Page 18

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.