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However, a person claiming to be disabled, who is not in an institution or approved for HCBS waiver services, may be approved for HIP pending a determination for Medicaid disability, if they request HIP during this time. This can be asked during the interview. If later found eligible for another Medicaid category, HIP must be discontinued to allow for the person’s eligibility to be transferred to the other category the following month.

If a disabled person fails to complete the initial interview within 30 days, they should be processed for HIP rather than automatically denied.

3515.05.00 MEDICALLY FRAIL

Medically frail means an individual who is determined to have any one of the following:

• A disabling mental disorder • A chronic substance abuse disorder • A serious and complex medical condition • A physical, intellectual, or developmental disability that significantly impairs the individual’s ability to perform one or more activities of daily living.2 • A disability determination from SSA but is not eligible for MA A, MA B or MA D due to income or resources.

HIP health plans will confirm the member’s frailty within 60 days of the member’s authorization to receive HIP benefits. Effective January 1, 2016, HIP health plans will confirm the member’s frailty within 30 days of the member’s authorization to receive HIP benefits.

3515.10.00 OTHER MEDICAID AND MEDICARE COVERAGE

An eligible Medicaid recipient enrolled in another category cannot choose to voluntarily withdraw from another Medicaid category for the purpose of enrolling in HIP. However, a HIP recipient that becomes eligible for another Medicaid category (excluding pregnancy, refer to 3515.10.00) must have HIP discontinued so that the recipient is eligible in the other Medicaid category. Additionally, DFR must evaluate whether the person is entitled to any retroactive coverage under the other Medicaid category, since HIP benefit begin dates are determined upon financial contribution to a POWER account.

In situations of dual processing, it is important to inform the applicant/AR that HIP coverage will not be removed retroactively. 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 process for HIP coverage.

Medicare beneficiaries are categorically ineligible for HIP. If a HIP member becomes eligible for Medicare, including eligibility for retroactive Medicare benefits that overlap HIP eligibility, HIP eligibility shall cease to allow for advanced notice of adverse action (see section IHCPPM 2232.00.00). However, the health plan is prevented from recovering any payment for services,