.1442 months = 4.15 months. Convert the .15 partial months to days: 30.42 x .15 = 4.563 days = 5 days. The penalty period is 4 months 5 days. Combined with the other penalty period, this penalty extends from 12/26/2010 and ends on 4/30/2011. 2640.10.35.15 TRANSFERRED PROPERTY IS RETURNED TO THE ORIGINAL OWNER If the transferred property is returned in its entirety, no penalty can be established. If a penalty has already been established, and then the property is returned to the individual, this transaction nullifies the penalty. It has the effect of restoring ownership of the property to the individual back to the month of the transfer. It does not necessarily restore full Medicaid coverage to the individual. The worker must redetermine Medicaid for the months in question by considering the value of the property. When only a portion of the property or its equivalent value is returned, the penalty period is to be reduced proportionately. 2640.10.35.20 BUDGETING PROCEDURES DURING A TRANSFER PENALTY PERIOD During the penalty period, "eligibility step" budgeting is to be used. Effective June 2014, the “eligibility step” is the comparison of individual income to the Special Income Level (SIL). Refer to IHCPPM 3455.14.00. The post-eligibility step is never completed. Once the penalty period has been served, the post-eligibility calculation to determine the liability amount is to be effective the month after the last month of the penalty period. Caseload controls must be in place to ensure that desk reviews are completed for appropriate action immediately after the penalty period expires. 2640.10.40 TRANSFER PENALTY HARDSHIP EXCEPTION The hardship procedures explained in this section are used when a transfer penalty has been imposed on an individual for a transfer of property occurring on and after November 1, 2009, except when the penalty is due to an annuity purchase. There is no hardship exception for an annuity purchase. POLICY: When a penalty is imposed, the eligibility system generated notice will explain that an appeal based on the merits of the penalty determination can be filed, or a hardship exception can be requested if the individual alleges and can document that such a hardship exists.

Procedures for filing the Request for Hardship Exception-Transfer of Property directly to the FSSA Office of Medicaid Policy & Planning (OMPP) are explained in the notice. (The text of the hardship language on the eligibility notice is at the end of this section.) The request for an undue hardship exception will serve as admission by the individual that a transfer of assets for less than adequate consideration was made, and that the agency’s penalty determination was correct. The penalty will be removed or modified under a hardship exception if documentation substantiates that the recipient’s health is endangered as result of the penalty or that the recipient will be deprived of food, clothing, shelter, or other necessities of life. PROCEDURE: A hardship exception request must be filed within 30 days of the notice imposing the transfer penalty. The Request for Hardship Exception – Transfer of Property State Form 54167 must be submitted to: Mail Stop 07 Family & Social Services Administration Office of Medicaid Policy & Planning – Eligibility 405 W Washington Street Indianapolis, IN 46204 The following people can apply for a hardship exception: • The recipient • The recipient’s authorized representative, or • The nursing facility in which the recipient currently resides if written consent from the recipient or the recipient’s personal representative is given for the nursing facility to file the request. OMPP will make the decision to waive all, or a portion of the transfer penalty based solely on the evidence submitted with the request. The Notice of Decision on Transfer of Property Hardship Exception Request will be issued by OMPP to the requestor within 45 days of receiving a request for an exception. A denial of a hardship exception is subject to administrative appeal. A copy of the Notice of Decision on Transfer of Property Hardship Exception Request will be sent to the Division of Family Resources. An approval of a hardship exception must be acted upon by the Division within 10 days (normal change processing requirements) to remove or shorten the penalty as approved.

1 20 CFR 416.1201(a)(1) 2 20 CFR 416.1201(c)(2) 3 20 CFR 416.1207(b) 4 20 CFR 416.1103 (c) 5 42 U.S.C. § 1396w 6 IC 12-15-41-2 7 20 CFR 416.1103(a)(3) 8 IRS.gov “Some things to know about crowdfunding and taxes” and Publication 525 9 IRS.gov Publication 535 10 20 CFR 416.1208(c) 11 20 CFR 416.1208(c)(4) 12 20 CFR 416.546 13 20 CFR 416.1201(a) and (b) 14 IC 12-7-2-44.6 (2) (c) (ii) 15 IC 12-7-2-44.6 16 IC 12-11-14 17 20 CFR 416.1202 18 IC 12-11-14-1; 26 USC 529A 19 20 CFR 416.1202 (a)(1) 20 20 CFR 416.1160(d) & 405 IAC 2-1-1 21 20 CFR 416.1121 (a) 22 42 USCS 1396r-5 23 405 IAC 2-3-26 24 42 U.S.C. 1396r-5 25 20 CFR 416.1231 (b) 26 IC 30-2-13-12 27 20 CFR 416.1231 (b) 28 IC 30-2-13-12 (b) 29 20 CFR 416.1201 (4) 3020 CFR 416.1201 (b) 31 20 CFR § 416.1230(a); 12-15-2-17(f) 32 20 CFR 416.12; Public Law 95-171 33 760 IAC 2-20-39 34 760 IAC 2-20-40 35 20 CFR 416.1216 36 20 CFR 416.1220 37 405 IAC 2-3-14(b)(1) 38 405 IAC 2-3-23 39 31 CFR 351.6, 31 CFR 359.6 40 20 CFR 416.1103(f) 41 20 CFR 416.1218(a) 42 20 CFR 416.1218(b)(1)(2) 43 20 CFR 416.1233(a) 44 405 IAC 2-3-2

45 SSA Section 1917(d) as added by P.L. 103-66, OBRA-93; 405 IAC 2-3-22 46 42 U.S.C 1396p(d)(4)(A), 405 IAC 2-3-22(i)(2) 47 405 IAC 2-3-22(i)(3)(D) 48 405 IAC 2-3 (i)(4) 49 405 IAC 2-3-29 50 405 IAC 2-3-29 51 20 CFR 416.1201(b) 52 405 IAC 2-3-14(b)(4) 53 405 IAC 2-3-14(b)(4) 54 405 IAC 2-3-14(b)(1) 55 405 IAC 2-3-14(f) 56 405 IAC 2-3-14(f) 57 20 CFR Part 416.11, 405 IAC 2-3-14(3) 58 405 IAC 2-9-4(c)(1) 59 20 CFR 416.1236(a)(4) 60 20 CFR 416.1236(a)(6) 61 20 CFR 416.1236(a)(5) 62 20 CFR 416.1236(a)(4), 20 CFR 416.1236 (a)(11) 63 20 CFR 416.1238 64 20 CFR 416.1236(a)(1) 65 20 CFR 416.1236(a)(13) 66 20 CFR 416.1236(a)(15) 67 SSA Section 1902(r)(1)(A) as amended by OBRA-90; P.L. 101-508 68 20 CFR 416.1229 69 P.L. 93-113, Sections 404(g) and 418 70 20 CFR 416.1236(a)(14) 71 P.L. 93-288; 20 CFR 416.1150 72 P.L. 101-426 as amended by P.L. 101-510; 20 CFR 416.1236 (a)(17) 73 20 CFR 416.1236(a)(16) 74 IC 4-4-28-5 75 IC 4-4-28-6 76 42 U.S.C. 1396R-5 77 20 CFR 416.1202(b) 78 405 IAC 2-1.1-7(c) 79 405 IAC 2-1.1-7(c) 80 SSA, Section 1924(c)(1) 81 SSA, Section 1924(f)(2) 82 SSA, Section 1924(c)(5)(A) as amended by OBRA-90 83 SSA, Section 1924(f)(1) as amended by OBRA-90 (P.L. 101-508) 84 405 IAC 2-3-1.1 85 405 IAC 2-3-1.1(1) 86 405 IAC 2-3-1.1(k)(5) 87 405 IAC 2-3-1.1(8)(l) 88 20 CFR 416.1216 89 20 CFR 416.1246(c) 90 405 IAC 2-3-27 91 405 IAC 2-3-27 92 20 CFR 416.1246(d)(1)

93 405 IAC 2-3-1.1 (d)(1)(H) 94 405 IAC 2-3-1.2 95 405 IAC 2-3-1.2 96 42 U.S.C 1396p(c)(1)(I)(iii) 97 405 IAC 2-3-2(b) 98 20 CFR 416.1231(a)(2)

Indiana Health Coverage Program Policy Manual Chapter 2800 INCOME Sections 2800.00.00 – 2890.10.50 Contents 2800.00.00 INCOME ............................................................................................................... 6

2800.05.00 INCOME ............................................................................................................ 6 2800.10.00 HOUSEHOLD INCOME (MED 3)…………………………………………………………………………6 2805.00.00 EARNED AND UNEARNED INCOME .................................................................... 9 2805.10.00 AVAILABILITY OF INCOME ................................................................................. 9 2805.15.00 OWNERSHIP OF INCOME .................................................................................. 9 2805.15.05 ESTABLISHING INCOME OWNERSHIP ............................................................... 10 2805.15.05.05 INCOME FROM NON-TRUST PROPERTY ......................................................... 10 2805.15.05.10 INCOME FROM TRUST PROPERTY ................................................................. 11 2805.20.00 INCOME THAT IS GARNISHED ........................................................................... 11

2805.25.00 INVOLUNTARY WITHHOLDING OF TAXES (MED 1, 2 AND 4) .............................. 11 2810.00.00 EARNED INCOME ................................................................................................ 12 2810.05.00 SALE OF BLOOD OR PLASMA ............................................................................ 12 2810.10.00 TIPS 13

2810.15.00 SHELTERED WORKSHOP EARNINGS .................................................................. 13 2810.20.00 EARNINGS OF CHILDREN (MED 1) .................................................................... 13 2810.25.00 EARNINGS (EARNED AND UNEARNED) OF CHILDREN OR TAX DEPENDENTS (MED 3) .............................................................................................................. 13 2810.26.00 EARNINGS OF STUDENTS UNDER AGE 22 (MED 1) ............................................ 14 2810.30.00 SELF-EMPLOYMENT ......................................................................................... 14 2810.30.05 SELF-EMPLOYMENT DEDUCTIONS ................................................................... 14 2810.35.00 INCOME RECEIVED FROM TRAINING PROGRAMS ............................................. 15

2810.35.05 JTPA INCOME (MED 1, 4) ................................................................................. 15 2810.40.00 SEASONAL INCOME .............................................................................................. 16

2810.45.00 BUDGETING MINISTER/CLERGY MEMBER INCOME ............................................... 16

2810.50.00 CENSUS INCOME (MED 1, 4) ............................................................................. 18 2815.00.00 IN-KIND INCOME, BARTERING, GIFTS AND GAMBLING ........................................ 19 2815.05.00 IN-KIND EARNINGS (MED 1, 2, 4) ...................................................................... 19 2815.10.00 IN-KIND SUPPORT AND MAINTENANCE (MED 1) .............................................. 19 2815.10.05 CASH SUPPORT FOR CERTAIN DEPENDENTS (MED 3) .......................................... 20 2815.15.00 BARTERING (MED 3) .......................................................................................... 20 2815.20.00 GIFTS AND INHERITANCES (MED 3) .................................................................... 21 2815.25.00 GAMBLING WINNINGS (MED 3) ......................................................................... 21 2820.00.00 CANCELED DEBT (MED 3)...................................................................................... 21 2825.00.00 INFREQUENT OR IRREGULAR INCOME (MED 1, 4) ................................................. 21

2830.00.00 CHILD AND SPOUSAL SUPPORT ............................................................................. 22 2830.05.00 CHILD SUPPORT (MAGI, MED 3) ........................................................................ 23 2830.10.00 CHILD SUPPORT AND ALIMONY (MED 1, MED 4) ............................................... 23 2835.00.00 ASSISTANCE FROM GOVERNMENT PROGRAMS .................................................... 24 2835.05.00 ENERGY ASSISTANCE PAYMENTS ....................................................................... 24 2835.10.00 TOWNSHIP TRUSTEE ASSISTANCE ..................................................................... 24 2835.15.00 HUD PAYMENTS................................................................................................ 24 2835.20.00 RELOCATION ASSISTANCE ACT PAYMENTS ....................................................... 25 2835.25.00 DISASTER ASSISTANCE PAYMENTS ................................................................... 25

2835.30.00 FOSTER CARE, KINSHIP CARE AND ADOPTION ASSISTANCE PAYMENTS ............. 25 2835.30.05 FOSTER CARE PAYMENTS ................................................................................. 25 2835.30.10 ADOPTION ASSISTANCE (MAGI, MED 3) ........................................................... 26 2835.30.15 ADOPTION ASSISTANCE (MED 1, 4) .................................................................. 26 2835.35.00 SUPPLEMENTAL SECURITY INCOME ................................................................. 26 2835.35.05 SUPPLEMENTAL SECURITY INCOME (MAGI, MED 3) ......................................... 26 2835.35.15 SUPPLEMENTAL SECURITY INCOME (MED 1, 4) ................................................ 27 2835.40.00 TANF/RCA PAYMENTS ...................................................................................... 27 2835.40.05 RETROACTIVE/CORRECTIVE TANF/RCA PAYMENTS (NON-MAGI, MED, 1, 4) ..... 27 2835.45.00 SNAP/NUTRITION PROGRAMS .......................................................................... 27

2835.50.00 RESIDENTIAL LIVING ALLOWANCES .................................................................. 28

2840.00.00 BENEFIT PROGRAMS ........................................................................................... 28 2840.05.00 SOCIAL SECURITY INCOME (MED 1, 2, 4) .......................................................... 28 2840.05.05 SOCIAL SECURITY BENEFITS (MED 3) ............................................................... 29 2840.10.00 VETERANS’ BENEFITS ....................................................................................... 29 2840.10.05 SPINA BIFIDA ALLOWANCE FOR VETERANS' CHILDREN ..................................... 29 2840.10.10 VA AID & ATTENDANCE ALLOWANCE AND HOUSEBOUND ALLOWANCE ........... 30 2840.15.00 RAILROAD RETIREMENT BENEFITS (MED 1, 2, 4) ............................................... 33 2840.15.05 RAILROAD RETIREMENT BENEFITS (MED 3) ...................................................... 33 2840.20.00 PENSIONS ........................................................................................................ 33 2840.20.05 PENSIONS (MED 1, 2, 4) ................................................................................... 33

2840.20.10 PENSIONS (MED 3) ........................................................................................... 34 2840.25.00 UNEMPLOYMENT COMPENSATION BENEFITS .................................................. 34 2840.30.00 WORKER’S COMPENSATION ............................................................................. 34 2840.30.05 WORKER’S COMPENSATION (MED 1, 2, 4) ........................................................ 35 2840.30.10 WORKER’S COMPENSATION (MED 3) ............................................................... 35 2840.35.00 STRIKE BENEFITS .............................................................................................. 35 2840.40.00 MILITARY ALLOTMENTS ................................................................................... 35 2840.40.05 MILITARY ALLOTMENTS (MED 1, 2, 4) .............................................................. 35 2840.40.10 MILITARY ALLOTMENTS (MED 3) ...................................................................... 35 2840.45.00 DISABILITY PAYMENTS ..................................................................................... 36

2840.45.05 DISABILITY PAYMENTS (MED 1, 2, 4) ................................................................ 36 2840.45.10 DISABILITY PAYMENTS (MED 3) ........................................................................ 36 2840.45.15 INDEMNITY HEALTH INSURANCE PAYMENTS .................................................... 36 2840.45.20 INDEMNITY HEALTH INSURANCE PAYMENTS (MED 1, 2, 4) ............................... 36 2840.45.25 INDEMNITY HEALTH INSURANCE PAYMENTS (MED 3) ...................................... 37 2840.50.00 LONG-TERM CARE INSURANCE PAYMENTS (MED 1, 4) ..................................... 37

2845.00.00 BENEFITS RECEIVED DUE TO FEDERAL LAW ......................................................... 37 2845.05.00 DOMESTIC VOLUNTEER SERVICE ACT COMPENSATION .................................... 38 2845.10.00 OLDER AMERICANS ACT ................................................................................... 38 2845.10.05 OLDER AMERICANS ACT (MED 1, 2, 4) .............................................................. 38

2845.10.10 OLDER AMERICANS ACT (MED 3) ..................................................................... 38

2845.15.00 ASSISTANCE FOR CERTAIN INDIAN TRIBES/ALASKAN NATIVES .......................... 38 2845.20.00 COMPENSATION TO GERMANS, JAPANESE, AND ALEUTS ................................. 42 2845.20.05 PAYMENTS TO JAPANESE AND ALEUTS ............................................................. 43 2845.20.10 GERMAN REPARATION PAYMENTS ................................................................... 43 2845.25.00 AGENT ORANGE BENEFITS ............................................................................... 43 2845.30.00 FEDERAL TAX REFUND PAYMENTS ................................................................... 43 2845.35.00 CHILD CARE PAYMENTS ................................................................................... 43 2845.40.00 RADIATION EXPOSURE ACT BENEFITS ............................................................... 44

2845.45.05 CRIME VICTIM PAYMENTS ................................................................................ 44 2845.50.00 UTILITY EXPENSE PAYMENTS ............................................................................ 44 2845.55.00 SETTLEMENT PAYMENTS UNDER WALKER V. BAKER CORPORATION, ET. AL. ..... 44 2845.60.00 MILITARY SUBSISTENCE ALLOWANCE ............................................................... 44 2845.65.00 AMERICORPS PROGRAM (MED 1) .................................................................... 45 2845.65.05 AMERICORPS PROGRAM (MAGI) ......................................................................... 45 2845.70.00 NATIONAL FLOOD INSURANCE PROGRAM (MED 1) .......................................... 45 2845.75.00 ENERGY EMPLOYEES’ OCCUPATIONAL ILLNESS COMPENSATION PROGRAM (MED 1) .............................................................................................................. 45 2850.00.00 DIVIDENDS, INTEREST AND ROYALTIES ................................................................ 45

2850.05.00 INTEREST ON INDIVIDUAL DEVELOPMENT ACCOUNTS ..................................... 46 2855.00.00 REIMBURSEMENTS ............................................................................................. 46 2860.00.00 EDUCATIONAL INCOME DEFINITION ................................................................... 47 2860.05.00 EXEMPT EDUCATIONAL INCOME (MED 1, 2, 4) ................................................. 47 2860.10.00 NON-EXEMPT EDUCATIONAL INCOME (MED 1, 2, 4) ........................................ 48 2860.15.00 WORK STUDY (MED 3) ..................................................................................... 49 2860.20.00 EMPLOYER EDUCATIONAL ASSISTANCE (MED 3) .............................................. 49 2860.25.00 SCHOLARSHIPS AND FELLOWSHIPS (MED 3) ..................................................... 50

2860.30.00 QUALIFIED TUITION REDUCTION (MED 3) ........................................................ 50 2860.35.00 EDUCATION EXPENSE DEDUCTIONS (MED 3) .................................................... 51 2860.35.05 STUDENT LOAN INTEREST DEDUCTIONS (MED 3) ............................................. 51 2860.35.10 TUITION AND FEES DEDUCTION (MED 3) .......................................................... 52

2865.00.00 LOANS ................................................................................................................ 52

2865.05.00 STUDENTS LOAN CANCELLATIONS AND REPAYMENT ASSISTANCE (MED 3) ...... 52 2866.00.00 REVERSE MORTGAGES ........................................................................................ 53 2866.05.00 REVERSE MORTGAGES (MED 1, 2, 4) ................................................................ 53 2866.10.00 REVERSE MORTGAGES (MED 3) ........................................................................ 53 2870.00.00 CONTRIBUTIONS-DEFINITION.............................................................................. 54 2870.05.00 CONTRIBUTIONS (MED 1, 2, 4) ......................................................................... 54 2870.10.00 CONTRIBUTIONS (MED 3) ................................................................................ 54 2875.00.00 REAL ESTATE INCOME ......................................................................................... 54 2875.05.00 RENTAL INCOME .............................................................................................. 54 2875.05.05 RENTAL INCOME (MED 3) ................................................................................ 54

2875.05.10 RENTAL INCOME (MED 1, 2, 4) ......................................................................... 55 2875.10.00 INCOME FROM CONTRACT SALES .................................................................... 55 2875.10.05 INCOME FROM CONTRACT OR INSTALLMENT SALES (MED 3) ........................... 55 2875.10.10 INCOME FROM CONTRACT SALES (MED 1, MED 4) ........................................... 56 2880.00.00 LUMP SUM PAYMENTS ....................................................................................... 56 2880.05.00 LUMP SUM PAYMENTS (MED 1, 2, 4) ............................................................... 56 2880.10.00 LUMP SUM PAYMENTS (MED 3) ....................................................................... 56 2885.00.00 DEEMED INCOME (MED 1 AND 4) ....................................................................... 57 2890.00.00 VERIFICATION OF INCOME .................................................................................. 58

2890.05.00 VERIFICATION OF EARNED INCOME ................................................................. 59 2890.05.05 VERIFICATION OF SELF-EMPLOYMENT INCOME/EXPENSES ............................... 59 2890.10.00 VERIFICATION OF UNEARNED INCOME ............................................................ 59 2890.10.05 VERIFICATION OF CHILD SUPPORT PAYMENTS (MED 1, 2, 4) ............................ 60 2890.10.10 VERIFICATION OF SUPPLEMENTAL SECURITY INCOME (SSI) (NON-MAGI, MED 1, 2, 4) .............................................................................................................. 61 2890.10.15 VERIFICATION OF SOCIAL SECURITY INCOME ................................................... 61 2890.10.20 VERIFICATION OF VETERANS' BENEFITS (NON-MAGI, MED 1, 2, 4) ................... 62 2890.10.25 VERIFICATION OF RAILROAD RETIREMENT ....................................................... 62

2890.10.30 VERIFICATION OF BLACK LUNG BENEFITS ......................................................... 62

2890.10.35 VERIFICATION OF PENSIONS ............................................................................ 63

2890.10.45 VERIFICATION OF WORKER'S COMPENSATION (NON-MAGI, MED 1, 2, 4) ......... 64 2890.10.50 VERIFICATION OF EDUCATIONAL INCOME ........................................................ 64

2800.00.00 INCOME This chapter discusses types of income for modified adjusted gross income (“MAGI”) categories (MED 3) and non-MAGI categories (MED 1, 2, 4). Refer to Chapter 3200 to determine which assistance group (AG) members must have their income considered. The specific income situations discussed in this chapter include: • Definition of Income (Section 2805) • Earned Income (Section 2810) • In-kind Income (Section 2815) • Vendor Payments (Section 2820) • Infrequent or Irregular Income (Section 2825) • Support, Child, Spousal (Section 2830) • Assistance from Government Programs (Section 2835) • Benefit Programs (Section 2840) • Benefits Due to Federal Law (Section 2845) • Dividends and Interest (Section 2850) • Reimbursements (Section 2855) • Student Loans, Grants, and Scholarships (Section 2860) • Loans (Section 2865) • Contributions (Section 2870) • Residential Living Allowances (Section 2835.50) • Real Estate Income (Section 2875) • Lump Sum Payments (Section 2880) • Deemed Income (Section 2885) • Verification of Income (Section 2890)

2800.05.00 INCOME Income is the gain or benefit, earned or unearned, which is received or is available to the AG.

All unearned and earned income, unless specifically exempted, disregarded, deducted for work expenses, or allocated to dependents as allowed by state or federal regulation, is to be evaluated in determining initial and continuing eligibility. 2800.10.00 HOUSEHOLD INCOME (MED 3) FOR MODIFIED ADJUSTED GROSS INCOME (“MAGI”) (MED 3) AGS, ELIGIBILITY IS BASED UPON HOUSEHOLD INCOME, WHICH IS THE SUM OF EVERY INDIVIDUAL INCLUDED IN THE

INDIVIDUAL’S HOUSEHOLD (REFER TO CHAPTER 3200 FOR THE COMPLETE DEFINITION OF “HOUSEHOLD”).3 HOUSEHOLD INCOME DOES NOT INCLUDE: • Income of a child living with his or her natural, adopted, or stepparent and is not required to file a tax return for the taxable year in which Medicaid eligibility is determined whether a tax return is filed; or • Income of a tax dependent claimed by parents/s with whom they live, where the tax dependent is not required to file a tax return for the taxable year in which Medicaid eligibility is being determined (whether a tax return is filed). Cash support provided by the person claiming a tax dependent who is not a spouse or biological, adopted or stepchild is not counted as income.2

MAGI income includes taxable income for the year in which eligibility is being determined. Items which are tax-exempt now, such as payments for disability or retirement programs; but will be taxed later when/if there are disbursements, do not count in the MAGI budget; but when these later disbursements are paid, they will then be something which would be included. For the most part, MAGI use the same rules used by the Internal Revenue Service (IRS)3 to calculate the Adjusted Gross Income (AGI, or line 7 on the 1040 form). The Internal Revenue Code defines MAGI as adjusted gross income plus any foreign income, tax exempt interest, and non-taxable Social Security benefits. Supplemental Security Income (“SSI”) is excluded under MAGI, but Social Security Disability Income (SSDI) counts in the budget whether it is taxed or not. The following are four exceptions from MAGI for Medicaid eligibility purposes: • A lump sum amount is counted as income only in the month received. • Scholarships, awards, or fellowship grants for educational purposes and not for living expenses are excluded from income. • Parent Mentor Stipend • Certain American Indian and Alaska Native settlement trusts, distributions, and student financial assistance.5

Eligibility based upon MAGI-based income does not include an asset (resources) test and does not include any income or expense disregards except for an amount equivalent to 5 percentage points of the applicable income standard for the family size as set forth in IHCPPM 3465.05.00.4 any items that are tax deductible should be deducted from a person’s MAGI-based income. Note: if using the tax return to verify income, Line 7 on the 1040 will already have any allowable deductions considered and they should not be deducted again. Income under MAGI-based methodologies includes, but is not limited to, the following: • Wages and salaries • Rents • Royalties

• Gains from dealings in property • Taxable interest • Tax exempt interest • Dividends • State income tax refunds • Alimony received; only for divorce decrees dated on or before 12/31/2018 • Business income • Capital gains • Income from life insurance and endowment contracts • Other gains • Taxable IRA distributions • Taxable pensions and annuities • Distributive share of partnership gross income • Estate and trust income • Farm income • Unemployment compensation • Taxable Social Security benefits • Non-taxable Social Security benefits (SSI, however, is excluded) • Net operating loss • Gambling earnings • Cancellation of debt • Foreign earned income exclusion • Foreign earned income 5

Under MAGI-based methodologies, the following deductions apply: • Educator expenses • Certain business expenses of reservists, performing artists, and fee-basis government officials (vehicle and transportation costs) • Health savings account deduction • Moving expenses • Deductible part of self-employment tax • Self-employed SEP, SIMPLE, and qualified plans • Self-employed health insurance deduction • Penalty on early withdrawal of savings • Alimony paid b Recipient’s SSN; only for divorce decrees dated on or before 12/31/2018 • IRA deduction • Student loan interest deduction • Tuition and fees • Domestic production activities deduction.

2805.00.00 EARNED AND UNEARNED INCOME Income is broken down into two categories: earned income and unearned income. Earned income is payment received in the form of wages, salaries, and commissions from an employer or from self-employment. In-kind earnings such as goods or services received in lieu of wages are also considered earned income. It can also be profits from the sale of farm crops, livestock, or poultry. Unearned income is income for which there is no current performance of work or services. Unearned income may include: • Retirement income • Disability payments • Unemployment/worker's compensation • Annuities, pensions, and other regular payments • Alimony and support payments o Counts for income in all non-MAGI o Counts for MAGI cases only if the divorce was finalized and/or amended prior to 1/1/2019) o Refer to 2830.00.00 for further information. • Dividends, interest, and royalties • Proceeds of life insurance policies (when paid in installments) • Winnings, prizes, and awards • Gifts and inheritances • Child support • Benefits administered through the Social Security Administration. 2805.10.00 AVAILABILITY OF INCOME Income is considered available when it is received and/or when the individual can make the income available. Refer to IHCPPM 3405.00.00 regarding the income budgeting principals. 2805.15.00 OWNERSHIP OF INCOME The individual who has title to the proceeds of a payment or property is the individual who "owns" the income. If the income is received by an individual's legal representative or guardian, the individual still owns the income. When a legal representative receives the income, ownership through one of the following documents must be verified:

• The designation on the payment, check, award letter, or other document • The title to the property. 2805.15.05 ESTABLISHING INCOME OWNERSHIP The ownership of all sources of income must be determined according to the criteria listed below. This process establishes the income attributable to everyone. For non-MAGI (MED 1, 2, 4) AGs, income received from a non-AG member and used for the care and maintenance of said individual is not counted as income. When a single payment is received for AG and non-AG members, the portion intended and used for the care and maintenance of the non-AG member will not be counted as income to the AG.

Example: Susie is a Medicaid member. Her mother lives next door and she runs errands for her mother. Her mother gives her cash of $150 a month to pick up her prescriptions and groceries. This is not income to Susie as it is used for the care and maintenance of her mother that lives in a separate household.

For MAGI (MED 3) AGs, payment for the care and maintenance of an AG member or non-AG member is only counted as income if it is taxable income. However, available cash support is not counted as income if provided by the person claiming a tax dependent if the tax dependent is someone other than a spouse or biological, adopted, or stepchild. When a legal representative receives the income, ownership may be verified by the following if electronic verification is not possible: • By specific designation on the payment, check, award letter, or other document; or • By contacting the payment source to ascertain for whom payment is intended and for what purpose is payment being made.

After ownership has been established, each income source must be attributed to the appropriate owner(s). 2805.15.05.05 INCOME FROM NON-TRUST PROPERTY Consider income paid in the name of one individual to be the income of that individual. For income paid in the name of one individual and another person or persons, consider available to each person the amount representing the individual's proportionate interest. For non-MAGI (MED 1, 2, 4) AGs, consider child support income to be the income of the child.

For MAGI (MED 3) AGs, child support income is excluded from income. For non-MAGI (MED 1, 2, 4) AGs, consider income paid in the name of one spouse to be the income of that spouse. For income paid in the names of both spouses, consider one-half of the income to be available to each spouse. For income paid in the name of one or both spouses and to another person or persons, consider available to each spouse the amount representing the spouse's proportionate interest. When no interest is specified, consider available to each spouse one-half of the couple's joint interest. 2805.15.05.10 INCOME FROM TRUST PROPERTY The income from a trust source should be considered as available to each individual or to each spouse in accordance with the specific terms of the trust. In the absence of specific provisions, the preceding rules for ownership of income from a non-trust source will apply. 2805.20.00 INCOME THAT IS GARNISHED Income earned by an AG member that is garnished by an employer and paid to a third party, such as IRS garnishments, is included as income. 2805.25.00 INVOLUNTARY WITHHOLDING OF TAXES (MED 1, 2 AND 4) The amount of tax that is involuntarily withheld from an individual's unearned income is an allowable deduction from income. For the tax to be considered involuntarily withheld, the payee must have no choice as to whether the tax is withheld or not. If the payee can choose the amount of a mandatory withholding, the deduction must be allowed in the smallest permissible amount. The amount of tax that is being voluntarily withheld from an individual's unearned income is not an allowable deduction from income. 2805.30.00 INCOME OF MEMBERS OF RELIGIOUS ORDERS AND VOW OF POVERTY Income of members of religious orders who take a vow of poverty is determined to be income to the applicant/member.

Cash or in-kind payment for members of religious orders who take a vow of poverty is considered wages if: • An individual receives compensation from the order as an active, working member of that order • An individual receives compensation from a third party for services performed as an employee • An individual receives compensation when they engage in self-employment activity unrelated to their membership in the order Any income provided by the order to a member who has taken a vow of poverty, which does not fall under one of the provisions above, is unearned income to the member, even if it is turned over to the order. Unearned income received by a member who takes a vow of poverty from any other source outside the order, such as Social Security or VA benefits, is unearned income to the member, even if the member turns it over to the order. 2810.00.00 EARNED INCOME Earned income is earnings received through wages, salaries, commissions, or profit from activities in which a person is engaged through either employment or self-employment. Income, to be considered as "earned", must entail personal involvement and effort on the part of the recipient, including managerial responsibilities. Examples of earned income include, but are not limited to the following: • Wages, salaries, commissions, bonuses, or profit received because of holding a job or being self-employed; this would include earnings from a graduate assistantship, if subject to taxation and available to the student for meeting non-educational living expenses • Wages received from sheltered workshop employment • Compensation for jury duty • Tips • Goods and services received in lieu of wages for work performed • The dollar value, as established by the employer, of income received in-kind for work performed when in-kind earnings are received in lieu of wages. Refer to IHCPPM 2815. 2810.05.00 SALE OF BLOOD OR PLASMA For all Medicaid AG’s, income from the sale of blood or plasma is included as earned income.

2810.10.00 TIPS The number of tips reported by the employee is included as earned income. Many times, an employer will include on the pay stub of the employee an amount the employer must report to the IRS for tax purposes. This is an allocated amount which may or may not be considered as the amount earned or received by the employee. The tip amount reported by the employee can be accepted unless questioned. In some instances, the employee reports actual tips to the employer. In this instance, the employer can verify actual tips earned. The individual should keep records daily if the tips are not reported to the employer, so this information can be used for verification. NOTE: Worker should be aware that when the hourly wage is less than the minimum wage, the possibility of tips may exist. 2810.15.00 SHELTERED WORKSHOP EARNINGS Any payments from a sheltered workshop are included as earned income. A sheltered workshop is a special workshop offering limited employment experience for the mentally or physically handicapped. Refer to IHCPPM 3455.15.10.05. 2810.20.00 EARNINGS OF CHILDREN (MED 1) All the earned income of a child under age 14 is disregarded.6 2810.25.00 EARNINGS (EARNED AND UNEARNED) OF CHILDREN OR TAX DEPENDENTS (MED 3) NOTE: The current policy reflects general information confirmed at time of review from the irs.gov website and is not intended to be given as tax advice to Medicaid applicants. Please direct applicants/members to review the irs.gov website for accurate and current tax-filing rules. Household income does not include the MAGI-based income (earned or unearned) of a child who is included in the household of his or her natural, adopted or stepparent, whether a tax return is filed. However, if such child or tax dependent is required to file a tax return pursuant to the Internal Revenue Code for the taxable year, the child’s or tax dependent’s MAGI-based income will be included in the calculation of household income for eligibility purposes. The Internal Revenue Service website at https://www.irs.gov presents instructions, schedules, and tables that provide minimum amounts for when a child or tax dependent must file a tax return based upon earned income per IRS rules (please note that the DFR must accept self-

attestation for tax filing and tax dependency status, unless there is conflicting information in the case record that cannot be resolved without other means of verification). If an individual is uncertain how to answer the tax questions, the DFR can refer the individual to https://www.irs.gov/forms-pubs/about-publication-501. Specific instructions for current and prior tax year’s filing status can be in the Publication 501 Revision Section. If a child or tax dependent has both earned and unearned income, they may be required to file taxes. Refer to the above IRS website for instructions on how to determine if a tax return must be filed or for tax filing requirements for filers who do not meet the requirements for filing but may be required to file a tax return. 2810.26.00 EARNINGS OF STUDENTS UNDER AGE 22 (MED 1) Effective June 1, 2014, earned income of a student regularly attending school at least half-time is excluded up to certain maximum amounts. The exclusion applies to an applicant/recipient as well as non-participating members of a MED 1 AG whose eligibility is being determined under the 100% FPL income standard. For 2023, the first $2,220 of monthly earned income is to be excluded. This exclusion cannot exceed $8,950 for the calendar year. For 2022 the monthly amount was $2,040 and the annual amount was $8,230. 2810.30.00 SELF-EMPLOYMENT

An individual is self-employed when the individual owns a business or otherwise engages in a private enterprise. Income derived from self-employment is considered earned income. Refer to IHCPPM 3410.05.00 for specific definitions. This includes, but is not limited to the following: • Operating a small business • Sales from a franchise company • Picking up and selling cans • Farm self-employment • Selling newspapers. Refer to IHCCPM section 3410.00.00 thru 3420.05.05 for information on how to budget self- employment income. 2810.30.05 SELF-EMPLOYMENT DEDUCTIONS

An individual who is self-employed may be eligible for certain business deductions from his or her taxable income when calculating household income. All IRS deductions are allowable for MAGI categories and MED 1. This section, however, does not apply to MA F or RMA. Deductible business expenses must be both ordinary and necessary. An ordinary expense means an expense that is common and accepted for a certain business. A necessary expense is an expense that is helpful and appropriate for a certain business. The full amount of the business expense is deducted if the business makes a profit, and the business expense is both ordinary and necessary. The following are types of business expenses that may be deducted: • Employees’ pay • Retirement and savings plans • Rent expenses • Business interest expense or amount charge for borrowing money for business • Depreciation (for MED 1, 3, and 4 only) • Taxes – certain federal, state, local, and foreign taxes directly attributable to business • Legal and professional fees • Travel, meals, and entertainment • Business use of home • Insurance. 2810.35.00 INCOME RECEIVED FROM TRAINING PROGRAMS When an individual participates in a work or on-the-job training program that involves work for payment, the payment is included as earned income for non-MAGI (MED 1, MED 2, and MED 4) AGs. The income is included in the household income for MAGI (MED 3) AGs if the individual participating in the on-the-job training program is required to file taxes. (Refer to IHCPPM 2810.25.15). Training allowances from vocational and rehabilitative programs recognized by a government agency are also included income, unless excludable as a reimbursement. For example, IMPACT and Job Training Partnership Act (JTPA) program payments or allowances are included income unless provided as a reimbursement or otherwise identified as excluded income in the following sections. Refer to IHCPPM 2855.00 for additional information on reimbursements. 2810.35.05 JTPA INCOME (MED 1, 4) Income received through a JTPA program for on-the-job training is counted as earned income. Reimbursements for supportive services are exempt.

2810.35.10 PARENT MENTOR STIPENDS A parent mentor is a guardian or parent of a Medicaid or CHIP eligible child, working in an outreach program funded under Section 2113 of the SSA- to assist families with children who have no health insurance coverage. The parent mentor may receive a nominal salary, a stipend, or other form of compensation. The amount paid as a stipend is excluded from income, however wages or any other form of compensation will be included as income. The State will determine the threshold (SSA 2113(f) (5). 2810.40.00 SEASONAL INCOME Seasonal employees/workers are hired/contracted to work fewer than 12 months of the year. This may be a permanent job with recurring periods of work and non-work, or temporary work for a busy season of a few months. Seasonal income can come from self-employment or working for an employer. Permanent seasonal workers have a position where they can reasonably predict the months, they will work each year (ex: construction workers, farmers, landscapers, etc.), or where they are contracted to work established dates (ex: bus drivers, teachers, etc.). Some of these workers are paid only for the months in which they work, while others have the option to have their pay spread out over the entire 12 months of the year. MAGI Medicaid is required to use the monthly income for the month of application to determine initial eligibility, but for ongoing MAGI and all other Medicaid budgeting, the income of permanent seasonal workers should always be annualized to establish a monthly amount. Temporary seasonal workers are hired on a short-term basis (ex: retailers hire extra workers for the holiday season, ski resorts hire during winter ski season, and amusement parks hire summer help). The employee is not automatically hired back each year and would have to reapply to return. This type of income can be counted as monthly while it is being received and removed from the budget if the employee is released from employment at the end of the season. It is possible for a person to return every year to work in a position which appears to be temporary seasonal work (ex: employee is hired by the same employer every year to assist in tax preparation from January through May). If a pattern of ongoing employment can be seen, this income may be annualized as well. 2810.45.00 BUDGETING MINISTER/CLERGY MEMBER INCOME

• All income received from performing ministerial services is subject to self- employment tax for social security tax purposes, but they also may be an employee for income tax or retirement plan purposes in performing those same services. For income tax or retirement plan purposes, the income earned as an employee will be considered wages. • Income of a minister/clergy member can either be budgeted as self-employment income or as taxable income for the year in which eligibility is being determined. Rental allowances If a salary is received as an amount officially designated as a rental allowance (including an amount to pay utility costs), this allowance can be excluded from the gross income if: • The amount is used to provide or rent a home, and • The amount is not more than reasonable pay for the services.

The amount excluded cannot be more than the fair rental value of the home, including furnishings, plus the cost of utilities. Designation requirement The church or organization that employs the minister/clergy member must officially designate the payment as a housing allowance before the payment is received. They must designate a definite amount. They cannot determine the amount of the housing allowance at a later date. If the church or organization does not officially designate a definite amount as a housing allowance, then the entire salary must be included in the income. If the minister/clergy member is employed and paid by a local congregation, a resolution by a national church agency of the denomination does not effectively designate a housing allowance for them. The local congregation must officially designate the part of the salary that is a housing allowance. However, a resolution of a national church agency can designate the housing allowance if they are directly employed by the national agency. An official designation of an amount as a housing or rental allowance may be shown in an employment contract, in the minutes of a church or qualified organization, in a budget, or any official action taken in advance of payment of the allowance. A designation is sufficient if it permits a payment to be identified as a payment of a rental or housing allowance as distinguished from salary or other remuneration. Informal discussions do not amount to an official designation. However, the facts and circumstances of a designation may demonstrate that the designation was official.53 • When a salary is received without a housing allowance If the church or organization does not officially designate a definite amount as a housing allowance, then the total salary must be included in the income.

• Budgeting on the self-employment screen when receiving a housing allowance If a minister/clergy member is self-employed and has to pay income taxes at the end of the year, then the 1040 and SE Tax Forms should be requested and used to calculate the gross amount of income and the housing allowance. The amount they are deducting/reporting on their taxes, as housing allowance, should be excluded from the gross amount. For MAGI cases, use the Gross Income Line (AGI) from the 1040 Tax Form as the gross amount to enter because it would already have the deduction taken out. The AGI line will include in the description: This is your Adjusted Gross Income. • Budgeting on the employment information/employment income screen when receiving a housing allowance If a minister/clergy member receives a salary and has a designated rental allowance including actual utility costs, that amount should be excluded from the gross amount, as per requirements above. 2810.50.00 CENSUS INCOME (MED 1, 4) For MED 1 & 4 budgeting, census income is exempt and should not be counted in the Medicaid budget. For the census income to be exempt, the worker must code it as census income. For MAGI budgeting, refer to 2810.40.00 Seasonal income. 2810.55.00 STRUCTURED FAMILY CAREGIVING (SFC) Income received from an HCBS waiver to care for HCBS waiver members from the SFC program is exempt for all Medicaid categories and will not count in the Medicaid budget. This applies only to specific SFC program income and not to all caregiver arrangements (such as difficulty of care payments). Structured Family Caregiving payments are paid through the HCBS waiver to assist caregivers to care for an HCBS waiver member. Verification of the Structured Family Caregiver agreement from the waiver provider must be sent to the DFR for review. Workers need to be sure to code the income correctly for the deduction to be applied. Difficulty of Care Payments (DCPs) are exempt for MAGI categories, but count for non-MAGI categories, which use SSI rules for income-counting unless there is a specific disregard (such as for SFC).7 It is important to verify the type of income from an official source. If questionable, more information should be obtained. For more information, see IHCPPM 2800.10.00. Note: Verification of the caregiver’s work relationship with provider (i.e., employer of agency or member, or independent contractor) must be provided and included in case notes. If the worker is unsure if the payment type is exempt, please send it to PAL for review.

2815.00.00 IN-KIND INCOME, BARTERING, GIFTS AND GAMBLING Non-cash or in-kind benefits, bartering, gifts, and gambling are discussed in the following sections. 2815.05.00 IN-KIND EARNINGS (MED 1, 2, 4) In-kind earnings are goods and services received in exchange for working i.e., in lieu of cash. The dollar value of the work performed as established by the employer is counted as earned income only in situations where the employee has the option of receiving cash for the performed work. If the employee does not have the option of receiving cash for the performed work, the goods and services received are exempt as income.

Example: If an AG member works off his rent and the landlord state, he would pay the client $200 a month, but he prefers to receive free rent in lieu of the money. Count $200 income and allow $200 as a shelter cost. If the landlord states he would not pay the client to do the work, do not count any income or allow any shelter deduction. 2815.10.00 IN-KIND SUPPORT AND MAINTENANCE (MED 1) Within MED 1, the policy stated in this section applies to MA A, MA B, and MA D. In-kind support and maintenance, or income-in-kind, is shelter received by the applicant/recipient (and the spouse or parent) because someone else pays for it8, 9. If a gift card or an awards program incentive is received on a regular basis and can be resold, or it can be used to purchase shelter, it is considered income in the month received. Any unspent balance remaining on a gift card/certificate is a resource beginning the month following the month the gift card/certificate was received.10

If a gift card or an awards program incentive is received irregularly, then this is considered a lump sum payment. See IHCPPM 2880.10.00. Shelter expenses are room, rent or mortgage payments, property taxes, heating fuel, gas, electricity, water, sewage, and garbage collection services.11 The amount to be budgeted as income is the actual value of the in-kind support and maintenance received, not to exceed one-third of the applicable federal benefit rate of SSI. (Refer to IHCPPM 3455.25.00). The actual value is determined and verified by a signed statement from the person providing the in-kind support and maintenance. The one-third value is

determined by dividing the income standard by three. Situations which require consideration of income-in-kind are enumerated below. The term "individual" used in this section means the applicant/recipient and his spouse or parent. • If the individual lives in their own household (owns or rents), income-in-kind is received if someone else pays for all the shelter expenses. • If another person in the household regularly pays a designated amount to the individual for shelter, that amount is to be considered as rental income from a roomer/boarder. • If the members of a household state that they "share" shelter expenses, income-in- kind is not received by the individual. A signed statement by the adult household members must be obtained as verification that the applicant/recipient pays their share. • If the individual lives in another person's household and pays nothing toward the shelter expenses, income-in-kind is received. • If the individual pays a designated amount for shelter, then this is not receiving income-in-kind. • In situations where the individual has no ownership interest or rental liability in his residence and does not pay for any of the shelter expenses, income-in-kind is received. A statement from the property owner or leaseholder as to the value of the shelter being provided is to be obtained as verification. If the individual pays any part of the shelter expense, for example, utilities, income-in-kind is not received.

Gifts from a non-profit organization as described under section 501(c)(3) of the Internal Revenue Code to or for the benefit of a child under 18 years of age who has a life-threatening condition are exempt so long as the gift does not exceed $2,000 in any calendar year. Any gift not converted to cash is considered an in-kind gift.12 Refer to IHCPPM 3455.25.00 regarding budgeting in-kind income. 2815.10.05 CASH SUPPORT FOR CERTAIN DEPENDENTS (MED 3) Cash support is excluded for MAGI purposes for a child under 19 years old who meets both of the following criteria:

• Is claimed by as tax dependent by someone other than a spouse or a biological, adopted, or stepparent • Receives financial support from the person claiming the child as the dependent. 2815.15.00 BARTERING (MED 3)

Bartering is an exchange of property or services. The fair market value of the services or property being bartered is taxable income to the individual receiving the services or property. Therefore, such income is counted in the calculation of MAGI for purposes of Medicaid eligibility. 2815.20.00 GIFTS AND INHERITANCES (MED 3) Property received as a gift, bequest, or inheritance is not considered taxable income and is not included in the calculation of MAGI for determination of eligibility. If such gifts, bequests, or inheritances produce income (e.g., interest, dividends, rent) later, that income will be considered taxable income. In addition, if such gift, bequest, or inheritance is placed in a trust for the individual and the income is paid or distributed to the individual, such income is taxable and included in the calculation of household income for eligibility determinations. 2815.25.00 GAMBLING WINNINGS (MED 3) Cash winnings and the fair market value of non-cash prizes (e.g., bonds, cars, houses, etc.) because of gambling, lotteries, and raffles are considered taxable income and must be included in the calculation of MAGI for eligibility determinations. Gambling losses can be deducted from income but only up to the amount of the individual’s winnings. 2820.00.00 CANCELED DEBT (MED 3) A debt is any amount of money for which an individual is liable, or which attaches to property owned by an individual. If a debt owed by an individual is canceled or forgiven, the canceled amount is taxable income and must be included in the calculation of household income for purposes of eligibility determinations. However, if the canceled debt is intended as a gift to the individual, it is not taxable income and is not included in the calculation of MAGI for purposes of eligibility determinations. Some examples of canceled debt that are gifts include: • A relative who is not an AG member pays the rent directly to the landlord • Medical payments made by a third party to a medical provider. 2825.00.00 INFREQUENT OR IRREGULAR INCOME (MED 1, 4) Within MED 1, the policy stated in this section applies to MA A, MA B, and MA D.

The following disregard is applicable to all individuals whose income is included in the eligibility determination. Up to $20 of unearned income and $10 of earned income if the income is "infrequent" or "irregular" as defined below and does not exceed the applicable $20 or $10 maximum in each month. • Infrequent: Received quarterly or less often than quarterly from a single source • Irregular: Cannot reasonably be expected.

Once it is determined that a source of income cannot be excluded under this provision, it must be considered in the eligibility determination.

Example 1: Interest income on a certificate of deposit paid semi-annually in the amount of $25 must be budgeted. Reason: It is "infrequent" (semi-annually is less often than quarterly), but it exceeds the $20 maximum. Applicable budgeting rule is to divide by the appropriate number of months. Therefore, $4.17 is budgeted monthly.

Example 2: Interest income on a certificate of deposit paid semi-annually in the amount of $20 is disregarded. Reason: It is "infrequent" and does not exceed the $20 maximum.

Example 3: Interest income on a passbook savings account paid monthly averaging $4 must be budgeted. It is not "infrequent" (monthly is more often than quarterly), although it is less than $20 in each month.

Example 4: Two sources of interest income are received: $2 paid quarterly on a savings account and $15 from a certificate of deposit paid semi-annually. Each source is evaluated separately for the "I or I" determination, then combined to determine if the total exceeds $20. Therefore, both the $2 and the $15 are disregarded. (They are infrequent and the total of $17 does not exceed $20.) Refer to IHCPPM 2850.00.00. 2830.00.00 CHILD AND SPOUSAL SUPPORT Child support payments are those funds paid by a legal, adjudicated, or alleged parent intended for the support or maintenance of a child. Child support can be voluntarily paid by the non- custodial parent, or court ordered. However, in order for voluntary payments to be considered child support for eligibility purposes, a court order will need to be in place and both parents

must be in agreement that the payments are for the support or maintenance of a child. Without a court order, the payments are considered to be contributions rather than child support. Child support is unearned income and is considered the child's income. Spousal support or alimony is an amount of money allocated from one spouse to another by a court in a divorce or separation agreement. A spousal support or alimony payment is unearned income. For MED 1, 2 & 4 AG’s: For the parent paying the child support, this is not an allowable deduction and should not be deducted from the gross income. Spousal support/alimony payments and child support received should be counted as unearned income in the Medicaid budget. For MAGI AG’s: For MAGI (MED 3) AGs with finalized divorces and/or changes/amendments prior to 1/1/2019: • Spousal support or alimony is taxable income for the individual receiving the support and should be listed as unearned income in the MAGI budget. • Spousal support or alimony paid to an ex-spouse is deducted for the individuals who paid spousal support or alimony to an ex-spouse for purposes of calculating MAGI.

For MAGI (MED 3) AGs with finalized divorces and/or changes/amendments on or after 1/1/2019: • Spousal support or alimony is not countable for the individual receiving the alimony nor will the spouse that is paying the alimony receive the deduction. • Spousal support or alimony is no longer taxable and is not required to be listed on tax documents on or after 1/1/2019.

Child support is never counted in the MAGI budget. 2830.05.00 CHILD SUPPORT (MAGI, MED 3) The amount of child support received or anticipated to be received for any member of the AG is excluded from the calculation of MAGI for household income. 2830.10.00 CHILD SUPPORT AND ALIMONY (MED 1, MED 4)

Child support payments, as defined in IHCPPM 2830.00 are counted as unearned income in the full amount paid on behalf of the child. Payments received for a child no longer in the home and not used for the child's benefit are considered a contribution. Effective June 1, 2014, for child applicants or recipients who receive child support payments, the child support income will be deducted by one-third (1/3) of the total amount received. Effective June 1, 2014, child support payments and alimony payments made by a non-recipient spouse, parent, or stepparent through a court order or Title-IV are not included as income for the non-recipient member. 2835.00.00 ASSISTANCE FROM GOVERNMENT PROGRAMS The treatment of assistance from government agencies will vary depending on the nature of the program and the payment. 2835.05.00 ENERGY ASSISTANCE PAYMENTS Home energy assistance payments made to or on behalf of the AG by the Indiana Department on Aging and Community Services under the Energy Assistance to Low Income Families Program are excluded from income for all Medicaid categories.13 This includes the Energy Assistance Program (EAP), Project SAFE, and Project HEAT. 2835.10.00 TOWNSHIP TRUSTEE ASSISTANCE All payments made by Township Trustees are exempt as income for all Medicaid categories. 2835.15.00 HUD PAYMENTS HUD payments are payments made by the Department of Housing and Urban Development. Housing assistance paid directly or indirectly by the United States Department of Housing and Urban Development under the following Acts are exempt: • The Housing Authorization Act of 1976 with respect to a dwelling unit under the United States Housing Act of 1937, as amended (Sections 8, 10, and 23 and the Experimental Housing Allowance Program) • The National Housing Act (loans for housing renovation, mortgage insurance, and investment insurance)

• Title V of the Housing Act of 1949 (loans to elderly individuals, farmers, and developers for the construction, improvement, or replacement of farm homes and other buildings) • Section 101 of the Housing and Urban Development Act of 1965 (payments to certain mortgagors in behalf of tenants with low income who are displaced by government action, age 62 or over, physically handicapped, living in substandard housing, present or past tenants of dwellings damaged or destroyed by disaster, or the head of the household is on active duty with the armed forces.14 2835.20.00 RELOCATION ASSISTANCE ACT PAYMENTS Relocation assistance provided under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 197015 is exempt for all Medicaid categories. 2835.25.00 DISASTER ASSISTANCE PAYMENTS Payments made under the Disaster Relief and Emergency Assistance Act of 198816 are excluded for all AG Medicaid categories. There must be a Presidentially declared disaster for these payments to be excluded. 2835.30.00 FOSTER CARE, KINSHIP CARE AND ADOPTION ASSISTANCE PAYMENTS The following sections describe program specific policy on foster care and adoption assistance payments for children and adults received from any agency. 2835.30.05 FOSTER CARE PAYMENTS For non-MAGI (MED 1, 2, 4) AGs, foster care payments received by a foster care parent from any federal, state, or local foster care maintenance payments intended to provide for adults or children are exempt income. For non-MAGI (MED 1, 2, 4) AGs, Kinship care payments received by a relative of a foster care individual from any federal, state, or local foster care maintenance payments intended to provide for children are exempt income. For MAGI (MED 3) AGs, foster care payments received from any federal, state, or local foster care agency for the care of qualified foster individuals in the home are exempt from taxable income unless foster care is being provided for five individuals aged 19 or older. A qualified

foster individual is a person who is living in a foster family home and was placed in the home by an agency of the state or one of its political subdivisions or a qualified foster care agency.17

Difficulty of care payments, compensation for providing additional care for physically, mentally, or emotionally handicapped foster individuals, for more than 10 qualified foster individuals under age 19 or five (5) qualified foster individuals aged 19 or older are also included in taxable income for purposes of determining household income. In addition, if an individual receives compensation for maintaining space in their home for emergency foster care, such compensation is also included as taxable income. Note: Kinship care payments are paid to relatives or fictive kin (unrelated individuals who have an established emotional relationship with member and considered family) of the adult or child in need of care. 2835.30.10 ADOPTION ASSISTANCE (MAGI, MED 3) Federal, state, or local adoption assistance payments for special needs children, children whom the state’s child welfare agency considers difficult to place for adoption, are exempt as income to the individual.18 2835.30.15 ADOPTION ASSISTANCE (MED 1, 4) Adoption assistance cash payments are considered income to the adopted child even though made to the adoptive parent. 2835.35.00 SUPPLEMENTAL SECURITY INCOME The following sections discuss program-specific policy on the inclusion or exclusion of income received from the Supplemental Security Income (SSI) program. SSI benefits are available through the Social Security Administration under Title XVI of the Social Security Act to individual’s aged 65 or older, blind, or disabled, and who meet specific income and resource requirements. Individuals who have never paid into the Social Security program may be eligible for SSI as well as individuals who are receiving RSDI in an amount less than the current SSI maximum benefit. Refer to IHCPPM 2890.10.10 for appropriate verification sources. 2835.35.05 SUPPLEMENTAL SECURITY INCOME (MAGI, MED 3) SSI income is excluded from the calculation of household income when determining an AG's eligibility.19

2835.35.15 SUPPLEMENTAL SECURITY INCOME (MED 1, 4) Within MED 1, the policy stated in this section applies to MA A, MA B, and MA D. SSI benefits of a non-institutionalized Medicaid applicant/recipient are exempt.20 SSI benefits of a non-participating member of an AG are counted. NOTE: In post-eligibility budgeting, SSI is counted for applicants/recipients in Medicaid-certified facilities with the following exceptions: • The maximum SSI payment for a recipient in a Medicaid-certified facility is $30. However, the full benefit amount may be erroneously paid for a few months to an individual just entering a facility. These erroneous payments can be disregarded only if the check is returned to the Social Security Administration uncashed. • SSI payments made to recipients who are in 1619 status and who enter public institutions and Medicaid certified facilities (hospital, nursing facility, ICF/IID, or CRF) are not reduced to the $30 cap for the first two full months of institutionalization. For Medicaid purposes, the SSI payments made during these two months are to be disregarded as income.21 • The SSI payments made for 90 days to recipients who are temporarily institutionalized are exempt. The SSA issues a special notice to these recipients indicating they are receiving benefits under P.L. 100-203. The DFR must retain a copy of this notice in the recipient's case file unless the temporary benefits are documented on DESX. 2835.40.00 TANF/RCA PAYMENTS For non-MAGI (MED 1, 2, 4) AGs, cash assistance (TANF and RCA) must be included as unearned income. This includes a payment for an AG which has a protective payee or a sanctioned member. 2835.40.05 RETROACTIVE/CORRECTIVE TANF/RCA PAYMENTS (NON-MAGI, MED, 1, 4) Retroactive/corrective TANF/RCA payments are exempt as income or as a resource in the month of receipt.22 Thereafter, amounts retained are treated as a resource. 2835.45.00 SNAP/NUTRITION PROGRAMS Benefits received under the following federal or federally assisted programs seeking to improve the nutrition of low- and moderate-income families and individuals are exempt:

• Food Stamp Act of 1977, as amended23

• Child Nutrition Act of 1966 (WIC), as amended24 • National School Lunch Act, as amended25 • Title VII Nutrition Program for the Elderly of the Older Americans Act of 1965 (Meals on Wheels), as amended.26 2835.50.00 RESIDENTIAL LIVING ALLOWANCES Residential Living Allowances provided by the Semi-Independent Living Program, or the Alternative Family Program are exempt. For MED 1 and 4, this disregard does not apply to essential persons. However, the nature of the Semi-Independent Living Program and the Alternative Family Program is such that the applicant/recipient would not have an essential person. 2840.00.00 BENEFIT PROGRAMS The following sections discuss types of benefits payables to individuals and their treatment as unearned income. 2840.05.00 SOCIAL SECURITY INCOME (MED 1, 2, 4) Benefits that are paid by the Social Security Administration (SSA) are unearned income for MED 1, 2, 4 AGs. These types of benefits include Retirement, Survivors, and Disability Insurance (RSDI), special age 72 payments (PROUTY), and black lung benefits. These benefits may be available through the SSA under Title II of the Social Security Act to the covered former wage earner and his dependents or survivors. Black Lung benefits may be available through the United States Department of Labor under Title IV of the Federal Coal Mine Health and Safety Act of 1969 to the former miner and his dependents or survivors. Application for benefits is to be made through the nearest Social Security Administration District Office. Social Security benefits recouped by SSA that are not received by the household are not counted as income. Refer to IHCPPM 2890.10.15 for verification requirements. All Social Security payments to individuals whose disability is based on Drug Addiction and/or Alcoholism (DAA) are required to be paid to a representative payee. Some organizations act as the representative payee but charge a fee for providing payee services.

2840.05.05 SOCIAL SECURITY BENEFITS (MED 3) Social Security benefits include monthly retirement, survivor, and disability benefits. Social security benefits do not include supplemental security income (SSI). Social security benefits can be taxable or tax exempt. However, all social security benefits, whether taxable or tax exempt, received by an individual are included in the calculation of MAGI for determining household income.27

Black Lung benefits made available through the United States Department of Labor under Title IV of the Federal Coal Mine Health and Safety Act of 1969 to the former miner and his dependents or survivors are considered countable income. 2840.10.00 VETERANS’ BENEFITS Veterans' benefits are unearned income in the form of compensation or pension benefits available through the Department of Veterans' Affairs to veterans and their dependents or survivors. Compensation is paid to veterans with service-connected disabilities and is based on the degree of the disability. Pensions are available to certain wartime veterans who are permanently and totally disabled. Additionally, a veteran who is in a nursing home or who needs regular assistance from another person for daily activities may qualify for an Aid and Attendance Allowance or a Housebound Allowance (see also 2840.10.10). A single veteran or a widow of a veteran who is in a Medicaid certified nursing home may be receiving a reduced pension of $90 per month. Any portion of the VA benefit which is allowed for a dependent is considered unearned income of the dependent. Refer to IHCPPM 2890.10.20 concerning verification requirements. For MAGI AGs (MED 3), VA benefits are not taxable income. Therefore, VA benefits are not counted in the calculation of household income. For MED 1, 4, MA F and RMA, VA benefits are counted for eligibility purposes. 2840.10.05 SPINA BIFIDA ALLOWANCE FOR VETERANS' CHILDREN For non-MAGI (MED 1, 2, 4) AGs, allowances paid to children who are born with Spina Bifida and are children of Vietnam veterans will have this allowance excluded from the income and resource determination.28 The monthly payment is to be considered as exempt income. Left over amounts (previous month's payment that is not spent in that previous month) of this allowance from previous months payments and/or lump sum payments of this allowance are to

be considered as an exempt resource. If the client has this in an account with other countable resources, the client must supply the worker with the amount of money that is the Spina Bifida amount so this amount may be exempt from the resource determination. It does not have to be in a separate account, but the client or a family member must keep track of the amount. Example: A client is receiving a monthly payment of $700 for Spina Bifida for his child and the client is a Vietnam veteran. The $700 is exempt income.

The next month the client receives another payment of $700 which is directly deposited into his bank account. The client also has $500 in this account of which $400 is money left over from the Spina Bifida allowance received in the previous month. For the resource determination, only $100 would be counted and the remaining $400 would be a left-over Spina Bifida allowance from the previous month's payment and this $400 would be an exempt resource.

For MAGI (MED 3) AGs, allowances paid to children who are born with Spina Bifida and are children of Vietnam veterans are not taxable income. Therefore, such allowances are not counted in the calculation of MAGI for household income. 2840.10.10 VA AID & ATTENDANCE ALLOWANCE AND HOUSEBOUND ALLOWANCE Aid & Attendance is a benefit paid in addition to a monthly Veterans’ Pension (given due to age) or Veteran’s Compensation (given due to service-oriented disability). The additional Aid & Attendance or Housebound allotment is awarded when a veteran or the widow qualifies for a pension and has a need for extra medical care. It is intended to reimburse the actual medical expenses which have been verified to the Veterans Administration (VA). In determining initial eligibility, Aid & Attendance and Housebound Allowances should not be counted as income. Except as noted, the rest of the information in this section is specific to Pension and does not address Compensation.

After Medicaid approval, the member’s out of pocket medical expenses should be greatly reduced or eliminated. It is the member’s responsibility to report this change to the VA when a recalculation of their award is necessary. How Pension and Aid & Attendance Amounts are Determined: The amount of a Veterans Pension for elderly or non-service-related disabled veterans or survivors is the difference between the applicable Maximum Annual Pension Rate (MAPR, a limit set each year by Congress based on disability and family criteria), and the countable income for the veteran’s family. The amount payable is reduced by countable income, so some veterans may not qualify for a pension payment.

If the individual’s countable income is too high to allow them to qualify for any VA pension per annually published MAPR levels (without Aid & Attendance) http://www.benefits.va.gov/pension/current_rates_veteran_pen.asp, medical expenses which exceed 5% of the base MAPR may be used to offset the countable income. When the pension is granted only due to ongoing medical expenses, the entire amount of a VA payment is considered “Aid & Attendance” and may be exempted in initial budgeting. Example: John, a single veteran aged 67, has countable income of $15,000 per year, an amount which is over his applicable MAPR. However, John also has ongoing medical expenses which total $5000 annually. These expenses offset his income so that he is awarded Aid & Attendance in the amount of the MAPR minus his remaining countable income of $10,000. If his medical expenses are later reduced because Medicaid begins to pay them, this will increase the income which the VA counts for him, and the Aid & Attendance payments may stop.

Applicants whose other income is less than the MAPR must provide a current breakdown of which portion, if any, of the VA benefit is Aid & Attendance. Only the Aid & Attendance amount will be discounted in the budget. This would also apply for individuals receiving VA compensation (based on service-related disability) instead of VA pension. Updated details from the VA should be requested at each annual redetermination. Budgeting After Medicaid is Approved: For institutionalized applicants/recipients without spouse or dependent/s, the total VA pension payment to the incapacitated individual will be reduced to $90 after Medicaid is approved.1 Whether the payment was regular pension, Aid & Attendance, or some combination of award reasons becomes irrelevant at this point. The reduced pension is exempt at all stages of budgeting. A veteran or veteran's widow is entitled to keep the normal personal needs allowance (currently set at $5229) given to institutionalized members without regard to the $90. The timeframe for the reduction can vary based on when the VA acts on the reported change, so verification of the effective date of the reduction to $90 must be provided. If the pension recipient failed to report the change to the VA in a timely manner, the VA will pursue recovery for all applicable months to recoup the excess payments, but the member is not penalized if the delay is on the part of the VA. The pension recipient has the option to ask the VA to waive the 60-day “due process period” to make the reduction effective as soon as possible, but they would need to consult the VA on specific rules. For institutionalized applicants/recipients with a spouse or dependents, the VA does not automatically reduce payment to $90 a month after Medicaid approval. These members have the option to request a reduction to $90 if they determine it would be more beneficial to their family; any such arrangement would need to be verified by current documentation from the VA. For non-institutionalized applicants/recipients, there is no automatic or optional reduction to $90 by the VA, but if medical expenses were used to calculate the award there will likely be an adjustment by the VA due to those expenses now being paid by Medicaid.

Initial Budgeting Considerations: • Awards which are a combination of pension and Aid & Attendance must be verified by documentation from the VA of the breakdown of the payment. • Awards which are made up entirely of Aid & Attendance do not need additional verification of expenses. • Awards which have already been reduced to $90 (for example, a transfer to a new facility or from out of state) do not need verification of expenses.

Budgeting After Medicaid Approval: The reduced VA pension of $90 (sometimes referred to as “Veteran’s Personal Needs”) is the only amount of Veteran’s Pension which is completely exempt in the budget, including post- liability budgeting. No other amount should be included in this amount when it is entered into the eligibility system. • For institutionalized single veterans or widow/ers, or those asking for a voluntary reduction to $90, there may be months after Medicaid approval where the pension amount is not yet reduced. o Medicaid is always the payer of last resort, and any third-party (TPL) liability must be billed before Medicaid. o Aid & Attendance is a form of TPL which is paid to the member for the purposes of reimbursement of medical expenses. Medical expenses may make a person qualify for Aid & Attendance, or they may be paid for by Medicaid; but not both. o When the reduction is pending, any funds above $90 which are received should be offset by verified non-Medicaid covered medical expenses provided by the member and entered in the eligibility system as normal. o If there are any excess (above $90) funds which are not offset by non- Medicaid covered expenses, or proof of the medical expenses is not provided; then the funds are a contribution from a third party which is available for paying medical expenses. The excess should be included in the income as a contribution for any months where the member is not receiving a reduced pension. • This will properly include the TPL in the liability for a long-term care member, and will also protect the member from becoming over resources if there is a delay before the VA is able to change their award amount • For members who do not receive a reduced pension amount, and are covered by Medicaid, an updated breakdown of the pension/Aid & Attendance and any medical expenses upon which it was figured will continue to be required when continuing eligibility is to be determined or re-determined.

o These members will need to verify that Medicaid approval has been reported to the VA and continues to be based on bills they would have to pay out of their own pocket. o It would be rare for enough non-Medicaid covered expenses to remain which would allow a person to receive an award that is completely Aid & Attendance at this point.

2840.15.00 RAILROAD RETIREMENT BENEFITS (MED 1, 2, 4) Railroad retirement benefits are unearned income and may be available to former railroad workers and their dependents or survivors. Included are retirement and disability benefits. The Railroad Retirement benefit and Social Security benefit are usually combined in one payment if the individual is entitled to both benefits. Verification of benefits is essential. Refer to IHCPPM 2890.10.25. 2840.15.05 RAILROAD RETIREMENT BENEFITS (MED 3) For MAGI, railroad retirement benefits can be taxable or tax exempt. However, all railroad retirement benefits, whether taxable or tax exempt, received by an individual are included in the calculation of MAGI for determining household income.30

2840.20.00 PENSIONS Payments may be available from private industry, local or state governments, or the federal government to former employees and their dependents or survivors. These payments are the result of purchase of an annuity, retirement from employment, survivor benefits for a former employee's dependents, or injury or disability, and may be made by an employer, an insurance company, or public or private funds. 2840.20.05 PENSIONS (MED 1, 2, 4) For non-MAGI (MED 1, 2, 4) AGs, pensions are counted as unearned income. Refer to IHCPPM 2890.10.35 for verification requirements. The amount of funds being recouped from a pension is an allowable deduction. Effective June 1, 2014, for MED 1 and 4, any pension paid by a state to person who was an honorably discharged veteran of the armed forces based on a disability determination made by the state making the pension payments is not considered as income.31

2840.20.10 PENSIONS (MED 3) For MAGI AGs, pension payments from a qualified employer retirement plan may be fully or partially taxable income. Pension payments are fully taxable if the individual did not contribute to the pension, the employer did not withhold contributions from the individual’s salary, or the individual received tax-free contributions in previous years. Such pension payments are counted in the calculation of MAGI for household income. Pension payments are partially taxable if the individual contributed after tax dollars to the pension. The part of the pension payment that represents the amount paid with after tax dollars by the individual is not taxable. The part of the pension payment that represents the amounts that the individual did not contribute to the pension, or the amounts contributed by the individual but were tax free is taxable income and will be included in calculating MAGI for the household income. If an individual has a traditional Individual Retirement Account (IRA), a full deduction is allowed for the amount contributed to the IRA if the individual and the spouse, if applicable, do not have a traditional IRA plan at a place of employment. If an individual has a traditional IRA plan at his or her place of employment, his or her contributions are deductible in full or partially based upon income limitations. Roth IRA contributions are not deductible from taxable income. 2840.25.00 UNEMPLOYMENT COMPENSATION BENEFITS Unemployment compensation benefits (UCB) may be available through Indiana Workforce Development to unemployed individuals who have a recent history of "covered" work and who are currently available for work. For non-MAGI (MED 1, 2, 4) AGs, UCB is counted as unearned income. Refer to IHCPPM 2890.10.40 for verification requirements. For MAGI (MED 3) AGs, UCB is taxable income and counted in the calculation of MAGI for household income. However, any amount an individual voluntarily contributes to a private fund is not taxable income and not counted in the calculation of MAGI for household income. The only amounts taxable from private funds are amounts received by the individual greater than the individual’s contribution. For purposes of calculating MAGI, if an individual is required to repay a portion of UCB, the amount repaid is deducted from the amount he or she receives. 2840.30.00 WORKER’S COMPENSATION

Worker's Compensation may be awarded to an injured employee or his survivors under federal and state worker's compensation statutes. Payment may be made in a lump sum payment or in monthly payments. 2840.30.05 WORKER’S COMPENSATION (MED 1, 2, 4) Worker’s Compensation is treated as unearned income and is counted when determining a client’s eligibility. Refer to IHCPPM 2890.10.45 for verification requirements. 2840.30.10 WORKER’S COMPENSATION (MED 3) For MAGI, Worker’s Compensation is not taxable income if it is paid pursuant to a worker’s compensation act or statute. Therefore, Worker’s Compensation is not counted in the calculation of MAGI for household income. 2840.35.00 STRIKE BENEFITS Strike Benefits may be awarded to employees who are striking against their employer and are considered countable unearned income. 2840.40.00 MILITARY ALLOTMENTS An individual may be receiving or be eligible to receive a Military Allotment if the spouse, adult child, or parent, is in the United States Armed Forces. 2840.40.05 MILITARY ALLOTMENTS (MED 1, 2, 4) These payments are counted as unearned income. If the individual in the military makes money available to the applicant or participating AG, the money is a contribution to the AG. Usually this is done by direct deposit into a joint checking account. 2840.40.10 MILITARY ALLOTMENTS (MED 3)

For MAGI AGs, Military Allotments may or may not be taxable income depending on the purpose of the allotment. For example, if the Military Allotment is for child support, it is not considered taxable income for the individual receiving the allotment. Therefore, the purpose of the Military Allotment must be determined. If such purpose results in taxable income to the individual receiving the Military Allotment, then the income is counted in the calculation of MAGI for household income. 2840.45.00 DISABILITY PAYMENTS An individual may have insurance coverage that pays a specified amount for a specific period during which he is unable to work because of a disabling condition. 2840.45.05 DISABILITY PAYMENTS (MED 1, 2, 4) Disability Payments are counted as unearned income. 2840.45.10 DISABILITY PAYMENTS (MED 3) For MAGI, Disability Payments may or may not be taxable income depending on who paid for the disability insurance. Disability Payments are fully taxable if the individual did not contribute to the disability insurance premium payments, or the employer did not withhold premium payments from the individual’s salary. Such Disability Payments are counted in the calculation of MAGI for household income. Disability Payments are not taxable if the individual paid for the premium payments with after tax dollars, and such payments will not be counted in the calculation of MAGI for household income. Disability Payments may also be partially taxable depending on who paid for the premium payments and whether such payments were with pre- tax or after-tax dollars. Generally, any payments made by the individual with after tax dollars toward the disability insurance premium will not be considered taxable income and will not be considered in the calculation of MAGI for household income. 2840.45.15 INDEMNITY HEALTH INSURANCE PAYMENTS Indemnity health insurance plans pay a specified benefit to a person based on the number of days the individual is hospitalized. There are other variations to this type of insurance, including accident and cancer policies. For eligibility purposes, an indemnity policy means one in which the terms of the plan do not in any way limit the way the applicant/recipient can use the benefits. 2840.45.20 INDEMNITY HEALTH INSURANCE PAYMENTS (MED 1, 2, 4)

Payments made by an indemnity health insurance plan are counted as unearned income unless the applicant/recipient uses the payments to pay his medical expenses. A payment or any portion thereof used to pay the applicant's/recipients medical expenses is not counted as income. Once the DFR verifies the applicants/recipient's receipt and usage of indemnity benefits, income will be budgeted accordingly. NOTE: Some payments may fall under the definition of lump sum, others may be regular, or fluctuating. In many of these situations the income will be considered through recovery. The amount of the premium of an indemnity policy is not an income deduction in the post- eligibility income determination of an institutionalized applicant/recipient, nor a medical expense in spend-down determinations. 2840.45.25 INDEMNITY HEALTH INSURANCE PAYMENTS (MED 3)

For MAGI, payments made by an indemnity health insurance plan may or may not be taxable income depending on who paid the premiums for the insurance. Payments are fully taxable if the individual did not contribute to the insurance premium payments, or the employer did not withhold premium payments from the individual’s salary. Such payments from an indemnity health insurance plan are counted in the calculation of MAGI for household income. Payments from an indemnity health insurance plan are not taxable if the individual paid for the premium payments with after tax dollars, and such payments will not be counted in the calculation of MAGI for household income. Payments made by an indemnity health insurance plan may also be partially taxable depending on who paid for the premium payments and whether such payments were with pre-tax or after-tax dollars. Amounts paid to reimburse for medical expenses incurred after the insurance plan was established are not counted as income. 2840.50.00 LONG-TERM CARE INSURANCE PAYMENTS (MED 1, 4) Payments from insurance, including a qualified Indiana Long Term Care Program (ILTCP) or other long-term care insurance policy, are not counted as unearned income if the applicant/recipient uses them to pay medical expenses. They are considered reimbursement of an expense even if payments are made directly to the individual to make the payment. Workers must verify the applicants/recipient’s receipt and usage of the LTC insurance payments. 2845.00.00 BENEFITS RECEIVED DUE TO FEDERAL LAW The benefits that are listed in the following sections are those that are received due to federal statute.

2845.05.00 DOMESTIC VOLUNTEER SERVICE ACT COMPENSATION The following are exempt income: • Assistance to volunteers who participate in ACTION programs funded under Public Law 93-113, including VISTA and other programs under Title I of that law • Payments for supportive services or reimbursement for expenses made to volunteers serving as foster grandparents, senior health aids, or senior companions, and to persons serving on the Service Corps of Retired Executives, Active Corps of Executives, and other programs under Title II and III of the Act.32 2845.10.00 OLDER AMERICANS ACT The organizations involved in the Senior Community Service Employment Program (Title V Public Law 89-73) are Experience Works, National Council on Aging, National Council on Senior Citizens, American Association of Retired Persons, U.S. Forestry Services, National Association of Spanish Speaking Elderly, National Urban League, and the National Council on Black Aging. 2845.10.05 OLDER AMERICANS ACT (MED 1, 2, 4) Payments other than wages/salaries made under the Older Americans' Act are exempt unearned income. Wages/salaries are earned income. 2845.10.10 OLDER AMERICANS ACT (MED 3) For MAGI, payments received under the Older Americans’ Act are taxable income, and such payments are included in the calculation of MAGI for household income. 2845.15.00 ASSISTANCE FOR CERTAIN INDIAN TRIBES/ALASKAN NATIVES The following Section discusses federal law pertaining to Indian tribes and Alaska natives. • P.L. 92-203, section 29, dated 1/2/76, the Alaska Native Claims Settlement Act, and Section 15 of P.L. 100-241, 2/3/88, the Alaska Native Claims Settlement Act Amendments of 1987 - All compensation (including cash, stock, partnership interest, land, interest in land, and other benefits) received under this Act are excluded from income and resources.

• P.L. 93-134, the Judgment Award Authorization Act, as amended by P.L. 97-458, Section 1407, 11/12/83 and P.L. 98-64, 8/2/83, the Per Capita Distribution Act. P.L. 97-458 required the exclusion of per capita payments under the Indian Judgment Fund Act (judgment awards) of $2,000 or less from income and resources. The exclusion applies to each payment made to each individual. Initial purchases made with exempt payments distributed between 1/1/82 and 1/12/83 are excluded from resources to the extent that excluded funds were used. P.L. 98-64 extended the exclusion to cover per capita payments from funds which are held in trust by the Secretary of Interior (trust fund distributions). P.L. 93-531, Section 22 - Relocation assistance payments to members of the Navajo and Hopi Tribes are excluded from income and resources. P.L. 94-114, Section 6 - Income derived from certain sub-marginal land held in trust for certain Indian tribes is excluded from income and resources. The tribes that may benefit are: • Bad River Band of the Lake Superior Tribe of Chippewa Indians of Wisconsin • Blackfeet Tribe • Cherokee Nation of Oklahoma • Cheyenne River Sioux Tribe • Crow Creek Sioux Tribe • Lower Brule Sioux Tribe • Devils Lake Sioux Tribe • Fort Belknap Indian Community • Assiniboine and Sioux Tribes • Lac Courte Oreilles Band of Lake Superior Chippewa Indians • Keweenaw Bay Indian Community • Minnesota Chippewa Tribe • Navajo Tribe

P.L. 94-189, Section 6, 12/31/75 - Funds distributed per capita to the Sac and Fox Indians or held in trust are excluded from income and resources. The funds are divided between members of the Sac and Fox Tribe of the Mississippi in Iowa. The judgments were awarded in Indian Claims Commission dockets numbered 219, 153, 135, 158, 231, 83, and 95. P.L. 94-540 - Payments from the disposition of funds to the Grand River Band of Ottawa Indians are excluded from income and resources. P.L. 95-433, Section 2 - Indian Claims Commission payments made pursuant to this Public Law to the Confederated Tribes and Bands of the Yakima Indian Nation, and the Apache Tribe of the Mescalero Reservation are excluded from income and resources.

P.L. 96-420, Section 9(c), 10/10/80, Maine Indian Claims Settlement Act of 1980 - Payments made to the Passamaquoddy Tribe, the Penobscot Nation, and the Houlton Band of Maliseet are excluded from income and resources. P.L. 97-403 - Payments to the Turtle Mountain Band of Chippewas, Arizona are excluded from income and resources. P.L. 97-408 - Payments to the Blackfeet, Grosventre, and Assiniboine tribes, Montana, and the Papago, Arizona, are excluded from income and resources. P.L. 98-123, Section 3, 10/13/83 - Funds distributed under this Act to members of the Red Lake Band of Chippewa Indians are excluded from income and resources. Funds were awarded in docket number 15-72 of the United States Court of Claims. P.L. 98-124, Section 5 - Per capita and interest payments made to members of the Assiniboine Tribe of the Fort Belknap Indian Community, Montana, and the Assiniboine Tribe of the Fort Peck Indian Reservation, Montana, under this Act are excluded from income and resources. Funds were awarded in docket 10-81L. P.L. 98-500, Section 8, 10/17/84, Old Age Assistance Claims Settlement Act, provides that funds made to heirs of deceased Indians under this Act shall not be considered as income or resources. P.L. 99-146, Section 6(b), 11/11/85 - Funds distributed per capita or held in trust for members of the Chippewas of Lake Superior are excluded from income and resources. Judgments were awarded in Dockets numbered 18-S, 18-U, 18-C and 18-T. Dockets 18-S and 18-U are divided among the following reservations: Wisconsin ▪ Bad River Reservation ▪ Lac du Flambeau Reservation ▪ Lac Courte Oreilles Reservation ▪ Sokaogon Chippewa Community ▪ Red Cliff Reservation ▪ St. Croix Reservation

Michigan ▪ Keweenaw Bay Indian Community (L'Anse, Lac Vieux Desert, and Ontonagon Bands) ▪ Minnesota ▪ Fond du Lac Reservation ▪ Grand Portage Reservation ▪ Nett Lake Reservation (including Vermillion Lake and Deer Creek) ▪ White Earth Reservation.

Under Dockets 18-C and 18-T funds are given to the Lac Courte Oreilles Band of the Lake Superior Bands of Chippewa Indians of the Lac Courte Oreilles Reservation of Wisconsin, the Bad River Band of the Lake Superior Tribe of Chippewa Indians of the Bad River Reservation, the Sokaogon Chippewa Community of the Mole Lake Band of Chippewa Indians, and the St. Croix Chippewa Indians of Wisconsin. P.L. 99-264, White Earth Reservation Land Settlement Act of 1985, 3/24/86, Section 16 excludes money paid under this Act from income and resources. This Act involves members of the White Earth Band of Chippewa Indians in Minnesota. P.L. 99-346, Section 6(b) (2) - Payments to the Saginaw Chippewa Indian Tribe of Michigan are excluded from income and resources. P.L. 99-377, Section 4(b), 8/8/86 - Funds distributed per capita to the Chippewa of the Mississippi or held in trust under this Act are excluded from income and resources. The judgments were awarded in Docket Number 18-S. The funds are divided by reservation affiliation for the Mille Lac Reservation, Minnesota; White Earth Reservation, Minnesota; and Leech Lake Reservation, Minnesota. P.L. 101-41, 6/21/89, the Puyallup Tribe of Indians Settlement Act of 1989, Section 10(b) provides that nothing in this Act shall affect the eligibility of the Tribe or any of its members for any Federal program. Section 10(c) provides that none of the funds, assets or income from the trust fund established in Section 6(b) shall at any time be used as a basis for denying or reducing funds to the Tribe or its members under any Federal, State, or local program. (The Puyallup Tribe is located in the State of Washington.) P.L. 101-277, 4/30/90, funds appropriated in satisfaction of judgments awarded to the Seminole Indians in Dockets 73, 151 and 73-A of the Indian Claims Commission are excluded from income and resources except for per capita payments in excess of $2,000. Payments were allocated to the Seminole Nation of Oklahoma, the Seminole Tribe of Florida, the Miccosukee Tribe of Indians of Florida, and the independent Seminole Indians of Florida.

P.L. 101-503, Section 8(b), Seneca Nation Settlement Act of 1990, dated 11/3/90, provides that none of the payments, funds or distributions authorized, established, or directed by this Act, and none of the income derived therefrom, shall affect the eligibility of the Seneca Nation or its members for, or be used as a basis for denying or reducing funds under, any Federal program. P.L. 93-134, Section 8, 10/19/73, the Indian Tribal Judgment Fund Use or Distribution Act, as amended by P.L. 103-66, Section 13736, 10/7/93, provides that interest of individual Indians in trust or restricted lands shall not be considered a resource and up to $2,000 per year of income received by individual Indians that is derived from such interests shall not be considered income in determining eligibility for assistance under the Social Security Act or any other Federal or federally assisted program.

If other types, not on this list, are encountered, contact the Policy Answer Line for guidance. In determining MAGI for household income, the following are excluded: (1) Distributions from Alaska Native Corporations and Settlement Trusts (2) Distributions from any property held in trust, subject to federal restrictions, located within the most recent boundaries of a prior federal reservation, or under the supervision of the Secretary of the Interior (3) Distributions and payments from rents, leases, rights of way, royalties, usage rights, or natural resource extraction and harvest from— a. Rights of ownership or possession in any lands described in paragraph (2) of this section b. Federally protected rights regarding off-reservation hunting, fishing, gathering, or usage of natural resources

(4) Distributions resulting from real property ownership interests related to natural resources and improvements— a. Located on or near a reservation or within the most recent boundaries of a prior federal reservation b. Resulting from the exercise of federally protected rights relating to such real property ownership interests (5) Payments resulting from ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable Tribal Law or custom; and (6) Student financial assistance provided under the Bureau of Indian Affairs education programs.33 2845.20.00 COMPENSATION TO GERMANS, JAPANESE, AND ALEUTS

German reparation and Japanese and Aleutian restitution payments are discussed in the following sections. 2845.20.05 PAYMENTS TO JAPANESE AND ALEUTS Restitution payments by the U.S. government under P.L. 100-383 to individual Japanese Americans (or, if deceased, to their survivors) and Aleuts who were interned or relocated during World War II are excluded from income and resources. Also, restitution payments from the Canadian government to individual Japanese Canadians who were interned or relocated during World War II are excluded from income.34 2845.20.10 GERMAN REPARATION PAYMENTS Payments made by the Republic of Germany to certain survivors of the Holocaust that may be received periodically or in a lump sum are exempt as income and resources. 2845.25.00 AGENT ORANGE BENEFITS Payments made from the Agent Orange Settlement Program35 are excluded as income to the veteran receiving the benefit as well as the veteran's survivors. The veteran receives a payment once per year while he is disabled for the life of the program. Survivors of the deceased veteran receive a one-time lump sum payment. 2845.30.00 FEDERAL TAX REFUND PAYMENTS For non-MAGI (MED 1, 2, 4) AGs, federal tax refunds received after December 31, 2009, are disregarded as income in the month received for all federal means-tested programs, including Medicaid. For MAGI (MED 3) AGs, federal tax refund payments are not considered income, so will not be counted in the calculation of MAGI for household income. See section 2630.70.00 for an explanation of determining resources with a tax refund. 2845.35.00 CHILD CARE PAYMENTS Childcare payments from Step Ahead voucher agents and other government agencies made on behalf of TANF recipients, former TANF recipients transitioning from TANF and families at risk of

becoming eligible for TANF are exempt as income. Additionally, no deduction is allowed for dependent care covered by these payments. These payments are income for the childcare provider who receives them. 2845.40.00 RADIATION EXPOSURE ACT BENEFITS Payments made from the Radiation Exposure Compensation Trust Fund established under the Radiation Exposure Compensation Act are exempt as income.36

2845.45.05 CRIME VICTIM PAYMENTS If a crime victim applies for assistance from any federal, state, or local government program that uses federal funds, the program may not include victim compensation benefits paid through the Crime Act of 1984 when determining income eligibility.37 Victim compensation payments are made to crime victims or their dependents for expenses such as medical expenses, funeral expenses, lost wages, and psychological counseling. In Indiana, victim compensation payments are made through the Indiana Criminal Justice Institute's Violent Crime Compensation Division. 2845.50.00 UTILITY EXPENSE PAYMENTS Payments made as a result of any federal law, such as HUD or FMHA, for the purpose of paying an AG's utility expenses, are exempt as income regardless of how they are paid. 2845.55.00 SETTLEMENT PAYMENTS UNDER WALKER V. BAKER CORPORATION, ET. AL. Payments made to individuals from the settlement fund in the class action lawsuit, Susan Walker v. Bayer Corporation, et. al. is exempt as income and resources in the Medicaid eligibility determination for non-MAGI (MED 1, 2, 4) AGs and are exempt as income for MAGI (MED 3) AGs.38 2845.60.00 MILITARY SUBSISTENCE ALLOWANCE Enlisted members of the Armed Forces may receive a cash benefit up to $500 per month. The benefits are issued by the Department of Defense and are shown on the member's Leave and Earnings Statement as Family Subsistence Supplemental Allowance. This form is the standard wage information form used by the military.

These benefits are to be considered as earned income for non-MAGI (MED 1, 2, 4) AGS. Effective June 1, 2014, combat pay is not to be considered as income. For MAGI (MED 3) AGs, these benefits are not considered taxable income, so are not included in the calculation of MAGI for household income. 2845.65.00 AMERICORPS PROGRAM (MED 1) Payments made from the AmeriCorps Program to AmeriCorps participants or on their behalf are excluded as income. 2845.65.05 AMERICORPS PROGRAM (MAGI) The Segal AmeriCorps Education Awards and Stipend are taxable in the year they are paid. It is considered taxable income regardless of whether it is used to pay current educational costs or to repay qualified student loans. If the applicant/recipient receives an award and the payment is $600 or more during the year, they should receive a Form 1099-MISC. The 1099-MISC will show the amount of the award in box 3, Other Income. The living allowance amount you receive during service is also considered taxable income in the calendar year in which you receive it and is counted in the MAGI budget. 2845.70.00 NATIONAL FLOOD INSURANCE PROGRAM (MED 1) Assistance received under the National Flood Insurance Program for flood mitigation activities with respect to property is not considered income or as a resource for the property owner. 2845.75.00 ENERGY EMPLOYEES’ OCCUPATIONAL ILLNESS COMPENSATION PROGRAM (MED 1) Lump sum payments made under the Energy Employees Occupational Illness Compensation Program for employees who suffered as result of work in the nuclear weapons industry and their survivors are exempt. 2850.00.00 DIVIDENDS, INTERESTAND ROYALTIES Payments of dividends, interest, and royalties are considered unearned income for non-MAGI (MED 1, 2, 4) AGs unless stated otherwise in this chapter and are included as taxable income for MAGI (MED 3) AGs. This includes interest on checking accounts and trust accounts. For MED 1 and 4, interest earned on exempt resources (refer to Chapter 2600) is exempt.

Dividends that the household has the option of either receiving as income or reinvesting in the trust stock or bond are to be considered as income in the month, they become available to the household. For the MED 1 and 4 categories, dividends paid on life insurance policies are exempt. Refer to IHCPPM 2825.00.00. For the MED 1 and 4 categories, royalties are generally considered unearned income unless they are received as part of a trade or business or received by the individual in connection with any publication of his/her work.39 2850.05.00 INTEREST ON INDIVIDUAL DEVELOPMENT ACCOUNTS For non-MAGI (MED 1, 2, 4) AGs, interest income that is earned on an Individual Development Account (IDA) under the Assets for Independence Act (AFIA), Public Law 106-554, is excluded from income. (See also ICES Program Policy Manual (IPPM) 2630.95.00, which states IDA’s are exempt as resources.) For MAGI (MED 3) AGs, interest income that is earned on an IDA is taxable income, so will be included in the MAGI calculation for household income. 2855.00.00 REIMBURSEMENTS Reimbursements for past or future expenses are exempt if they do not exceed actual expenses and do not represent a gain or benefit. To be exempt, these payments must be specifically intended and used for expenses other than normal living expenses. Normal living expenses include the amount spent for rent or mortgage, personal clothing, and food eaten at home. Any part of the reimbursement amount that exceeds the actual expense is included as income. However, reimbursements are not considered to exceed actual expenses, unless the AG or the provider indicates the amount is excessive. Reimbursements for normal household living expenses such as rent or mortgage, personal clothing, or food eaten at home are a gain or benefit and, therefore, are included as income. Reimbursements from employers over and above the basic wages for necessary job-related expenses are exempt unless reimbursements are in excess of such job-related expenses and the employee did not return the excess amount to the employer.

2860.00.00 EDUCATIONAL INCOME DEFINITION Educational income includes, but is not limited to, grants, scholarships, fellowships, work-study, veterans’ educational benefits, and deferred educational loans (loans received for educational expenses which are to be repaid at a later date, usually after graduation), that is used for tuition and mandatory fees at an institution of post-secondary education, including correspondence schools at that level or a school at any level for the physically or mentally handicapped. Wages from graduate assistantships are not treated as educational income if they are subject to taxation and are available for meeting the individual's non-educational living expenses; they are budgeted as earned income. A loan on which repayment must begin within 60 days after receipt is not considered a deferred loan. For MED 3 AGs, all scholarships, awards, or fellowship grants used for educational purposes and not for living expenses are not taxable income and are not utilized in the calculation of MAGI. All scholarships, awards, or fellowship grants used for non-educational expenses, such as living expenses, are taxable income and are utilized in the calculation of MAGI, unless they are specifically exempted by federal or state law.40 2860.05.00 EXEMPT EDUCATIONAL INCOME (MED 1, 2, 4) Grants, awards, scholarships, and work study income received under Title IV of the Higher Education Act, or the Bureau of Indian Affairs (BIA) programs are exempt. For MED 1, 2, 4 AGs, they are exempt only for undergraduate students. Included are the following: • Basic Educational Opportunity Grants (BEOG or PELL Grants) • Presidential Access Scholarships (Super PELL Grants) • Supplemental Educational Opportunity Grants (SEOG) • State Student Incentives Grants (SSIG) • Federal Work Study Funds (NOTE: Not all federal work study funds come under Title IV of the Higher Education Act.) (Refer to IHCPPM 2860.15.00.) • TRIO Grants (which go to organizations or institutions for students from disadvantaged backgrounds): o Upward Bound (Some stipends go to students) o Student Support Services o Robert E. McNair Post-Baccalaureate Achievement. • Robert C. Byrd Honors Scholarship Program • College Assistance Migrant Program (CAMP) for students whose families are engaged in migrant and seasonal farm work • High School Equivalency Program (HEP) • National Early Intervention Scholarship and Partnership Program.

Federally funded educational loans are exempt for all students (undergraduate and graduate) for all programs. They include the following: • Federal Direct Student Loan Programs (FDSLP) (formerly GSL and FFELP) • Federal Direct Supplemental Loan Program (provides loans to students) • Federal Direct PLUS Program (provides loans to parents) • Federal Direct Stafford Loan Program • Federal Consolidated Loan Program.

Direct loans to students in institutions of higher education (Perkins Loans, formerly NDSL). 2860.10.00 NON-EXEMPT EDUCATIONAL INCOME (MED 1, 2, 4) Student financial assistance received from a source not listed in IHCPPM 2860.05.00 is considered as non-exempt income. However, it is not necessarily budgeted as income to the AG. Non-exempt educational income is included only to the extent that it is accessible for meeting the AG's general living expenses. When educational income is inaccessible (received directly by the school in an amount less than or equal to the student's educational expenses as verified by the financial aid office), it is excluded from budgeting. Non-exempt educational income sent directly to the student or refunded by the school after tuition and fees have been paid is budgeted. However, any remaining allowable educational expenses are deducted from it. This applies to undergraduate and graduate students alike. Non- exempt educational income includes assistance provided under the Carl D. Perkins Vocational Educational Act. Programs under this Act include the following: • Indian Vocational Education Program • Native Hawaiian Vocational Education Program • State Vocational and Applied Technology Education Program which contains: o State Program and State Leadership Activities. o Program for Single Parents, Displaced Homemakers, and Single Pregnant Women. o Sex Equity Program. o Programs for Criminal Offenders. o Secondary School Vocational Education Program. o Post-secondary and Adult Vocational Education Program. o State Assistance for Vocational Education Support Programs by Community Based Organizations. o Consumer and Homemaking Education Program. o Comprehensive Career Guidance and Counseling Program.

o Business-Labor-Education Partnership for Training Program. • National Tech-Prep Education Program • State-administered State Grants for Facilities and Equipment and Other Program Improvement Activities • Community Education Employment Centers Program • Vocational Education Lighthouse Schools Program • Tribally Controlled Post-Secondary Vocational Institutions Program • Vocational Education Research Program • National Network for Curriculum Coordination in Vocational and Technical Education • National Center or Centers for Research in Vocational Education • Materials Development in Telecommunications Program • Demonstration Centers for the Training of Dislocated Workers Program • Vocational Education Training and Study Grants Program • Vocational Education Leadership Development Awards Program • Vocational Educator Training Fellowships Program • Internships for Gifted and Talented Vocational Education Students Program • Business and Education Standards Program • Blue Ribbon Vocational Education Program • Educational Programs for Federal Correctional Institutions • Vocational Education Dropout Prevention Program • Model Programs of Regional Training for Skilled Trades • Demonstration Projects for the Integration of Vocational and Academic Learning Program • Cooperative Demonstration Programs • Bilingual Vocational Training Program • Bilingual Vocational Instructor Training Program • Bilingual Materials, Methods, and Techniques Program. 2860.15.00 WORK STUDY (MED 3) For MAGI, work-study educational income is received for the performance of work. Income received for a work study program is considered taxable income, so it is included in the calculation of MAGI for purposes of determining household income. 2860.20.00 EMPLOYER EDUCATIONAL ASSISTANCE (MED 3) For MAGI, up to $5,250 of qualified employer-provided educational assistance can be excluded from taxable income and not included in the calculation of MAGI for determining household income.

2860.25.00 SCHOLARSHIPS AND FELLOWSHIPS (MED 3) A scholarship is an amount paid to or for the benefit of a student (undergraduate or graduate) at an educational institution to assist in the pursuit of a degree. A fellowship is an amount paid to a student to assist with the pursuit of study or research. Qualified scholarship and fellowship payments may be excluded from taxable income and will not be included in the calculation of MAGI for household income. A qualified scholarship or fellowship consists of any payment an individual receives that is for tuition and fees for enrollment in an eligible educational institution or course related expenses, such as required fees, books, and equipment. Any scholarship or fellowship amount used for non-educational expenses (e.g., room and board, travel, research, or clerical help) or any amount in excess of educational expenses is considered taxable income so will be included in the calculation of MAGI for household income. If any part of a scholarship or fellowship that represents payment for teaching, research or other services required to receive the scholarship or fellowship is considered taxable income it will be included in the calculation of MAGI. Exceptions to this rule include any scholarship or fellowship amounts received from the National Services Corps Scholarship Program or the Armed Forces Health Professions Scholarship and Financial Assistance Program. Example: An individual receives a scholarship of $5,000.00, and the scholarship was not received from the National Services Corps Scholarship Program or the Armed Forces Health Professions Scholarship and Financial Assistance Program. The individual is required to work as a teaching assistant in order to receive the scholarship. $2,000.00 of the scholarship represents payment for teaching, $2,000.00 is used for qualified educational expenses, and $1,000.00 is used for rent payments. The $2,000.00 for qualified educational expenses would not be taxable income, so it is not counted in the calculation of MAGI. The $2,000.00 for teaching and the $1,000.00 for rent are considered taxable income and will be included in the calculation of MAGI for household income.

Scholarship prizes won in a contest that do not require the winner to use the prize for educational purposes are considered taxable income so will be included in the calculation of MAGI for household income. Pell grants and other Title IV need-based education grants are treated the same as scholarships and fellowships. Any amount received for qualified educational expenses as explained above is not considered taxable income and will not be included in the calculation of MAGI. Any amounts received from the Department of Veterans Affairs for education are not considered taxable income and will not be included in the calculation of MAGI. 2860.30.00 QUALIFIED TUITION REDUCTION (MED 3)

A tuition reduction is when an individual is allowed to study at no cost or for a reduced tuition. A qualified tuition reduction is not considered taxable income unless a portion of the reduction represents payment for teaching, research, or other services. In order for a tuition reduction to be qualified it must be received from and used at an eligible educational institution (an institution that maintains a regular faculty and curriculum and has a regularly enrolled student body at the location where it provides its educational activities). The tuition reduction does not have to be used at the same eligible institution that provided the reduction if it is for a college-level or above degree. Therefore, a tuition reduction that falls within the parameters will not be included in the calculation of MAGI for household income. If an individual receives a tuition reduction for education below the college-level (primary, secondary, or high school), one of the following requirements must be met for the reduction to not be considered taxable income and not included in the calculation of MAGI: • The individual is an employee of the educational institution • The individual was an employee of the educational institution, but retired or left on disability • The individual is a widow or widower whose spouse died while an employee of the educational institution or who retired or left on disability • The individual is the dependent child or spouse of an individual described in requirements 1 through 3 above. 2860.35.00 EDUCATION EXPENSE DEDUCTIONS (MED 3) The following sections discuss the deductions allowed for the calculation of MAGI for household income. 2860.35.05 STUDENT LOAN INTEREST DEDUCTIONS (MED 3) If an individual’s MAGI is less than $75,000 there is a special deduction of up to $2,500 allowed for interest paid on student loans. This special deduction is allowed when the following requirements are met: • The student loan was taken out solely to pay qualified education expenses. • The student loan was not from a related person or made under a qualified employer plan. • The student is the individual applying for Medicaid or his or her spouse or dependent. • The student is enrolled at least half-time in a degree program.

The deduction is allowed for both required and voluntary interest payments.

2860.35.10 TUITION AND FEES DEDUCTION (MED 3) Tuition and fees for qualified educational expenses for higher education are considered a deduction in the calculation of MAGI. Worker should refer to www.irs.gov for rule changes and/or exception. 2865.00.00 LOANS For MED 1, 2, 4 AGs, a loan in the month of receipt is exempt providing there is a verifiable repayment schedule in effect. A source with which to repay the loan need not exist for the loan to be exempt.41

When income proceeds are received as repayment on a loan only the amount received as interest is considered countable.42 For MED 3 AGs, loans are not taxable income. However, if a loan is canceled or forgiven, other than a gift, the amount canceled or forgiven is considered taxable income and is included in the calculation of MAGI for household income. 2865.05.00 STUDENTS LOAN CANCELLATIONS AND REPAYMENT ASSISTANCE (MED 3) Student loan cancellation and student loan repayment assistance may not be considered taxable income if certain requirements are met. The cancellation of a student loan will not be considered taxable income and not be considered in the calculation of MAGI if: • The loan was made by a qualified lender to assist the individual in attending an eligible educational institution. A qualified lender is the United States, a State, a tax- exempt state/county/municipal hospital whose employees are considered public employees under state law, an eligible educational institution (if the loan was made as part of an agreement with one of the lenders or was made under a program designed to encourage students to serve in occupations with unmet needs or areas with unmet needs). • A condition of the loan was that all or part of the loan would be cancelled if the individual worked for a certain period, in a certain profession, and for any of a broad class of employers.

The cancellation of a student loan does not qualify as tax-free if the loan was made by an educational institution and is canceled because of services performed for the educational institution.

Student loan repayments made to an individual are not considered taxable income if received from any of the following: • The National Health Service Corps Loan Repayment Program • A state education loan repayment program eligible for funds under the Public Health Service Act • Any other state loan repayment programs that are intended to provide for an increased availability of health services in underserved or health professional shortage areas.

Student Loan debt that is discharged, forgiven, or cancelled is generally treated as taxable income to the borrower and included in MAGI. The Tax Cuts and Jobs Act provided an exception to this rule for tax years 2018 through 2025. Student loan debt discharged on account of the death or permanent and total disability of the student is not included in the income. Such discharged debt is not counted in determining the MAGI-based household income of the borrower or other members of the borrower’s household. 2866.00.00 REVERSE MORTGAGES A reverse mortgage is a mortgage contract that allows a homeowner, age 62 or older, to borrow a percentage of the appraised value of his home. The homeowner then receives either a periodic payment or a line of credit which does not have to be repaid if he lives in the home. 2866.05.00 REVERSE MORTGAGES (MED 1, 2, 4) The proceeds from a reverse mortgage are not counted as income in the month received. However, if they are retained into the following month, they must be evaluated as resources. Another reverse mortgage arrangement consists of the purchase of an annuity and is called a reverse annuity mortgage (RAM). Annuity payments from a reverse annuity mortgage are counted as unearned income. 2866.10.00 REVERSE MORTGAGES (MED 3) For MAGI, the IRS does not distinguish between the different types of reverse mortgages when determining taxable income but sets forth that the monthly advances received from a reverse mortgage are not taxable income, so they are not included in the calculation of MAGI for purposes of determining household income.

2870.00.00 CONTRIBUTIONS-DEFINITION All direct money payments from any source that represent a gain or benefit to the individual, with no obligation to repay. 2870.05.00 CONTRIBUTIONS (MED 1, 2, 4) Cash contributions are included as unearned income. 2870.10.00 CONTRIBUTIONS (MED 3) For MAGI, cash contributions are not considered taxable income and are not included in the calculation of MAGI for purposes of determining household income. Exceptions to this rule include: • The cash contribution is from property income • The cash contribution is from an employer and is not nominal in nature. 2875.00.00 REAL ESTATE INCOME Income from real estate includes any funds resulting from property ownership. This income can be earned or unearned, depending on the program involved and the individual's management activity. The following sections describe income received from rental property, sales contracts on property, and room and board. 2875.05.00 RENTAL INCOME Rental income is any payment for using real or personal property. Examples of rent include payments for the use of any of the following: • Land • Buildings • An apartment, room, or house • Machinery or equipment. 2875.05.05 RENTAL INCOME (MED 3)

Income received from the rental of real estate is considered earned taxable income and is included in the calculation of MAGI for determining household income. Expenses related to rental income that can be deducted when calculating MAGI include all allowable IRS deductions such as: • Depreciation • Advertising • Auto and travel expenses • Commissions • Insurance • Interest • Legal and other professional fees • Local transportation expenses • Management fees • Mortgage interest paid to bank • Taxes • Utilities • Repairs to keep property in good working condition but do not add value • Operating expenses • Uncollected rents (cannot deduct if a cash basis taxpayer – only report actual cash collected). 2875.05.10 RENTAL INCOME (MED 1, 2, 4)

Rental income that is payment for the use of real or personal property is unearned income. Rental payments may be received for the use of land (including farmland), for land and buildings, for a room, apartment, or house, or for machinery and equipment. Another type of rental situation occurs when an individual owns multiple rental units, so that he is administering a rental business. That situation is considered self-employment, and the resulting income is earned income. Refer to IHCPPM 2810.30.00 2875.10.00 INCOME FROM CONTRACT SALES Income from land contract sales is paid in installments. The following sections discuss the treatment of payments from contract sales. 2875.10.05 INCOME FROM CONTRACT OR INSTALLMENT SALES (MED 3)

A contract or installment sale of property is where an individual receives at least one payment for the property after the tax year of the sale. This type of sale applies to personal and real property. Any payment of interest and any gain on the sale received because of the sales or installment contract is taxable income and included in the calculation of MAGI for determining household income. 2875.10.10 INCOME FROM CONTRACT SALES (MED 1, MED 4) A loan payment received by the applicant or member is not considered income in the month of receipt if the agreement meets the criteria in section 2615.55.15. The interest portion of the payment received is counted as income while the down payment is considered a resource..00.00 LUMP SUM PAYMENTS A lump sum is any type of cumulative payment made to an individual. A payment of retroactive benefits such as SSI, Social Security, Veterans' benefits, a 13th PERF check or a refund of Medicare Part B premiums is considered a lump sum. Insurance settlements, inheritances, and lottery winnings are also examples of lump sum payments. When evaluating a lump sum, the worker must carefully determine whether it is a recurring payment or a non-recurring payment. Non-recurring means the payment is a one-time payment and is not expected to be received from the same source for the same reason as a lump sum again. Conversely, if a payment is expected to be received again from the same source, it is a recurring lump sum payment. 2880.05.00 LUMP SUM PAYMENTS (MED 1, 2, 4) Any lump sum payment received in a month prior to the month in which authorization of the application takes place, is income in the month of receipt. However, for an active AG, an unanticipated non-recurring lump sum payment does not affect eligibility in the month of receipt, and Medicaid benefits paid during the month of receipt are not recoverable. Recurring lump sum payments are budgeted as income. Any portion of the lump sum remaining after the month of receipt is a resource for non-MAGI (MED 1, 2, 4) AGs. 2880.10.00 LUMP SUM PAYMENTS (MED 3) For MAGI, any amount received as a lump sum is counted as income only in the month received; except “qualified lottery winnings” and “qualified lump sum” i.e., Gambling winnings of $80,000 or greater, received in a single payout. Effective January 1, 2018, under Section 53103 of the Bipartisan Budget Act (BBA) of 2018, “qualified lottery winnings” and “qualified lump sum” i.e., gambling winnings of $80,000 or greater, received in a single payout, are to be counted as income in the month received as well as a period of up to 120 months. This does not apply to

winnings paid in installments. “Non-cash prizes “such as a car or a boat” should continue to be counted as lump sum income in the month in which they are received and not counted as “qualified lottery winnings.”40 The requirement to count qualified lottery and qualified lump sum income applies to the individual who receives the winnings only, the determination of household income for other members of the individual’s household are not affected (53103 (b)(2) of the BBA of 2018). “Qualified lottery winnings” are “winnings from a sweepstakes, lottery or pool” conducted by a state agency or under authority of state law, or winnings from a lottery operated by a multistate or multijurisdictional lottery association Qualified lump sum income” from gambling includes income from: betting pools; wagers placed through bookmakers; slot machines; roulette wheels; dice tables; lotteries; and bolita numbers games, or the selling of chances therein (1902 (e)(14)(K) of the Act). SSI lump sum payments are considered exempt. Formula for Counting Qualified Winnings Amount of Winnings: $1.00-79,999.00 $80,000.00- $89,999.00 $90,000.00- $99,999.00 Each Additional $10,000.00 Length of Time Counted only in the month received Counted over 2 Months Counted over 3 Months Counted over 1 additional month

• Total winnings are divided into equal installments over each month • The Maximum period that winnings may be counted is 120 months for winnings of $1,260,000 or higher • Applies only to individuals(s) receiving such winnings • Count only in the month received for other household members • Lottery winnings from other states are treated equivalent • Lottery and gambling winnings calculation applies to each instance of winnings • Gambling losses are not considered nor deducted from winnings in MAGI calculation. o Gap-filling regulation at 42CFR435.603(i)do not apply, however members who receive undue medical or financial burden due to lottery/gambling winnings may apply for a hardship exemption with the state. 2885.00.00 DEEMED INCOME (MED 1 AND 4) Deemed income refers to a special budgeting calculation in which a portion of an individual's income is considered available to participating AG members. Deemed income is considered as unearned income in the budget. For additional information regarding deeming, refer to IHCPPM 3455.05.20.

2890.00.00 VERIFICATION OF INCOME All income must be documented and verified. For MED 1, 2, 4 AGs, income can be verified through an electronic interface or database or a written, telephone, or personal collateral contact with the employer or source of income. When verifying income, the date and source of verification and the receipt date and amount of income received must be recorded. The worker is responsible for obtaining and verifying all pertinent information regarding the financial situation of the applicant/recipient to make accurate determinations of initial and continuing eligibility. The applicant/recipient must supply required documents and records and must assist in obtaining verifications if such information cannot be obtained electronically through an interface or database. All paper documentation must be completed and signed by the appropriate individuals (for example, the employer, and the client). For MAGI, an applicant must attest to income on the application. The income provided by the applicant is then verified by electronic sources or paper documentation. If an individual attests to income below the Medicaid or CHIP income standard and electronic data on the income is unavailable or conflicts with the amount attested, further documentation will be requested from the applicant. If an individual attests to income above the Medicaid or CHIP income standard and the electronic data verification amount indicates income below the applicable threshold, the individual is determined ineligible with no additional information requested. The individual will then be screened for eligibility in other insurance affordability programs available on the Federal Marketplace and the application transferred to the Federal Marketplace for a determination of qualified health coverage, Advance Premium Tax Credit (APTC), and Cost Sharing Reduction (CSR). If the difference between the attested amount and the electronic data verification amount results in the placement in a different benefit package or cost sharing amount, further documentation will be requested from the applicant. Documentation that may be requested includes, but is not limited to, a signed contract for employment, wage receipts, wage statements, employment verification form or pay stubs.43 For time standards and responsibility for verification refer to IHCPPM sections 2025.00, 2215.15.00 and 2220.00. • Ongoing benefits must not be closed or reduced based on electronic income verifications unless the member was subsequently sent a request for information giving them the chance to explain or rebut the information which was found. The notice of closure or benefit reduction itself is not a request for information and does not serve this purpose. 42 CFR 435.952(c), (d)

2890.05.00 VERIFICATION OF EARNED INCOME All earned income must be verified. Acceptable forms of verification include, but are not limited to, the following: • Wage receipts • Wage statements • Pay stubs • Employment verification form or written statements containing the required information • Information obtained from the Work Number • Collateral contact with employer • Work calendar (for tips and daily cash payments).

For MAGI (MED 3) AGs, the applicant will attest to earned income on the application, and the worker will verify the earned income via electronic sources, if available. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request paper documentation as set forth in IHCPPM 2890.00.00, which includes but is not limited to, the above-mentioned documents.44

2890.05.05 VERIFICATION OF SELF-EMPLOYMENT INCOME/EXPENSES Self-employed individuals must verify earned income. In addition, these individuals must make all business records which are necessary to verify income and/or expenses available to the caseworker. Examples of business records include documentation on: • Income tax records necessary to determine gross income and deductible expenses • Purchases • Sales • Salaries • Capital improvements • Utility, transportation, and other operating costs.

For MAGI (MED 3) AGs, the applicant will attest to self-employment earned income on the application, and the worker will verify the earned income via electronic sources. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in IHCPPM 2890.00.00, which includes but is not limited to, the above-mentioned documents.45 2890.10.00 VERIFICATION OF UNEARNED INCOME

All unearned income must be verified. The following sources may be used to verify unearned income: • BENDEX or SDX • SSA award letters • VA award letter • Pension check or award letter • Correspondence with the payor • Unemployment Compensation award letter • Support court statement and/or current statement from payor • Interest on bank account statements.

The agencies and the type of match (es) they provide are as follows:

• Internal Revenue Service (IRS): Unverified Unearned Income Data Exchange • Social Security Administration (SSA): o Beneficiary Earnings Exchange Record o Beneficiary Data Exchange (BENDEX) o State Data Exchange (SDX) • Indiana Department of Employment and Training (IDETS): o Wage Data Exchange (WDX) o Unemployment Insurance (UI)

More information concerning Data Exchange is found in the following IPPM sections: • Section 4430.05.00 • Section 4430.10.00 • Section 4430.15.00 • Section 4430.35.00 • Section 4430.30.00 • Section 4430.40.00

For MAGI (MED 3) AGs, the applicant will attest to unearned income on the application, and the worker will verify the unearned income via electronic sources. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in Section 2890.00.00, which includes but is not limited to, the above-mentioned documents.46 2890.10.05 VERIFICATION OF CHILD SUPPORT PAYMENTS (MED 1, 2, 4) Verification of support payments must be obtained. The following sources may be used to verify support.

• Verification from the County Clerk's Office if paid through the court • If the absent parent does not pay through the County Clerk's Office, a signed statement showing • the amount paid and how often it is paid must be obtained from the absent parent • Case Payment Information 2890.10.10 VERIFICATION OF SUPPLEMENTAL SECURITY INCOME (SSI) (NON-MAGI, MED 1, 2, 4) Sources of verification of SSI include: • SDX • Entitlement letter • Benefit check, which will be the net payment.

If the individual does not appear on the SDX, the following sources may be used: • Form SSA 1610

SDX lists all persons receiving SSI benefits and will have the latest benefit information for each SSI recipient. Since information is accessible on individuals who are not on any of Indiana's assistance programs confidentiality guidelines (see IHCPPM 1425.00.00) must be strictly followed. Refer to IHCPPM 2835.35 for discussion on inclusion or exclusion of SSI income. 2890.10.15 VERIFICATION OF SOCIAL SECURITY INCOME The Social Security Administration rounds down the entitlement amount to the nearest whole dollar. The amount of all Social Security checks (with a few rare exceptions) are in whole dollars. When verifying Social Security benefits, the "unrounded gross benefit amount" and the "net payment amount" (Medicare Part B is withheld) are required. The "gross payment amount" is the unrounded amount with the cents dropped and is the amount of the benefit check for an individual who does not have the Medicare Part B deducted. Sources of verification of Social Security include: • The un-cashed benefit check (by itself) if: o The individual does not have Medicare Part B coverage; or o The individual is on Buy-In. • Form SSA-1610 - request verification of the "unrounded gross benefit amount" and the "net payment amount"

• BENDEX • The entitlement letter if the unrounded gross benefit and "net payment amount" are clearly specified.

For MAGI (MED 3) applicants, the applicant will attest to the Social Security benefit income on the application. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in IHCPPM 2890.00.00, which includes but is not limited to, the above-mentioned documents.47 2890.10.20 VERIFICATION OF VETERANS' BENEFITS (NON-MAGI, MED 1, 2, 4) Verification of Veterans' Benefits generally must be obtained by contacting the Department of Veterans' Affairs. If the veteran has no dependents, the amount can be verified by the benefit check or entitlement letter. However, if the benefit includes an allowance for dependents, the worker must request a breakdown of the benefit. If the Department of Veterans' Affairs will not provide such breakdown, the entire amount is considered income to the veteran. Refer to IHCPPM 2840.10.00. 2890.10.25 VERIFICATION OF RAILROAD RETIREMENT Verification of the gross monthly entitlement must be obtained. This is the full entitlement amount without the deduction of the Medicare Part B premium. Sources of verification include Railroad Retirement Board, or the entitlement letter. Railroad retirement benefit is combined with the Social Security amount and contained in one check for most railroad retirement recipients. For MAGI (MED 3) AGs, the applicant will attest to the railroad retirement benefit income on the application, and the worker will verify the income via electronic sources. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in IHCPPM 2890.00.00, which includes but is not limited to, the above-mentioned documents.48 Refer to IHCPPM 2840.15.00. 2890.10.30 VERIFICATION OF BLACK LUNG BENEFITS Sources of Black Lung benefit verification include: • The benefit checks

• The SSA District Office for benefit checks received on the third of the month. For benefits paid on the 15th of the month, contact the United States Department of Labor, Division of Coal Mine Workers Compensation, 121 East State Street, Columbus, Ohio 43215. Telephone: (614) 469-5227. 2890.10.35 VERIFICATION OF PENSIONS Verification of the gross amount of a pension payment must be obtained. Viewing the check will not provide accurate information since optional deductions, such as federal income taxes and health insurance premiums, are often withheld. The worker must verify if any deductions are mandatory or optional. Sources of verification include: • Notices regarding benefit amounts, deductions, and payments in the possession of the individual • Correspondence from the payor.

Verification of the gross amount of a federal pension can be obtained by writing to the Office of Personnel Management, Insurance and Retirement Programs, Washington, D.C. 20415. The request for information must contain the individual's name and Civil Service Annuitant (CSA) number. For MAGI (MED 3) AGs, if the applicant’s pension benefits are counted in the calculation of MAGI, the applicant will attest to the benefit income on the application, and the worker will verify the income via electronic sources. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in IHCPPM 2890.00.00, which includes but is not limited to, the above-mentioned documents.49 Refer to IHCPPM 2840.20.00.

2890.10.40 VERIFICATION OF UNEMPLOYMENT COMPENSATION BENEFITS (UCB)

An automatic request for verification of Unemployment Compensation Benefits (UCB) is accomplished through data exchange. This request is completed for all AG members, age 16 and over, at application and for ongoing cases. The information from the Indiana Department of Workforce Development includes wage and unemployment verification from the prior month. If only part of the maximum benefit is being paid out there may be a deduction for child support, recoupment, or part-time earnings. Refer to IHCPPM 2840.25.00. For MAGI (MED 3) AGs, if the applicant’s unemployment benefits are counted in the calculation of MAGI, the applicant will attest to the income on the application, and the worker will verify the income via electronic sources. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in IHCPPM 2890.00.00.50 Refer to IHCPPM 2840.25.00.

2890.10.45 VERIFICATION OF WORKER'S COMPENSATION (NON-MAGI, MED 1, 2, 4) Inquiries regarding entitlement to benefits are to be directed to the Industrial Board, Indiana Government Center South, 402 West Washington Street, Room W-196, Indianapolis, Indiana 46204. Verification of the amount of such payment, payment receipt date intervals, and the length of time for which payments are approved is to be obtained by viewing the award notice in the possession of the individual, or by contacting the Industrial Board. When contacting the Industrial Board, the name of the employee, the date of injury, and the name of the employer should be given. If a portion of the award is verified as being designated for medical, legal, or related expenses paid or deducted at the source and is not controlled by the individual, that portion is to be deducted from the amount of the award when determining the amount of the payment that is available to the individual. Refer to sections under IHCPPM 2840.30. 2890.10.50 VERIFICATION OF EDUCATIONAL INCOME All student income from educational grants, scholarships, and loans must be verified and documented. For non-MAGI (MED 1, 2, 4) AGs, documentation must include the name of the educational institution and the amounts of any grants, scholarships, and loans; the type of assistance, the dates covered, and expenses covered (earmarked by each source of income). If the income includes grants or scholarships which are not automatically exempt (see IHCPPM 2860.65.00), the school must also verify whether the funds are sent directly to the school or to the student. If the school receives the educational income directly and the amount exceeds the student's documented educational expenses, a financial aid administrator must be questioned as to whether the school expects to refund the difference to the student at some point. (See IHCPPM 2860.10.00 for additional information on non-exempt educational income.) Verification may be obtained in writing or by telephoning the school or loan office. A written agreement with the lending institution which contains the necessary dates and that is signed by the individual will also serve as documentation. For MAGI (MED 3) AGs, only scholarships, awards, or fellowship grants used for non-educational expenses, such as living expenses, are taxable income and are utilized for the calculation of MAGI.51 The applicant will attest to the income on the application, and the worker will verify the income via electronic sources. If there are discrepancies between the income information provided by the applicant and the electronic data or electronic data is not available, the worker will request documentation as set forth in IHCPPM 2890.00.00.52

Indiana Health Coverage Program Policy Manual Chapter 3000 ELIGIBILITY STANDARDS Sections 3000.00.00 – 3047.00.00

Contents 3000.00.00 ELIGIBILITY STANDARDS ........................................................................................ 2 3005.00.00 RESOURCE LIMITS ................................................................................................. 2 3005.10.00 RESOURCE LIMITS (MED 1) ........................................................................ 2 3005.10.05 HOME EQUITY RESTRICTION (MED 1) ........................................................ 2 3005.15.00 RESOURCE LIMITS (MED 2) ........................................................................ 4 3005.20.00 RESOURCE LIMITS (MED 3) ........................................................................ 5 3005.25.00 RESOURCE LIMITS (MED 4) ........................................................................ 5 3006.00.00 FACILITY RATE USED TO CALCULATE PENALTY PERIOD (MED)................................ 5 3010.00.00 INCOME/NEED STANDARDS .................................................................................. 5 3010.20.00 INCOME STANDARDS (MED 1) ................................................................... 7 3010.20.05 ELIGIBILITY INCOME STANDARDS (MED 1) ................................................. 7 3010.20.05.05 ADDITIONAL ELIGIBILITY INCOME STANDARDS (MED 1) . Error! Bookmark not defined. 3010.20.10 POST-ELIGIBILITY STANDARDS (MED 1) ...................................................... 8 3010.20.15 SPECIAL INCOME LEVEL USED FOR INSTITUTIONAL RESIDENTS AND WAIVER SERVICES (MED 1) ........................................................................................................... 9 3010.20.20 INCOME STANDARD/PREMIUMS FOR M.E.D. WORKS ............................... 10 3010.25.00 INCOME STANDARDS (MED 2) .................................................................. 10 3010.26.00 TRANSITIONAL MA STANDARDS (MA F) .................................................... 12 3010.30.00 INCOME STANDARDS (MED 3) .................................................................. 12 3010.30.05 INCOME STANDARDS/LOW-INCOME PARENTS OR CARETAKERS, AND CHILDREN IN PSYCHIATRIC FACILITIES (MED 3) ............................................................. 12

3010.30.10 INCOME STANDARDS HIP ......................................................................... 13

3010.30.10.05 INCOME STANDARDS LOW-INCOME PARENT CARETAKER.................... 13 3010.30.10.10 INCOME STANDARDS HIP TMA ............................................................. 14 3010.30.15 INCOME STANDARDS/CHILD AGE 6 - 18 (MED 3) ...................................... 14 3010.30.20 INCOME STANDARDS/CHILD AGE 1 - 5 (MED 3) ........................................ 14 3010.30.25 INCOME STANDARDS/CHILD UNDER 19 (MED 3) ...................................... 15 3010.30.30 PREGNANT WOMEN, INFANTS UNDER AGE ONE (MED 3) ......................... 15 3010.30.35 FOSTER CARE INDEPENDENCE (MED 3) .................................................... 15 3010.30.40 CERTAIN CHILDREN / PREMIUMS, AND (MED 3) ....................................... 15 3010.35.00 INCOME STANDARDS (MED 4) .................................................................. 16

3010.35.05 QMB INCOME STANDARDS (MED 4) ......................................................... 17 3010.35.10 SLMB INCOME STANDARDS (MED 4) ........................................................ 17 3010.35.15 QDW INCOME STANDARDS (MED 4) ......................................................... 17 3010.35.20 QI INCOME STANDARDS (MED 4) ............................................................. 18 3040.00.00 GENERAL INCOME DISREGARD (MED 1, 4) ........................................................... 18 3041.00.00 MEDICARE PART D BENCHMARK (MED 1) ............................................................ 18

3045.00.00 GENERAL EARNED INCOME DISREGARD (MED 1 MED 4) ...................................... 19 3046.00.00 SUBSTANTIAL GAINFUL ACTIVITY AMOUNT (MED 1) ............................................ 19 3047.00.00 MINIMUM EARNINGS FOR M.E.D. WORKS IMPROVED CATEGORY (MED 1) .......... 19

3000.00.00 ELIGIBILITY STANDARDS

Each program has separate standards established by law or regulation which must be used to determine eligibility for assistance. This chapter includes information on the following:

• Resource Limits (Section 3005) • Facility Private Pay Rate (Section 3006) • Income/Need Standards (Section 3010) • MA Earned Income Disregard (Section 3035) • General Income Disregard (Section 3040) • Medicare Part D Benchmark (Section 3041) • General Earned Income Disregard (Section 3045) • Substantial Gainful Activity (Section 3046) • Minimum Earnings for MEDWorks Improved Category (Section 3047).

3005.00.00 RESOURCE LIMITS

The resource limit is the maximum value of nonexempt resources which an assistance group (AG) may retain in order to be eligible for assistance.

3005.10.00 RESOURCE LIMITS (MED 1)

The resource limit is dependent upon the category of assistance and the composition and living arrangement of the AG.1

The resource limits for Aged, Blind, and Disabled categories (MA A, MA B, and MA D) are as follows:

$2000 for an applicant/member, who is single or whose spouse qualifies as a "community spouse". For those in an institution, PACE members or on an HCBS waiver, MCCA rules apply.2

Example 1: Ann is in a Medicaid Certified Facility and applying for Medicaid. Ann’s spouse John, who is living in the community, has also applied under Med 1. The resource standard for Ann would follow the resource standards under MCCA at point of initially determining eligibility. After the 90-day protective period, Ann’s resource limit would be $2000. John would also have a $2000 resource limit.

$3000 for an applicant/member and their spouse (whether or not the spouse is an applicant/member) if the couple is living together or separated only for medical reasons and the spousal impoverishment provisions do not apply.

Example 2: Leo and Ann have both applied for Medicaid. Leo is in a nursing facility and Ann has an approved HCBS waiver. They are both applying for Med 1. Both Leo and Ann would have a combined $3000 resource limit.

Spousal Impoverishment rules apply in the below scenarios: • Spouse 1 is in a nursing home, spouse 2 is in the home and not on an HCBS waiver or a PACE member • Spouse 1 is on an HCBS waver or a PACE member, spouse 2 is in the home and not on an HCBS waiver or a PACE participant

Spousal Impoverishment rules do not apply in the below scenarios: • Both spouses are in a nursing home • Both spouses are on an HCBS waiver • Both spouses are PACE participants • Spouse 1 is in a nursing home and spouse 2 is on an HCBS waiver • Spouse 1 is a PACE member and spouse 2 is on an HCBS waiver • Spouse 1 is a PACE member and spouse 2 is in a nursing home

For the applicant/member who is under age 18 and living with their parents and not on an HCBS waiver, the resource limit for their parents is as follows:

• $2000 for a biological or adoptive parent who is unmarried or separated from their spouse [prior to June 1, 2014, the limit is $1,500]; • $3000 for biological or adoptive parents living together, or who are separated only for medical reasons [prior to June 1, 2014, the limit is $2,250].

*For children under 18, approved for Medicaid disability and on an HCBS waiver, parent’s income and resources are exempt in the budget. See IHCPPM 3315.00.00. The resource limits for MEDWorks (MADW, MADI) are: $2000 for an applicant/member, who is single or whose spouse qualifies as a "community spouse". 3

$3,000 for an applicant/member and their spouse (whether or not the spouse is an applicant/member if the couple is living together or separated only for medical reasons and the spousal impoverishment provisions do not apply). Parental resources are exempt for applicant/member children.

When an institutionalized individual has a community spouse, the community spouse resource limit is the greatest of the following amounts effective January 1, 2006

• The state standard of $32,532 effective 1/1/26; ($31,584 effective 1/1/25; $30,828 effective 01/1/24; $29,724 effective 1/1/23; $27,480 effective 01/1/22; $26,076 effective 01/1/21; $25,728 effective 1/1/20; $25,284 effective 1/1/19; $24,720 effective 1/1/18; $24,180 effective 1/1/17; $23,844 effective 1/1/15; $23,448 effective 1/1/14; $23,184 effective 1/1/13; $22,728.00 effective 1/1-12; $22,728 effective 1-1-12; $21,912 effective 1/1/09 through 12/31/11; $20,880 effective 1/1/08 through 12/31/08). • The spousal share, up to a maximum of $162,660 effective 1/1/26; ($157,920 effective 1/1/25; $154,140 effective 1/1/24; $148,620 effective 01/1/23; $137,400 effective 01/1/22; $130,380 effective 1/1/21; $128,640 effective 1/1/20; $126,420 effective 1/1/19; $123,600 effective 1/1/18; $120, 900 effectives 1/1/17; $119,220 effective 1/1/15; 117,240 effectives 1/1/14; $115,920 effective 1/1/13; $113,640 effective 1/1/12; $109,560, effective 1/1/09 through 12/31/11; $104,400 effective 1/1/08 through 12/31/08). • Any number of resources ordered by a court against the institutionalized spouse for the support of the community spouse. • The amount established by an Administrative Law Judge as the result of an appeal; • The above standards were not adjusted effective 1/1/10 through 1/1/11 as usual because the CPI did not increase.

3005.10.05 HOME EQUITY RESTRICTION (MED 1)

An applicant will be ineligible for long-term care services, if the applicant’s equity interest in the real property is greater than $752,000 effective 1/1/2026. Please refer to IHCPPM- 2640.10.15.06 regarding home equity restriction and how the limit set by the Federal Government affects the member/applicant resource limit for Medicaid.

• From 1/1/2024 to 12/31/2024 the limit was $713,000 • From 1/1/2023 to 12/31/2023 the limit was $688,000 • From 1/1/2022 to 12/31/2022 the limit was $636,000 • From 1/1/2021 to 12/31/2021 the limit was $603,000 • From 1/1/2020 to 12/31/2020 the limit was $595,000 • From 1/1/2019 to 12/31/2019 the limit was $585,000 • From 1/1/2018 to 12/31/2018 the limit was $572,000

• From 1/1/2017 to 12/31/2017 the limit was $560,000 • From 1/1/2016 to 12/31/2016 the limit was $552,000 • From 1/1/2015 to 12/31/2015 the limit was $552,000 • From 1/1/2014 to 12/31/2014 the limit was $543,000

• From 1/1/2013 to 12/31/2013 the limit was $536,000 • From 1/1/2012 to 12/31/2012 the limit was $525,000 • From 1/1/2011 to 12/31/2011 the limit was $506,000 • From 1/1/2009 to 12/31/2010 the limit was $500,000.

3005.15.00 RESOURCE LIMITS (MED 2)

This section is applicable to MA Q (Refugee Medical Assistance) only.

The resource limit is $1,000 for applicants.

3005.20.00 RESOURCE LIMITS (MED 3)

There are no resource limits for any of the MED 3 categories of assistance. Any number of resources may be retained by an AG.

3005.25.00 RESOURCE LIMITS (MED 4)

The resource limits for the QMB, SLMB, QDW, and QI categories are:4

$9,950 effective 1/01/26 for an applicant/member who is unmarried or not living with their spouse. $14,910 effective 1/01/26 for an applicant/member and their spouse if the couple is living together.

3006.00.00 FACILITY RATE USED TO CALCULATE PENALTY PERIOD (MED)

The average monthly private pay rate for nursing facilities in the statewide geographic region to be used in computing transfer penalties as explained in Section 2640.10.35 is $8,027. This amount is in effect for applications filed on and after July 1, 2026. For applications filed on or after:

7-1-25 through 6-30-26 $7651 7-1-24 through 6-30-25 $7635 7-1-23 through 6-30-24 $7496 7-1-22 through 6-30-23 $7167 7-1-21 through 6-30-22 $6873 7-1-20 through 6-30-21 $6681 7-1-19 through 6-30-20 $6682 7-1-18 through 6-30-19 $6527 7-1-17 through 6-30-18 $6439 7-1-16 through 6-30-17 $6078 7-1-15 through 6-30-16 $5923

7-1-14 through 6-30-15 $5733 7-1-13 through 6-30-14 $5449 7-1-12 through 6-30-13 $5353 7-1-11 through 6-30-12 $5139 7-1-10 through 6-30-11 $4826 7-1-09 through 6-30-10 $4611 7-1-08 through 6-30-09 $4456 7-1-07 through 6-30-08 $4249 7-1-06 through 6-30-07 $3960 7-1-05 through 6-30-06 $3898 7-1-04 through 6-30-05 $3817 7-1-03 through 6-30-04 $3667 7-1-02 through 6-30-03 $3,598

For applications filed 11-1-98 through 6-30-02, the amount for the appropriate geographic region below is to be used.

Region I $3,405.21 Region II $3,422.07 Region III $3,267.05

COUNTY REGION COUNTY REGION ADAMS l ALLEN I BARTHOLOMEW III BENTON II BLACKFORD II BOONE II BROWN III CARROLL II CASS I CLARK III CLAY III Clinton ii CRAWFORD III DAVIESS III DEARBORN III DECATUR III DEKALB I DELAWARE II DUBOIS III ELKHART I FAYETTE II FLOYD III FOUNTAIN II FRANKLIN II FULTON I GIBSON III GRANT II GREENE III HAMILTON II HANCOCK II HARRISON III HENDRICKS II HENRY II HOWARD II HUNTINGTON I JACKSON III JASPER III JAY II JEFFERSON III JENNINGS III

JOHNSON II KNOX III KOSCIUSKO I LAGRANGE I LAKE I LAPORTE I LAWRENCE III MADISON II MARION II MARSHALL I MARTIN III MIAMI I MONROE III MONTOGMERY II MORGAN III NEWTON I NOBLE I OHIO III ORANGE III OWEN III PARKE III PERRY III PIKE III PORTER I POSEY III PULASKI I PUTNAM III RANDOLPH II RIPLEY III RUSH II ST. JOSEPH I SCOTT III SHELBY II SPENCER III STARKE I STEUBEN I SULLIVAN III SWITZERLAND III TIPPECANOE II TIPTON II UNION II VANDERBURGH III

3010.00.00 INCOME/NEED STANDARDS

Income and Need Standards are the maximum income or expense consideration that is given to an AG in order to determine financial eligibility. For some programs, both a gross income and net income comparison are necessary. The specific income or need standards of each program are discussed in the following sections. Income and Need Standards are the maximum income or expense consideration that is given to an AG in order to determine financial eligibility. For some programs, both a gross income and net income comparison are necessary. The specific income or need standards of each program are discussed in the following sections.

3010.20.00 INCOME STANDARDS (MED 1)

The income standards used in determining eligibility for MA A, MA B, and MA D AGs are based on AG size, composition, and living arrangement. The following sections list the income standards to be utilized in a given case.

3010.20.05 ELIGIBILITY INCOME STANDARDS (MED 1)

The monthly income standards listed in this section are used in the eligibility determination. These standards are effective March 1, 2026.

$1330 - unmarried applicant/member of any age; or applicant/member not living with a spouse $1804- married couple, either or both of whom are applicants/members.

3010.20.05.05 ADDITIONAL ELIGIBILITY INCOME STANDARDS (MED 1)

The monthly income standards listed in this section are used in the eligibility determination. These standards are effective January 1, 2026.

$498: A dependent child; applicable for a child not in an MA assistance group or one who is in an MA assistance group other than MA B or MA D. $498: An essential person. $994: One parent of the child applicant/member. $1491: Two parents of the child applicant/member; and $498: Stepparent.

3010.20.10 POST-ELIGIBILITY STANDARDS (MED 1)

The policies stated in this section apply only to the MA A, MA B, and MA D and MEDWorks members residing in Medicaid certified long-term care (LTC) facilities.

The purpose of post-eligibility is to determine the institutionalized applicant's/member's liability to the facility. This determination also establishes the amount of the institutionalized applicant's/member's income which is allocated to meet the needs of his community spouse and certain other family members. The following standards are used in the post-eligibility calculation:

Personal needs allowance: • $525 Effective 7-1-02 ($50 effective 7-1-99) this is the minimum amount allowed for all applicants/members.

If the person is receiving long term care services through a home-and-community based waiver (HCBS), the personal needs allowance is equal to the Special Income Level (SIL). Refer to 3010.20.15.

• In specific situations, an additional individual amount for increased personal needs is to be deducted. Refer to Section 3455.15.10.

For those on the MEDWorks program (MADW and MADI) and residing in a Medicaid certified long-term care (LTC) facility, the member will have a standard patient liability

applied.6 MEDWorks members with an approved HCBS waiver will continue to pay their premium (if applicable) rather than a waiver liability.

Spousal allocation7 based on: • Spousal Income Standard -- $2705 effective 7-1-26 ($2644 effective 7-1-25; $2555 effective 7-1-24; $2465 effective 7-1-23; $2289 effective 7-1-22; $2178 effective 7- 1-21; $2155 effective 7-1-20; $2114 effective 7-1-19; $2058 effective 7-1-18; $2030 effective 7-1-17 through 6-30-18; $2003 effective 7-1-16 through 06-30-17; $1992 effective 7-1-15 through 6-30-16; $1967 effective 7-1-14 through 6-30-15; 1939 effective 7-1-13 through 6-30-14; $1892 effective 7-1-12 through 6-30-13; $1839 effective 7-1-11 through 6-30-12; corrected to $1822 effective 1-1-11 through 6-30- 11); $1823 effective 7-1-09 through 12-31-10; $1751 effective 7-1-08 through 6-30- 09) • Shelter Standard - $812 effective 7-1-26 ($793 effective 7-1-25; $767 effective 7-1- 24; $740 effective 7-1-23; $687 effective 7-1-22; $653 effective 7-1-21; $647 effective 7-1-20; $634 effective 7-1-19; $617 effective 7-1-18; $609 effective 7-1-17 through 06/30/18; $601 effective 7-1-16 through 06/30/17; $597 effective 7-1-15 through 6-30-16; $590 effective 7-1-14 through 6-30-15; $582 effective 7-1-13 through 6-30-14; $568 effective 7-1-12 through 6-30-13; 552 effective 7-1-11 through 6-30-12; $547 effective 7-1-09 through 6-30-11; $526 effective 7-1-08 through 6-30-08) • Maximum Maintenance Standard – $4,067 effective 1-1-26 ($3,948 effective 1-1-25; $3,854 effective 1-1-24; $3,716 effective 1-1-23; $3,435 effective 1-1-22; $3,260 effective 1-1-21; $3,216 effective 11-20; $3,161 effective 1-1-19; $3,090 effective 1- 1-18; $3,023 effective 1-1-17; $2,981 effective 1-1-15; $2,931 effective 1-1-14: $2898 effective 1-1-13; $2841 effective 1-1-12; $2739 effective 1-1-09 through 12- 31-11; $2610 effective 1-1-08)

Family allocation based on:

• 1/3 of the difference between a family member’s income and $2705 effective 7-1-26 ( $2644 effective 7-1-25; $2555 effective 7-1-24; $2465 effective 7-1-23; $2289 effective 7-1-22; $2178 effective 7-1-21; $2155 effective 7-1-20; $2114 effective 7-1-19; $2058 effective 7-1-18; $2030 effective 7-1-17 through 6-30-18; $2003 effective 7-1-16 through 06-30-17; $1992 effective 7-1-15 through 06-30-16; $1967 effective 7-1-14 through 6-30-15; $1939 effective 7-1-13 through 6-30-14; $1892 effective 7-1-12 through 6-30-13; $1839 effective 07-01-11 through 6-30-12; $1822 corrected effective 01-01-11 through 06-30-11; $1823 effective 07-01-09 through 12-31-10; $1751 effective 07-07-08 through 06-30-09)

3010.20.15 SPECIAL INCOME LEVEL USED FOR INSTITUTIONAL RESIDENTS, PACE members

AND WAIVER SERVICES (MED 1)