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• The provider or provider-related entity does not include the cost of such payments in either the cost of care for purposes of Medicare or Medicaid cost reporting or as part of a Medicaid shortfall or uncompensated care for any purpose.17

Except for the $1 minimum contribution to a POWER account, a member's out-of-pocket cost sharing amount shall not exceed five percent (5%) of the member's annual household income.18 The 5% maximum contribution value will be calculated by IEDSS (Indiana Eligibility Determination Services System) on a quarterly frequency.

In the case where two members are married, the combined total of both spouses’ required POWER account contributions cannot exceed two percent (2%) of the monthly household income, subject to the one dollar ($1) minimum contribution amount.19 A member’s POWER account under either MASP or MARP may change in accordance with change processing policy when changes are verified.

3545.00.00 CHANGE PROCESSING

HIP members are required to timely notify DFR of any changes. (Refer to sections 2220.05.00 and 2220.10.00). Members receive notice of this requirement through the Rights and Responsibilities portion of their application for health coverage.

An individual who is in the HIP program, who becomes pregnant during their eligibility period will be transitioned to the MAMA category, have their POWER Account suspended and stop all cost sharing, refer to Section 2426.00.00. For pregnant HIP members during redetermination, refer to 3550.10.00.

3545.05.00 POWER ACCOUNT CONTRIBUTIONS IN MULTIPLE-MEMBER HOUSEHOLDS

For households in which two members are enrolled in HIP, each enrollee will have his/her own POWER account. However, for a married couple, the total of both enrollees’ POWER account contributions may not exceed two percent (2%) of the family’s household income as specified in Section 3550.05.00 of this Chapter. This does not apply to unmarried couples.

3545.10.00 POWER ACCOUNT CONTRIBUTIONS AND INITIAL ELIGIBILITY

After an individual meets all eligibility requirements for the HIP program, they are considered “conditionally eligible” until the first POWER account contribution is made to the health plan, unless an FTE payment had already been made (refer to 3525.05.05). If the individual fails to make this initial payment within a 60-day timeframe, they are no longer conditionally eligible for HIP PLUS. If the individual income is at or below 100% FPL, they will be enrolled in HIP Basic after failing to make the first POWER account contribution. If the individual’s income is above 100% FPL, they are denied HIP eligibility for failure to pay Pac payment.