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• 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.