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us-in/policy/cms/chip-state-plan/compiled — Axiom

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 1 General Description and Purpose of the State Child Health Plans and State Child Health Plan Requirements (Section 2101)

1.1 The state will use funds provided under Title XXI primarily for (Check appropriate box) (42 CFR 457.70):

1.1.1 Obtaining coverage that meets the requirements for a separate child health program (Section 2103); OR

1.1.2 Providing expanded benefits under the State’s Medicaid plan (Title XIX); OR

1.1.3 A combination of both of the above.

Medicaid expansion under Phase I of the CHIP program was approved June 26, 1998. State-designed child health program under Phase II of the program was approved December 22, 1999.

1.2 Please provide an assurance that expenditures for child health assistance will not be claimed prior to the time that the State has legislative authority to operate the State plan or plan amendment as approved by CMS. (42 CFR 457.40(d))

1.3 Please provide an assurance that the state complies with all applicable civil rights requirements, including title VI of the Civil Rights Act of 1964, title II of the Americans with Disabilities Act of 1990, section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, 45 CFR part 80, part 84, and part 91, and 28 CFR part 35. (42CFR 457.130)

1.4 Please provide the effective (date costs begin to be incurred) and implementation (date services begin to be provided) dates for this plan or plan amendment (42 CFR 457.65):

Original plan: Phase I - Medicaid Expansion  Effective:

October 1, 1997  Approval:

June 26, 1998  Implementation: July 1, 1998

Amendment 1: Phase II - State Program Addition  Submitted:

September 22, 1999  Approval:

December 22, 1999  Effective:

January 1, 2000

Amendment 2: CMS Template and End Continuous Eligibility  Submitted:

September 6, 2002  Approved:

November 26, 2002  Effective:

July 1, 2002

Amendment 3: Health Services Initiative  Submitted:

August 24, 2004  Withdrawn: May 30, 2006

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 2 General Background and Description of State Approach to Child Health Coverage and Coordination (Section 2102 (a) (1)-(3)) and (Section 2105) (c) (7) (A)-(B))

2.1. Describe the extent to which, and manner in which, children in the state including targeted low-income children and other classes of children, by income level and other relevant factors, such as race and ethnicity and geographic location, currently have creditable health coverage (as defined in 42 CFR 457.10). To the extent feasible, make a distinction between creditable coverage under public health insurance programs and public-private partnerships (See Section 10 for annual report requirements). (42 CFR 457.80(a))

The table below provides information from the Kaiser State Health Facts website regarding general population characteristics. This information can be used to establish a general understanding of the current environment in the State of Indiana. Kaiser State Health Facts (2007) for State of Indiana Description Number Total Children 0-18 1,685,904 Total Children 0-18 w/o Health Insurance 113,581 Total Children 0-18 Below 574,010

The table below provides information from the State of Indiana regarding the populations currently being served by Indiana Medicaid. It should be noted that MCHIP refers to the portion of the CHIP population funded via Medicaid funding and CHIP refers to the CHIP population not funded via Medicaid funding. It should also be noted that many of the State’s children are served in non-CHIP program areas. The information below can be used to establish a general understanding of the current environment in the State of Indiana. State of Indiana (January 2009) Description Number Total Children 0-18 Enrolled in Medicaid 550,971 Total Children 0-18 Enrolled in Care Select 26,989 Total Children 0-18 Enrolled in Hoosier Healthwise 479,303 Total Children 0-18 Enrolled in MCHIP (Enrolled in Hoosier Healthwise) 51,008 Total Children 0-18 Enrolled in CHIP (Enrolled in Hoosier Healthwise) 18,351

2.2. Describe the current state efforts to provide or obtain creditable health coverage for uncovered children by addressing: (Section 2102) (a) (2) (42CFR 457.80(b))

Public health insurance in Indiana is provided via the Medicaid program. CHIP enrollees are enrolled in the Hoosier Healthwise program. Children eligible for the Medicaid expansion component (referred to specifically as MCHIP) are enrolled in Hoosier Healthwise under Benefit Package A. Those eligible for the State-designed component of Indiana’s CHIP program (referred to as the CHIP population) are enrolled in Hoosier Healthwise under Benefit Package C.

2.2.1. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs (i.e. Medicaid and state-only child health insurance):

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Program Purpose Division of Family Resources (DFR) Enrollment Centers Individuals currently apply for Hoosier Healthwise at one of more than 300 enrollment centers or through the offices of the Division of Family Resources (DFR) located in all 92 counties throughout the State. These enrollment centers can provide information on the programs under Medicaid. Eligibility Modernization Project Beginning October 29, 2007 the State of Indiana is modernizing its eligibility process. There is a uniform call center for questions regarding eligibility, enrollment, and Medicaid Programs. Free and Reduced Lunch Program Literature regarding the Medicaid program is distributed to all children that participate in the free and reduced lunch program. Volunteer Community Access Network (V-CAN) Formal network of service providers and community organizations that provide information about and access to the ways to apply for benefits. Healthy Families Indiana Program A voluntary home visitation program that makes referrals to the Hoosier Healthwise program. Children’s Special Health Care Services (CSHSC) Program Insurance program that provides medical assistance to approximately 8,000 families of children who have certain chronic medical conditions and who also meet medical and financial eligibility requirements. Children are referred to the CSHCS program by providers and by other programs throughout the State. CSHCS requires that children who apply for the program also apply for Medicaid. Indiana Maternal and Child Health (MCH) Program MCH funds 22 child or adolescent health clinics and 4 school based health clinics. Requires direct service grantees to facilitate their clients into Medicaid if they meet eligibility requirements. Indiana Family Helpline Provides health care information and referrals through a toll free telephone number. The Family Helpline staff screen all clients for Hoosier Healthwise eligibility and provide appropriate referrals. Local Health Departments Local Health Departments (LHDs) provide immunizations, lead screenings and other direct services to individuals throughout Indiana. Some LHDs have special staff dedicated specifically to outreach activities. Step Ahead Initiative Designed to develop, at the local level, comprehensive seamless delivery systems for children from birth to age thirteen. The initiative is designed to support county efforts to centralize programs in order to reduce duplication and fragmentation of services. First Steps Indiana’s early intervention system for infants and toddlers, who have developmental delays, brings together federal, state, local, and private funding sources in order to create a coordinated, community-based system of services. In each community, a ―child find‖ system is developed and is utilized

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: to identify, locate and evaluate children who are eligible for early intervention services. First Steps collaborates with the DFR by distributing information about the Hoosier Healthwise program. Community Health Centers (CHC) These centers design their services around needs identified in their particular communities. Many of the CHCs engage in significant outreach activities and some serve as Hoosier Healthwise enrollment centers. Indiana Minority Health Coalition (IMHC) Used to promote healthy lifestyles through disease prevention and health awareness; and to provide referrals, information services, community outreach, and program services. The agency also collaborates with these coalitions on outreach activities for the immunization program and other programs administered by the agency. In addition, Indiana has developed statewide enrollment partnerships with Indiana Black Expo, the Wishard Hospital Hispanic Health Project and the Indiana Primary Health Care Association (IPHCA). Consolidated Outreach Project (COP) Provides intake assessment for migrant farm workers who enter Indiana for seasonal employment.

2.2.2. The steps the State is currently taking to identify and enroll all uncovered children who are eligible to participate in health insurance programs that involve a public-private partnership:

Program Purpose ISDH and the IPHCA Through a collaborative arrangement between the ISDH and the IPHCA, health care services are provided to children and other individuals throughout the State. This arrangement was designed to improve access to primary health care programs for the medically underserved; individuals at poverty level; working poor; migrant and seasonal farm workers; the homeless; and individuals who lack health care due to geographic, financial and/or cultural barriers. DMHA The DMH has undertaken a collaborative effort with mental health providers throughout the state. The providers act as mini-HMOs in that they receive a payment up-front from the DMH, and, in return, provide a full array of mental health services to seriously emotionally disturbed children who are at 200% of poverty or below. The DMH is also involved in the Dawn Project, a collaborative effort with the DOE Division of Special Education, the Marion County Office of Family and Children, the Marion County Superior Court Juvenile Division and the Marion County Mental Health Association. The goal of this pilot project is to provide community-based services to children and youth in Marion County who are seriously emotionally disturbed and who are at imminent risk of long-

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: term inpatient psychiatric hospitalization or residential care. Families are assigned a service coordinator who works with the family to design an array of services that meet the individual needs of the child and family. Referrals to the program come primarily from the Office of Family and Children, the DOE and the Juvenile Court. Insurance Risk Pool A partnership between the health insurance industry and the State is the underlying principle behind the financing of an insurance risk pool for medically challenged individuals who are unable to obtain traditional health insurance. The Indiana Comprehensive Health Insurance Association (ICHIA), a private non-profit association created by the Indiana General Assembly, covers adults and children. State programs make referrals to ICHIA where appropriate. ICHIA is funded through premiums, and an assessment on insurance companies licensed in the State. Since the insurance companies are able to obtain a State tax credit for these assessments, the State is an important partner in this initiative as well.

2.3. Describe the procedures the State uses to accomplish coordination of CHIP with other public and private health insurance programs, sources of health benefits coverage for children, and relevant child health programs, such as title V, that provide health care services for low-income children to increase the number of children with creditable health coverage. (Previously 4.4.5) (Section 2102)(a)(3), 2102(c)(2) and 2102(b)(3)(E)), and (42CFR 457.80(c))

The CHIP program, the MCHIP Medicaid expansion, and the Title XIX Medicaid program are all closely coordinated. Individuals who apply for benefits will be considered for each of the programs. Since the CHIP program is a component of Hoosier Healthwise, the CHIP program utilizes the same delivery system as is already in place for Medicaid. The goal is to provide a medical home for each child, and to establish a seamless system of care. This ensures that the programs are coordinated not only for the benefit it provides to enrollees, but also for the purpose of administrative simplification and efficiency. For example, FSSA has modified ICES, IndianaAIM, FSSA’s cost allocation plan, and other related systems to correctly reflect expenditures eligible for reimbursement from Indiana’s federal CHIP allocation.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:

Section 3 Methods of Delivery and Utilization Controls (Section 2102)(a)(4))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 4.

3.1. Describe the methods of delivery of the child health assistance using Title XXI funds to targeted low-income children. Include a description of the choice of financing and the methods for assuring delivery of the insurance products and delivery of health care services covered by such products to the enrollees, including any variations. (Section 2102)(a)(4) (42CFR 457.490(a))

Public health insurance in Indiana is provided via the Medicaid program. CHIP enrollees are enrolled in the Hoosier Healthwise program (risk-based capitated managed care program). Children eligible for the Medicaid expansion component (referred to specifically as MCHIP) are enrolled in Hoosier Healthwise under Benefit Package A. Those eligible for the State- designed component of Indiana’s CHIP program (referred to as the CHIP population) are enrolled in Hoosier Healthwise under Benefit Package C. The Hoosier Healthwise program is governed by the Indiana Medicaid State Plan, Indiana’s section 1115 demonstration project and a 1915(b) waiver. Please refer to the Indiana Medicaid State Plan, Indiana’s section 1115 demonstration project and the 1915(b) waiver for more information regarding the delivery system and structure. To clarify, the MCHIP population is located on the 1915(b) waiver and the CHIP population is only governed by the state plan. It is not on the 1115 demonstration.

3.2. Describe the utilization controls under the child health assistance provided under the plan for targeted low-income children. Describe the systems designed to ensure that enrollees receiving health care services under the state plan receive only appropriate and medically necessary health care consistent with the benefit package described in the approved state plan. (Section 2102)(a)(4) (42CFR 457.490(b))

Hoosier Healthwise has a number of utilization control mechanisms in place that are designed to ensure that health care use is appropriate and medically necessary.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:

Area Description Medicaid Management Information System (MMIS) The MMIS contains a Surveillance and Utilization Review (SUR) subsystem that provides a comprehensive method for conducting utilization review and program management. Under this system, computerized reports are generated that provide a statistical profile of provider practices and recipient utilization. The system allows for the flagging of areas where there is deviation from peers. Rankings are made to indicate which individuals have the greatest amount of deviation. SUR analysts take action where warranted. The objective is for misuse of health services to be identified, investigated, and corrected. Provider desk reviews are conducted based upon Federal and State requirements, and prepayment review and other action is taken where warranted. Recipient restricted card procedures are implemented in cases of recipient over utilization. Programmatic (CHIP) Specific mechanisms designed to prevent over utilization are also built into the Phase II CHIP program. Limitations are placed on the benefit package and nominal copayments will be imposed for certain services. A more detailed discussion regarding benefits can be found in Section 6; and a more detailed discussion regarding copayments can be found in Section 8. Programmatic (Hoosier Healthwise) The managed care system established under Hoosier Healthwise also has some built in utilization controls. The PMP serves as a gatekeeper who provides or authorizes primary care services and makes referrals for specialty care (except those which may be self- referred) where appropriate. Referrals must be documented in the patient’s medical record. In addition, MCOs are required to have written utilization review (UR) programs in place. The program must include a utilization review committee directed by the Medical Director of the MCO; utilization management practices that conform to industry standards; and resources for evaluating, and, if necessary, modifying the UR process. In order for the State to track expenditures and service utilization in the RBMC program, shadow claims are required to be reported for patient encounters. The shadow claims provide details regarding diagnoses, procedures, place of services, billed amounts and providers.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 4 Eligibility Standards and Methodology. (Section 2102(b))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5. 4.1. The following standards may be used to determine eligibility of targeted low-income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) (42CFR 457.305(a) and 457.320(a))

4.1.1.

Geographic area served by the Plan:

Statewide

4.1.2.

Age:

0-18 (less than 19 years of age)

4.1.3.

Income:

Children with incomes from 150-300% of the FPL are eligible for CHIP. For income amounts above 200 % FPL up to 300% FPL, no standard Medicaid income deductions will be applied. Families with higher incomes will be subject to higher premiums. (A more detailed discussion on cost sharing can be found in Section 8).

4.1.4.

Resources (including any standards relating to spend downs and disposition of resources):

4.1.5.

Residency (so long as residency requirement is not based on length of time in state):

Must be residents of Indiana

4.1.6.

Disability Status (so long as any standard relating to disability status does not restrict eligibility):

4.1.7.

Access to or coverage under other health coverage:

Children cannot have other creditable health care coverage. A three- month waiting period from the date the child was last covered will be imposed.

Exceptions to the waiting period will be provided if the coverage was lost involuntarily (such as through the loss of employment, divorce etc.) or if the child was previously covered by Medicaid.

4.1.8.

Duration of eligibility:

All children have 12 months as the duration of eligibility. Families are asked to notify DFR if their income increases or if health insurance coverage is obtained during the eligibility period.

Children age 3 through 18 remain eligible only as long as they meet income and other program requirements.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:

Children under age 3 receive continuous eligibility for 12 months, regardless of changes in income.

An exception to this is allowed if an individual reports a change in income which would qualify the individual for Medicaid.

4.1.9.

Other standards (identify and describe):

To be eligible for CHIP, families must agree to cost-sharing requirements.

The CHIP program is also permitted to adjust eligibility requirements based upon available resources.

Applicants must provide a Social Security Number in order to be eligible for the program, as permitted in 42 CFR 457.340.

4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102) (b) (1) (B)) (42CFR 457.320(b))

4.2.1.

These standards do not discriminate on the basis of diagnosis. 4.2.2.

Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3.

These standards do not deny eligibility based on a child having a pre- existing medical condition.

4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) (42CFR 457.350)

The application process and eligibility determination process for the CHIP program is integrated into the application and eligibility determination process for Hoosier Healthwise. Eligibility determinations for MCHIP (Title XIX) and CHIP (XXI) are made by the DFR. Applicants are first screened for eligibility under Title XIX, and if found ineligible, they will be screened for eligibility under Title XXI. Before an application will be approved, income of a parent or guardian must be verified by supporting documentation from the payer. Acceptable items for verifying earnings include: pay stubs, statements from employers, or a wage verification form that is completed by employers. Indiana will conduct follow-up screening to identify when coverage is available through another plan. CHIP will be discontinued beginning the day the child receives other creditable coverage.

Families who apply for benefits will be advised of the cost sharing requirements under CHIP, and, to be considered for eligibility under CHIP, they must agree to meet the cost-sharing requirements if the child is found eligible. In addition a conditional approval notice will be sent to the family and a record will be sent to the premium collection vendor. Once the first premium payment is made, the child becomes enrolled in the program.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: 4.3.1 Describe the state’s policies governing enrollment caps and waiting lists (if any). (Section 2106(b) (7)) (42CFR 457.305(b))

Check here if this section does not apply to your state.

The following procedures will be used to determine when the State might need to consider options for containing enrollment and expenditures to ensure that Indiana’s budget or annual appropriation is not exceeded. This process was approved by the Children’s Health Policy Board in the spring of 2000.

The CHIP office will analyze current and past MCHIP and CHIP enrollment in order to determine future enrollment trends and projected enrollment levels. CHIP expenditures will be estimated for MCHIP and CHIP based on previous expenditures and will monitor projected expenses to determine their impact on the budget.

Enrollment and expenditure projections will be utilized to develop an estimate of how many enrollees the State can afford to cover in CHIP and then when to consider implementing mechanisms to ensure that the budget or annual appropriation is not exceeded. Budget limitations may be the result of the state appropriation or the annual federal allocation. If either the state appropriation or the federal allocation is exceeded, the state could choose to:

Allocate additional funds from another source or limit enrollment or expenditures to remain within the original state appropriation or federal allocation by pursuing one of the following options:

Cover CHIP at the Medicaid match rate once Title XXI funds are exhausted

Establish a waiting list for CHIP

Change the benefit package for CHIP

Implement cost-sharing for CHIP to a maximum of 5% of a family’s income.

The State will inform CMS if an enrollment cap is implemented.

4.4. Describe the procedures that assure that:

4.4.1. Through the screening procedures used at intake and follow-up eligibility determination, including any periodic redetermination, that only targeted low- income children who are ineligible for Medicaid or not covered under a group health plan or health insurance coverage (including access to a state health benefits plan) are furnished child health assistance under the state child health plan. (Sections 2102(b) (3) (A) and 2110(b) (2) (B)) (42 CFR 457.310(b) (42CFR 457.350(a) (1)) 457.80(c) (3))

Eligibility determinations for MCHIP (Title XIX) and CHIP (XXI) are made by the DFR. Applicants are first screened for eligibility under Title XIX, and if found ineligible, they will be screened for eligibility under Title XXI. The ICES system has a systematic approach to screening and enrolling an enrollee into the appropriate aid category.

Before an application will be approved, income of a parent or guardian must be verified

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: by supporting documentation from the payer. Acceptable items for verifying earnings include: pay stubs, statements from employers, or a wage verification form that is completed by employers. Indiana will conduct follow-up screening to identify when coverage is available through another plan. CHIP will be discontinued beginning the day the child receives other creditable coverage. Three primary methods of third party liability policy gathering will be utilized:  Absent parent data match using data from the State Wage Information Collection Agency  Match with data from the Department of Defense that shows CHAMPUS coverage for dependents  Match through Health Management Systems which matches claims information from the IndianaAIM system with insurance information from private insurance policies.  The State will utilize the employment section of the application form to identify children who are eligible for dependant coverage under the state employees’ health plan.

4.4.2. The Medicaid application and enrollment process is initiated and facilitated for children found through the screening to be potentially eligible for medical assistance under the state Medicaid plan under Title XIX. (Section 2102)(b)(3)(B)) (42CFR 457.350(a) (2))

4.4.3. The State is taking steps to assist in the enrollment in CHIP of children determined ineligible for Medicaid. (Sections 2102(a) (1) and (2) and 2102(c) (2)) (42CFR 431.636(b) (4))

Children who are found not eligible for Medicaid under Title XIX, are enrolled in MCHIP if they are up to 150% FPL and do not have other insurance. Title XIX, rather than Title XXI, is used to provide services for children who are under 150% FPL but who have other health insurance. The enhanced match does not apply for these children since they do not fall under the targeted low-income definition due to their other insurance coverage. Children who are above 150% but not more than 300% FPL, who do not have other health coverage and who meet the other CHIP eligibility requirements are enrolled in CHIP if the parent/guardian agrees to the cost sharing obligation.

4.4.4. The insurance provided under the state child health plan does not substitute for coverage under group health plans. Check the appropriate box. (Section 2102)(b)(3)(C)) (42CFR 457.805) (42 CFR 457.810(a)-(c))

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: 4.4.4.1. Coverage provided to children in families at or below 200% FPL: describe the methods of monitoring substitution.

Indiana has instituted a number of mechanisms designed to address crowd out. To ensure that CHIP enrollees do not have other health insurance, the State requires that all CHIP recipients attest to the lack of current health care coverage and specify the date of last coverage.

Since the MCHIP program limits family income to 150% of poverty, crowd out is not a significant issue because many of the lower income families do not have the option of employer-based health insurance.

Crowd out is of greater concern under CHIP due to the higher income threshold. As such, Indiana has instituted three-month waiting periods and monthly premiums as crowd out deterrents under the CHIP program. Also provisions included in Public Law 273-1999 prohibit insurers from knowingly or intentionally referring children covered under their dependent coverage policies to the CHIP program.

The Hoosier Healthwise application asks "Did any applicants who do not have health insurance lose their coverage in the last three months? Please tell us why coverage was lost." The choices are:

Loss of employment

Could not afford

Coverage limit reached

Company ended coverage

Non-custodial parent dropped coverage

Divorce

Other

This information (for both approved and denied children) is entered into the Indiana Client Eligibility System (ICES) and monitored for signs of crowd-out among applicants. Applicants who lose coverage involuntarily are not subjected to the three-month waiting period. Denial reasons are tracked, resulting in:

Count of applicants who were denied because they voluntarily dropped coverage but did not wait the required three months before applying

Count of applicants who were denied because they currently carry private insurance

Count of currently enrolled children who are denied because they gained private coverage rendering them ineligible for CHIP. This information is monitored using our aggregated data system, COGNOS.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: 4.4.4.2. X Coverage provided to children in families over 200% and up to 250% FPL: describe how substitution is monitored and identify specific strategies to limit substitution if levels become unacceptable.

In addition to the above tracking procedures to monitor potential crowd out, Indiana will institute a three-month waiting period for CHIP applicants in this income group. The only exceptions are previous coverage by Medicaid and expiration of COBRA coverage.

4.4.4.3. X Coverage provided to children in families above 250% FPL: describe how substitution is monitored and identify specific strategies in place to prevent substitution.

4.4.4.4.

If the state provides coverage under a premium assistance program, describe:

The minimum period without coverage under a group health plan, including any allowable exceptions to the waiting period.

The minimum employer contribution.

The cost-effectiveness determination. CHIP 4.4.5. Child health assistance is provided to targeted low-income children in the state who are American Indian and Alaska Native. (Section 2102)(b)(3)(D)) (42 CFR 457.125(a))

Indiana contracted with the Indiana Minority Health Coalition (IMHC) to assure health assistance to targeted low-income children who are American Indians. The IMHC has a local Native American coalition which worked closely with the IMHC and the State of Indiana to develop culturally sensitive materials targeting a Native American audience. The State will continue to engage in collaborations with the Native American Minority Health Coalition to ensure that Native American children who are eligible for Hoosier Healthwise receive assistance. Currently, the Coordinator of the American Indian Center

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 5 Outreach (Section 2102(c))

Describe the procedures used by the state to accomplish:

Outreach to families of children likely to be eligible for child health assistance or other public or private health coverage to inform them of the availability of the programs, and to assist them in enrolling their children in such a program: (Section 2102(c) (1)) (42CFR 457.90)

The outreach initiatives are listed below.

Central Office Activities: The steps the central DFR office took are:  Issuing a new policy directive regarding enhancing outreach and enrollment  Analyzing the number of uninsured children per county  Reviewing equipment specifications and technical needs so that local providers and agencies who want to partner with the State can purchase compatible equipment  Developing a simplified shortened or joint Hoosier Healthwise application form  Developing program outreach materials and campaigns  Delinking Hoosier Healthwise from TANF in the computer system  Redesigning the membership card so that enrollees can be proud to carry the card  Creating a new training curriculum for caseworkers and other individuals  Developing relationships with hospitals, schools, health centers and social service agencies to create enrollment centers statewide

Local Efforts: Local DFR agency efforts include:  Given a county-specific enrollment target and are furnished a list of names of individuals and entities that they were required to contact  Responsible for working with partners in the individual communities and develop local enrollment centers  Required to develop local outreach plans geared to the specific communities.

State and Local Collaborations: The State worked with eight community coalitions on a three year Robert Wood Johnson (RWJ) Covering Kids outreach grant which targeted hard to reach populations.

Public Law 273-1999 provides that the CHIP program may contract with community entities for services such as outreach and enrollment, and consumer education.

Special Populations: The State has contracted with Black Expo, the IMHC, the Consolidated Outreach Project (migrant farmers) and the Wishard Hospital Hispanic Health Access Initiative to develop culturally sensitive materials and to implement outreach initiatives.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 6 Coverage Requirements for Children’s Health Insurance (Section 2103)

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 7.

6.1. The state elects to provide the following forms of coverage to children: (Check all that apply.) (42CFR 457.410(a))

6.1.1.

Benchmark coverage; (Section 2103(a) (1) and 42 CFR 457.420) 6.1.1.1.

FEHBP-equivalent coverage; (Section 2103(b) (1)) (If checked, attach copy of the plan.) 6.1.1.2.

State employee coverage; (Section 2103(b) (2)) (If checked, identifies the plan and attaches a copy of the benefits description.) 6.1.1.3.

HMO with largest insured commercial enrollment (Section 2103(b) (3)) (If checked, identifies the plan and attach a copy of the benefits description.)

6.1.2.

Benchmark-equivalent coverage; (Section 2103(a) (2) and 42 CFR 457.430) Specify the coverage, including the amount, scope and duration of each service, as well as any exclusions or limitations. Please attach a signed actuarial report that meets the requirements specified in 42 CFR 457.431. See instructions. (See Attachment A, benefits package, and Attachment B, actuarial opinion memo)

6.1.3.

Existing Comprehensive State Based Coverage; (Section 2103(a) (3) and 42 CFR 457.440) [Only applicable to New York; Florida; Pennsylvania] Please attach a description of the benefits package, administration, date of enactment. If existing comprehensive state-based coverage is modified, please provide an actuarial opinion documenting that the actuarial value of the modification is greater than the value as of 8/5/97 or one of the benchmark plans. Describe the fiscal year 1996 state expenditures for existing comprehensive state-based coverage.

6.1.4.

Secretary Approved Coverage. (Section 2103(a) (4)) (42 CFR 457.450) 6.1.4.1.

Coverage the same as Medicaid State plan 6.1.4.2.

Comprehensive coverage for children under a Medicaid Section 1115 demonstration project 6.1.4.3.

Coverage that either includes the full EPSDT benefit or that the state has extended to the entire Medicaid population 6.1.4.4.

Coverage that includes benchmark coverage plus additional coverage 6.1.4.5.

Coverage that is the same as def comprehensive state-

6.1.4.6.

Coverage under a group health plan that is substantially equivalent to or greater than benchmark coverage through

(current-state-plan)(page-21)Page 21#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: a benefit by benefit comparison (Please provide a sample of how the comparison will be done) 6.1.4.7.

Other (Describe)

6.2. The state elects to provide the following forms of coverage to children: (Check all that apply. If an item is checked, describe the coverage with respect to the amount, duration and scope of services covered, as well as any exclusions or limitations) (Section 2110(a)) (42CFR 457.490)

For discussion of scope of services, amount, duration, exclusions and limitations, see Attachment A. 6.2.1.

Inpatient services (Section 2110(a) (1)) 6.2.2.

Outpatient services (Section 2110(a) (2)) 6.2.3.

Physician services (Section 2110(a) (3)) 6.2.4.

Surgical services (Section 2110(a) (4)) 6.2.5.

Clinic services (including health center services) and other ambulatory health care services. (Section 2110(a) (5)) 6.2.6.

Prescription drugs (Section 2110(a) (6)) 6.2.7.

Over-the-counter medications (Section 2110(a) (7)) Coverage only applies to insulin. 6.2.8.

Laboratory and radiological services (Section 2110(a) (8)) 6.2.9.

Prenatal care and prepregnancy family services and supplies (Section 2110(a) (9)) 6.2.10.

Inpatient mental health services, other than services described in 6.2.18., but including services furnished in a state-operated mental hospital and including residential or other 24-hour therapeutically planned structural services (Section 2110(a)(10)) 6.2.11.

Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state-operated mental hospital and including community-based services (Section 2110(a) (11) 6.2.12.

Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices) (Section 2110(a) (12)) 6.2.13.

Disposable medical supplies (Section 2110(a) (13)) Coverage subject to limitations. 6.2.14.

Home and community-based health care services (See instructions) (Section 2110(a) (14)) 6.2.15.

Nursing care services (See instructions) (Section 2110(a) (15)) 6.2.16.

Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest (Section 2110(a) (16) 6.2.17.

Dental services (Section 2110(a) (17)) 6.2.18.

Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a) (18)) 6.2.19.

Outpatient substance abuse treatment services (Section 2110(a) (19)) 6.2.20.

Case management services (Section 2110(a) (20)) Not Covered. 6.2.21.

Care coordination services (Section 2110(a) (21)) Not Covered. 6.2.22.

Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a) (22))

(current-state-plan)(page-22)Page 22#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: 6.2.23.

Hospice care (Section 2110(a) (23)) 6.2.24.

Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services. (See instructions) (Section 2110(a) (24)) 6.2.25.

Premiums for private health care insurance coverage (Section 2110(a) (25)) 6.2.26.

Medical transportation (Section 2110(a) (26)) 6.2.27.

Enabling services (such as transportation, translation, and outreach services (See instructions) (Section 2110(a) (27)) Not Covered. 6.2.28.

Any other health care services or items specified by the Secretary and not included under this section (Section 2110(a) (28))

6.3 The state assures that, with respect to pre-existing medical conditions, one of the following two statements applies to its plan: (42CFR 457.480)

6.3.1.

The state shall not permit the imposition of any pre-existing medical condition exclusion for covered services (Section 2102(b) (1) (B) (ii)); OR 6.3.2.

The state contracts with a group health plan or group health insurance coverage, or contracts with a group health plan to provide family coverage under a waiver (see Section 6.4.2. of the template). Pre-existing medical conditions are permitted to the extent allowed by HIPAA/ERISA (Section 2103(f)). Please describe: Previously 8.6

6.4 Additional Purchase Options. If the state wishes to provide services under the plan through cost effective alternatives or the purchase of family coverage, it must request the appropriate option. To be approved, the state must address the following: (Section 2105(c) (2) and (3)) (42 CFR 457.1005 and 457.1010)

6.4.1.

Cost-Effective Coverage. Payment may be made to a state in excess of the 10% limitation on use of funds for payments for: 1) other child health assistance for targeted low-income children; 2) expenditures for health services initiatives under the plan for improving the health of children (including targeted low-income children and other low-income children); 3) expenditures for outreach activities as provided in section 2102(c)(1) under the plan; and 4) other reasonable costs incurred by the state to administer the plan, if it demonstrates the following (42CFR 457.1005(a)):

6.4.1.1. Coverage provided to targeted low-income children through such expenditures must meet the coverage requirements above. Describe the coverage provided by the alternative delivery system. The state may cross reference section 6.2.1 - 6.2.28. (Section 2105(c) (2) (B) (i)) (42CFR 457.1005(b))

6.4.1.2. The cost of such coverage must not be greater, on an average per child basis, than the cost of coverage that would otherwise be provided for the coverage described above.

Describe the cost of such coverage on an average per child

(current-state-plan)(page-24)Page 24#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 7 Quality and Appropriateness of Care

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 8.

7.1. Describe the methods (including external and internal monitoring) used to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan. (2102(a) (7) (A)) (42CFR 457.495(a))

External Quality Review The State contracts with an evaluation consultant who develops and updates performance criteria, and also provides assistance in producing the evaluation and annual reports. The performance criteria are an important tool for measuring quality of care, particularly with respect to well-baby care, well-child care, and immunizations. Hoosier Healthwise uses NCQA’s HEDIS measures to monitor quality.

Quality Improvement Programs Quality assurance requirements are imposed on MCOs that contract with the State under Hoosier Healthwise. MCOs must have quality improvement (QI) programs in place that meet the federal requirements (42 CFR 438 Subpart D) and the National Committee for Quality Assurance (NCQA) standards. The QI programs must be based on annual plans that are approved by the OMPP. In addition, MCOs must meet a number of other QI requirements, including: establishing a QI Committee overseen by the MCO Medical Director; submitting Quarterly QI reports; conducting focused studies, including medical data abstraction and data entry, in areas of clinical priority for the Indiana Medicaid population; establishing internal systems for monitoring services; conducting a quality of care chart audit of providers of services; attending monthly Hoosier Healthwise Quality Improvement Committee (QIC) meetings; submitting QI data to the State; and taking other steps to improve quality of services.

Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.)

7.1.1.

Quality standards

 MCOs that provide services under Hoosier Healthwise must have QI programs in place that meet NCQA standards.  PMPs will be required to comply with universally accepted standards for preventive care, as endorsed by the American Academy of Pediatrics, the Academy of Family Physicians, the American College of Obstetrics and Gynecology, and the American Society of Internal Medicine. Specifically, these standards apply to the following areas: childhood immunizations, pregnancy, lead toxicity, comprehensive well child periodic health assessment, HIV status, asthma, diabetes, ETOH and drug abuse, sexually transmitted diseases, motor vehicle accidents, pregnancy prevention, prevention of influenza, smoking prevention and cessation, and others. Clinical practice guidelines from the Agency for Healthcare Research and Quality and the Indiana Medicaid Coordinated Care Technical

(current-state-plan)(page-25)Page 25#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Assistance Group (TAG) may also recommend.  Through the Clinical Advisory Committee, providers provide the OMPP with input on Hoosier Healthwise policies affecting quality, accessibility, appropriateness and cost effectiveness of care.  The Hoosier Healthwise QIC oversees quality of care and appropriateness of care and integrates the quality improvement process. The QIC membership consists of MCO medical directors, MCO QI staff representatives, and the OMPP staff members

 Requests to disenroll are documented, tracked and monitored.

7.1.2.

Performance measurement

 MCOs must conduct annual member satisfaction surveys, and present this information to the OMPP, recipients and providers.  MCOs must provide HEDIS measures to OMPP on an annual basis.  The evaluation consultant will develop performance criteria to measure the quality of services provided under CHIP. These measurements will include health status indicators and EPSDT compliance.

7.1.3.

Information strategies

 Hoosier Healthwise applicants are provided with materials regarding managed care; PMPs; MCOs; preventive services; 1-800 telephone hotline; emergency room usage; grievance procedures; recipients’ rights and responsibilities; coverage, cost and claims; and a summary of program activities.  The State conducts provider training and benefit advocate training. Indiana has implemented an enhanced outreach campaign.

7.1.4.

Quality improvement strategies

 The State has a toll free telephone number for recipients and providers. Staff investigates inquires and complaints received through this phone line.  The Hoosier Healthwise MCOs monitor PMPs 24-hour accessibility by making random calls to PMPs during regular business hours and after hours.  The State monitors several key indicators to assure that access problems do not arise. These indicators include: waiting periods; access to care after hours; referrals to specialists; and access to emergency or family planning services.  MCOs must conduct focus studies on areas of clinical priority including preventive care, behavioral health, prenatal outcomes, and disease management (e.g. asthma and diabetes care).

7.2. Describe the methods used, including monitoring, to assure: (2102(a) (7) (B)) (42CFR 457.495)

7.2.1 Access to well-baby care, well-child care, well-adolescent care and childhood and adolescent immunizations. (Section 2102(a) (7)) (42CFR 457.495(a))

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:

 The State employs an External Quality Review Organization (EQRO) that monitors and assesses the quality of and access to health care enabled by Hoosier Healthwise. Advising the monitoring process is a Quality Improvement Committee, a Clinical Advisory Committee, and a few Focused Study Workgroups. The Focused Study Workgroups include neonatal outcomes, management of members with complex needs, and behavioral health. The Health Plan Employer Data Information Set (HEDIS) is being utilized for tracking health plan performance on an annual basis. Several quarterly reports based on HEDIS specifications are also provided to OMPP by the Hoosier Healthwise MCOs. The State’s EQRO is also the CHIP’s independent evaluation consultant. Data collected by the vendor for the EQR are refined for the purpose of assessing CHIP’s programmatic effectiveness in this area.  CHIP monitors the size of Primary Physician panels monthly.

7.2.2 Access to covered services, including emergency services as defined in 42 CFR 457.10. (Section 2102(a) (7)) 42CFR 457.495(b))

The evaluation consultant is responsible for updating and developing tools to measure the utilization of health services. The measurement set will be intended to assess how often, how effectively and how appropriately enrollees are utilizing services under the program.

7.2.3 Appropriate and timely procedures to monitor and treat enrollees with chronic, complex, or serious medical conditions, including access to an adequate number of visits to specialists experienced in treating the specific medical condition and access to out-of-network providers when the network is not adequate for the enrollee’s medical condition. (Section 2102(a) (7)) (42CFR 457.495(c))

All Hoosier Healthwise members are allowed to select a Primary Medical Provider. If one is not selected within 30 days, a PMP will be assigned to them. By ensuring that all members have a medical home, chronic, complex, or serious medical conditions can be closely monitored and appropriate referrals can be made when necessary. In addition, When the network is not adequate for the enrollee’s medical condition, managed care organizations are required to allow members to access to out-of-network providers.

7.2.4 Decisions related to the prior authorization of health services are completed in accordance with state law or, in accordance with the medical needs of the patient, within 14 days after the receipt of a request for services. (Section 2102(a) (7)) (42CFR 457.495(d))

Decisions related to the prior authorization of health services are completed in accordance with the CHIP administrative rules, found in Title 407 of the Indiana Administrative Code, Section 3-3-2:

―The procedures and requirements set forth in 405 IAC 5-3 and 405 IAC 5-7 for Medicaid

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 8 Cost Sharing and Payment (Section 2103(e))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 9.

8.1. Is cost-sharing imposed on any of the children covered under the plan? (42CFR 457.505)

8.1.1.

YES 8.1.2.

NO, skip to question 8.8.

8.2. Describe the amount of cost-sharing, any sliding scale based on income, the group or groups of enrollees that may be subject to the charge and the service for which the charge is imposed or time period for the charge, as appropriate. (Section 2103(e) (1) (A)) (42CFR 457.505(a), 457.510(b) &(c), 457.515(a) &(c))

8.2.1. Premiums:

Sliding scale premiums (see chart below) will be imposed on families of children eligible for the Title XXI CHIP program. Cost-sharing for these families (with incomes above 150% of FPL), will not exceed five percent of the family’s yearly income. Individuals eligible under MCHIP (with incomes up to 150% of FPL) will continue to comply with cost-sharing limitations established under Medicaid. CHIP individuals pay premiums monthly.

If an applicant is determined to be eligible for CHIP (Hoosier Healthwise Package C), ICES issues a notice to the applicant informing him or her of the premium payment responsibility for enrollment, and holds the account in suspense. Information regarding the eligibility status and cost-sharing responsibilities is transferred to the premium-collection vendor. The premium-collection vendor issues a premium statement and provides detailed information regarding the cost-sharing requirements. If the premium is paid by the due date, the premium-collection vendor transfers this information to ICES and the applicant’s account is changed from suspended status to enroll. The applicant becomes retroactively eligible for CHIP coverage beginning the first day of the month the application was submitted to the DFR.

If the premium is not paid by the due date (the 12th day of the month following eligibility determination), the applicant’s ICES account will remain in suspense and a second premium notice will be sent. If the premium has not been paid by the last day of the month following eligibility determination, the applicant will be notified that the application has been denied.

In situations where a child is enrolled in the program, but the family later fails to make a payment by the due date, a 60-day grace period will be provided. If fees are not paid by the end of the 60- day grace period, the child will be disenrolled from the program. Families that have been disenrolled due to non-payment of premiums may re-apply for coverage immediately. After meeting eligibility requirements, including the payment of all delinquent and current premiums due, the disenrolled child (ren) may be re-enrolled in the program.

(current-state-plan)(page-30)Page 30#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:  Notice in the first premium voucher which is sent to the family by the premium collection vendor;  Notice in the members’ handbooks which are sent once the first premium has been paid and the child has been enrolled;  Public hearings are held regarding state statute rule changes including those defining cost sharing requirements;  Publication in the Indiana Register; and  Publication in the Indiana Administrative Code.  Enrollees are sent a notice generated from the eligibility system that informs them of their cost-sharing maximum

8.4. The state assures that it has made the following findings with respect to the cost sharing in its plan: (Section 2103(e))

8.4.1.

Cost-sharing does not favor children from higher income families over lower income families. (Section 2103(e) (1) (B)) (42CFR 457.530) 8.4.2.

No cost-sharing applies to well-baby and well-child care, including age- appropriate immunizations. (Section 2103(e) (2)) (42CFR 457.520) 8.4.3

No additional cost-sharing applies to the costs of emergency medical services delivered outside the network. (Section 2103(e) (1) (A)) (42CFR 457.515(f))

8.5. Describe how the state will ensure that the annual aggregate cost-sharing for a family does not exceed 5 percent of such family’s income for the length of the child’s eligibility period in the State. Include a description of the procedures that do not primarily rely on a refund given by the state for overpayment by an enrollee: (Section 2103(e) (3) (B)) (42CFR 457.560(b) and 457.505(e))

Indiana will utilize a ―shoe box‖ approach, similar to that used by the Massachusetts CHIP program.

In an enrollment notice, automatically generated from the eligibility system, families are informed of their cost sharing limit based on their individual income, and instructed to keep records of their payments. They are further instructed to contact the Hoosier Healthwise Package C payment line for instructions about future payments if they believe their premium plus co-payments (if applicable) have reached the amount on the enrollment notice.

To ensure that no eligible children are charged cost sharing in excess of the cumulative cost- sharing maximum the office will obtain monthly reports from the Indiana Client Eligibility System (ICES) that will reflect cost-sharing limits at the case level. Monthly, these reports will be compared to premium payment reports provided by the premium collection vendor. We will monitor MCOs for co-payment activity to confirm none are made or to track amounts per enrollee. Using this information the office will be able to determine which enrollees are within range, yet under the cost-sharing maximum. Those enrollees who have accumulated premium payment and co-payment liability within 4% of their annual income will be notified of their status and advised to stop premium payments and co pays, and to submit their records for review and confirmation of non-payment status. After payment record review and non-payment status

(current-state-plan)(page-31)Page 31#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: confirmation, the office will notify: a) The premium vendor to waive premiums/suspend invoicing through the remainder of the benefit period, and b) The MCO (who will then notify their pharmacy and ambulance transportation vendors) to waive co-payments through the specified date.

A letter will be sent to each family that meets their 5% cap that can be used to confirm their cost- share-free status to vendors as needed with instructions to the vendor on how to verify

8.6 Describe the procedures the state will use to ensure American Indian (as defined by the Indian Health Care Improvement Act of 1976) and Alaska Native children will be excluded from cost-sharing. (Section 2103(b) (3) (D)) (42CFR 457.535)

Targeted low-income children of American Indiana and Alaskan Native families are excluded from the cost-sharing requirements. The Indiana Client Eligibility System (ICES) has been modified to allow a manual system override procedure to exempt these individuals from cost- sharing once they have been deemed eligible.

8.7 Please provide a description of the consequences for an enrollee or applicant who does not pay a charge. (42CFR 457.570 and 457.505(c))

In both situations above, the applicant or enrollee will receive an ICES notice that provides for appeal of the closure or denial decision. The notice states in part:

―You have the right to appeal and have a fair hearing. An appeal will be accepted it is received within 30 days of the effective date of the action, whichever is later. We will allow 3 extra days for mailing.

If you wish to appeal, send a signed letter to your local Division of Family Resources office at the address at the top of this Notice. If you prefer, you can send your appeal to the Indiana Family and Social Services Administration, Division of Family Resources, Hearings and Appeals, room W392, Indianapolis IN 46204. If you have questions, please contact your caseworker.

You will be notified in writing of the date, time and place for the hearing. You can represent yourself, or have someone represent you such as attorney, friend, or relative. If your wish to have legal representation and cannot afford it, you may call the Legal Services Organization serving your area at (800) 869-0212.‖

(current-state-plan)(page-32)Page 32#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Enrollee non-payment of cost-sharing fees for generic and brand name drugs may result in the pharmacist failing to dispense the medication sought.

8.7.1 Please provide an assurance that the following disenrollment protections are being applied:

State has established a process that gives enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment. (42CFR 457.570(a))

The disenrollment process affords the enrollee an opportunity to show that the enrollee’s family income has declined prior to disenrollment for non-payment of cost-sharing charges. (42CFR 457.570(b))

In the instance mentioned above, that the state will facilitate enrolling the child in Medicaid or adjust the child’s cost-sharing category as appropriate. (42CFR 457.570(b))

The state provides the enrollee with an opportunity for an impartial review to address disenrollment from the program. (42CFR 457.570(c))

8.8 The state assures that it has made the following findings with respect to the payment aspects of its plan: (Section 2103(e))

8.8.1.

No Federal funds will be used toward state matching requirements. (Section 2105(c) (4)) (42CFR 457.220) 8.8.2.

No cost-sharing (including premiums, deductibles, copays, coinsurance and all other types) will be used toward state matching requirements. (Section 2105(c) (5) (42CFR 457.224) (Previously 8.4.5) 8.8.3.

No funds under this title will be used for coverage if a private insurer would have been obligated to provide such assistance except for a provision limiting this obligation because the child is eligible under the this title. (Section 2105(c) (6) (A)) (42CFR 457.626(a) (1)) 8.8.4.

Income and resource standards and methodologies for determining Medicaid eligibility are not more restrictive than those applied as of June 1, 1997. (Section 2105(d) (1)) (42CFR 457.622(b) (5)) 8.8.5.

No funds provided under this title or coverage funded by this title will include coverage of abortion except if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (Section 2105)(c)(7)(B)) (42CFR 457.475) 8.8.6.

No funds provided under this title will be used to pay for any abortion or to assist in the purchase, in whole or in part, for coverage that includes abortion (except as described above). (Section 2105)(c)(7)(A)) (42CFR 457.475)

(current-state-plan)(page-33)Page 33#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 9 Strategic Objectives and Performance Goals and Plan Administration (Section 2107)

9.1. Describe strategic objectives for increasing the extent of creditable health coverage among targeted low-income children and other low-income children: (Section 2107(a) (2)) (42CFR 457.710(b))

See Chart below.

9.2. Specify one or more performance goals for each strategic objective identified: (Section 2107(a) (3)) (42CFR 457.710(c))

See Chart below.

9.1 Strategic Objective

9.2 Performance Goal

9.3 Objective Means of Measuring Performance 9.1.1 Reduce Uninsured Previously uninsured low- income children will have health insurance through Indiana’s Title XXI program Maintain state’s uninsured rate for population at or below 200% FPL below the 25th percentile of states nationally US Census CPS 3 year average uninsured rate for children under age 19 at or below 200% FPL 9.1.2 Enrollment Targeted low-income children will have health insurance through Indiana’s Title XXI program Enrollment of approximately 13,500 children between 200% and 300% FPL by 9/30/2012 Hoosier Healthwise enrollment in the 200-300% FPL bracket 9.1.3 Access to Care Children enrolled in Indiana’s Title XXI Program will have access to appropriate behavioral health care The rate at which children prescribed ADHD medication will have the appropriate follow up visits with a behavioral health provider will exceed the HEDIS 50th percentile for Medicaid HEDIS measure for follow up care for ADHD medications (ADD), initiation phase 9.1.4 Preventive Care Immunizations-children will receive the recommended immunizations The rate at which children receive immunizations will exceed the Medicaid HEDIS 50th percentile available at the time of HEDIS Report Submission (July of each year) HEDIS (CIS), Combo Three 9.1.5 Adolescent well care Adolescents aged 12-21 will receive recommended well care visits The rate at which adolescents aged 12-21 will receive the recommended well care visits will exceed the Medicaid HEDIS 50th percentile available at the time of HEDIS report submission (July of each year) HEDIS (AWS) for ages 12-21 years 9.1.6 Well-Child Visits First 15 months of life, six or The rate at which children 0-15 months of age receive at least HEDIS (W15) for children ages 0-15 months

(current-state-plan)(page-34)Page 34#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: more visits.

six well care visits will exceed the Medicaid HEDIS 50th percentile available at the time of HEDIS report submission (July of each year). 9.1.7 Well-Child Visits, ages 3- 6 years The rate at which children 3-6 years of age receive at least one preventive exam will exceed the HEDIS 50th percentile at the time of HEDIS report submission (July of each year. HEDIS (W34) for children 3-6 years of age

9.3. Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to determine the state’s performance, taking into account suggested performance indicators as specified below or other indicators the state develops: (Section 2107(a) (4) (A), (B)) (42CFR 457.710(d))

See Chart above.

Check the applicable suggested performance measurements listed below that the state plans to use: (Section 2107(a) (4)) 9.3.1.

The increase in the percentage of Medicaid-eligible children enrolled in Medicaid. 9.3.2.

The reduction in the percentage of uninsured children. 9.3.3.

The increase in the percentage of children with a usual source of care. 9.3.4.

The extent to which outcome measures show progress on one or more of the health problems identified by the state. 9.3.5.

HEDIS Measurement Set relevant to children and adolescents younger than 19. 9.3.6.

Other child appropriate measurement set. List or describe the set used. Milliman EBM for adolescengs aged 7-11, similar to HEDIS measures for other age ranges, to fill the age gap not included in HEDIS measurement set. 9.3.7.

If not utilizing the entire HEDIS Measurement Set, specify which measures will be collected, such as: 9.3.7.1.

Immunizations 9.3.7.2.

Well child care 9.3.7.3.

Adolescent well visits 9.3.7.4.

Satisfaction with care 9.3.7.5.

Mental health 9.3.7.6.

Dental care 9.3.7.7.

Other, please list:

(current-state-plan)(page-35)Page 35#

Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: 9.3.8.

Performance measures for special targeted populations.

9.4.

The state assures it will collect all data, maintain records and furnish reports to the Secretary at the times and in the standardized format that the Secretary requires. (Section 2107(b) (1)) (42CFR 457.720)

9.5. The state assures it will comply with the annual assessment and evaluation required under Section 10. Briefly describe the state’s plan for these annual assessments and reports. (Section 2107(b) (2)) (42CFR 457.750)

The State assures that it will submit the evaluation required under Section 10 by January 1st of each year. The State also assures that it will complete an annual assessment of the progress made in reducing the number of uncovered low-income children, and report to the Secretary on the result of the assessment.

The assessments will be based largely upon the strategic objectives set forth in Section 9 and program evaluation criteria designed by the evaluation consultant. The strategic objectives focus on enrolling children, establishing usual sources of care, measuring enrollee and provider satisfaction, and improving health status. The data used to measure performance and assess the quality of care provided to Hoosier Healthwise children will be compiled from existing databases and the audited health plan-reported HEDIS results for child-relevant measures.

9.6.

The state assures it will provide the Secretary with access to any records or information relating to the plan for purposes of review of audit. (Section 2107(b) (3)) (42CFR 457.720)

9.7.

The state assures that, in developing performance measures, it will modify those measures to meet national requirements when such requirements are developed. (42CFR 457.710(e))

9.8. The state assures, to the extent they apply, that the following provisions of the Social Security Act will apply under Title XXI, to the same extent they apply to a state under Title XIX: (Section 2107(e)) (42CFR 457.135)

9.8.1.

Section 1902(a) (4) (C) (relating to conflict of interest standards) 9.8.2.

Paragraphs (2), (16) and (17) of Section 1903(i) (relating to limitations on payment) 9.8.3.

Section 1903(w) (relating to limitations on provider donations and taxes) 9.8.4.

Section 1132 (relating to periods within which claims must be filed)

9.9. Describe the process used by the state to accomplish involvement of the public in the design and implementation of the plan and the method for insuring ongoing public involvement. (Section 2107(c)) (42CFR 457.120(a) and (b))

Public Input on Plan Design: In designing the first and second phases of the CHIP program, Indiana developed a public input

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: plan that included several different levels of discussion, and which capitalized on the expertise and experience of a myriad of individuals and entities within the state. This input included:

A twenty-one member bi-partisan Governor’s Advisory Panel representing a cross-section of Indiana experts was appointed to develop a blueprint on implementation of the CHIP program. Members on the panel included: hospital representatives, physicians, insurance executives, parents, advocates, school officials, health clinic representatives, and members of the Indiana General Assembly. Numerous press releases were utilized to publicize the work of the Advisory Panel. All meetings were publicized and covered by the news media. Further, there was significant news coverage during the General Assembly’s deliberations on the Governor’s CHIP proposal.

Five subcommittees were established to provide a broader range of input and allow for in- depth discussion and analysis on key areas of importance. Membership on the subcommittees included: hospitals, physicians, nurses, pharmacists, local health department representatives, optometrists, mental health providers, economists, academics, numerous community and social services programs, migrant farmworkers and homeless parents, and various other experts. The subcommittees focused on the following key topics: Coordination/Infrastructure/Provider Supply/Community Systems; Benefits and Cost Sharing; Eligibility and Crowd Out; Outreach and Education; and Data, Evaluation and Outcomes. The subcommittees’ reports were submitted to the Advisory Panel for consideration.

A series of eight public forums were held across the state in order to allow for a wide range of input from individuals and entities within individual communities. The forums provided opportunities for citizens to share their concerns regarding methods for improving and for building upon the state’s current health care system, and mechanisms for encouraging parents to access health services. In order to maximize awareness and participation, the forums were held at a number of different sites and at varying times. The local social service and health promotion agencies helped select the most appropriate time and location for each hearing. To promote the forums, the organizers worked closely with numerous individuals and entities. Assistance was provided by the local WIC sites, local MCH agencies, local immunization sites, local Medicaid providers, community health centers, local DFR offices, the LHDs, and the Indiana Coalition on Housing and Homeless Issues. In order to make it easier for parents to attend, child care was provided during the forums. Individuals who were not able to attend were encouraged to submit written comments. State and local news media were notified in advance of all public forums through a myriad of sources. News releases, media advisories and telephone calls were all utilized in an effort to maximize press coverage.

Numerous focus groups were established to draw upon the expertise, experience, and perspectives of homogeneous groups of individuals. The focus groups consisted of groups of providers, advocates, parents and adolescents. The groups met in various locations throughout the State and discussed key issues from their own specific perspectives.

The Phase II benefits package was sent to stakeholders with requests for comments.

Discussion of plan design was also possible during the rulemaking process. A public hearing was held during this process.

As part of its CHIP oversight responsibility, the Policy Board established broad based committees in the areas of: children with special health care needs, data, and program coordination.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:

Legislative oversight of the CHIP program will be provided by the Select Joint Committee on Medicaid Oversight.

Promotion of Plan Implementation: The Chair of the Governor’s Advisory Panel appeared before various editorial boards as a means of increasing awareness of the CHIP program. A CHIP website was developed to provide information regarding the CHIP program. This website (http://www.in.gov/fssa/ompp/2545.htm) is updated regularly and also includes a link to the Hoosier Healthwise website for families. Radio and television public service announcements were aired throughout the State. A radio blitz that included information about Hoosier Healthwise in a ―Back to School‖ message was run throughout the State. Billboards, bus placards, and newspaper ads have also been used to promote the program. And, with the assistance of local DFR offices, local newspapers have run articles informing families about Hoosier Healthwise.

9.9.1 Describe the process used by the state to ensure interaction with Indian Tribes and organizations in the state on the development and implementation of the (Section 2107(c)) (42CFR 457.120(c))

Indiana contracted with the Indiana Minority Health Coalition (IMHC) and Wishard Hispanic Health Project during the design, implementation, and early stages of the CHIP program to develop culturally sensitive materials targeting a Native American audience and to assure that Native American children who are eligible for the program received assistance. Currently, the Coordinator of the American Indian Center is available in an advisory role to the State regarding this population.

9.9.2 For an amendment relating to eligibility or benefits (including cost sharing and enrollment procedures), please describe how and when prior public notice was 457.65 (b) through (d).

In the 2002 Indiana legislative session, state law (P.L. 107-2002) was passed to eliminate continuous eligibility from Hoosier Healthwise. As a result, it was necessary to amend our MCHIP administrative rules. As required by Indiana's rulemaking statute (IC 4-22-2), the agency provided public notice of the change before the rule was adopted. The proposed rule was published in the Indiana Register on June 1, 2002. Notice of the public hearing concerning the proposed change was published in the Indianapolis Star newspaper on May 24, 2002. A public hearing was held June 24, 2002. The agency complied with the public notice requirements prior to the July 1, 2002 effective date of the change in eligibility.

In addition to the public notice required by the rulemaking process, we provided notice of the change to all Hoosier Healthwise members. All Hoosier Healthwise members were sent a notice between June 17, 2002 and June 21, 2002 advising them of the change in law and how it would affect them. In addition, the CHIP premium collection vendor also sent flyers out with members' invoices in order to provide them with an additional reminder of the change in eligibility. These flyers were included with the June, July, and August 2002 invoices.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date: Section 12 Applicant and Enrollee Protections (Sections 2101(a))

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan.

Eligibility and Enrollment Matters and Health Services Matters

12.1 Please describe the review process for eligibility and enrollment matters that complies

See section 12.2.

12.2 Please describe the review process for health services matters that complies with 42

The Division of Family Resources is responsible for determining eligibility for the aid categories that provide medical assistance through CHIP. The DFR has a comprehensive hearings and appeals process in place for all public assistance programs, including Medicaid and CHIP. The following is their policy on the review process for both eligibility and medical assistance matters.

All individuals must be informed in writing at the time of application and when action is taken which affects their benefits, of: the right to a fair hearing; and the method for requesting a hearing. This information is contained in the Rights and Responsibilities listing which is given to applicants, and is also on all eligibility notices. The freedom to make such a request must not be limited or interfered with in any way.

The Local DFR Office is responsible for assisting an unhappy individual so that he may fully exercise his right to appeal. Any time an individual expresses a disagreement with any action taken, he must be verbally reminded of the right to request a fair hearing. Assistance is to be provided to the individual who is having difficulty in preparing the written request for an appeal. The individual is to be informed that he may represent himself at the hearing or be represented by an attorney, a relative, a friend, or any other spokesman of his choice. Information and referral services should also be provided to help the unhappy individual make use of any free legal services that are available in the community.

Any action with which an applicant/recipient is dissatisfied may be appealed. An applicant may appeal and have a fair hearing when his application for financial or medical assistance is denied or not acted upon with reasonable promptness. A recipient may appeal when he believes the Local Office has taken erroneous action to reduce, suspend or discontinue assistance. In addition, a recipient or provider of medical services may appeal an action to deny or limit services under the Medicaid program.

Below is the language found on all CHIP eligibility notices:

―You have the right to appeal and have a fair hearing. An appeal will be accepted if is received within 30 days of the effective date of the action, whichever is later. We will allow 3 extra days for mailing.

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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

Approval Date:

FSSA requires an expedited review process for medical services when requested by the enrolled member in certain situations. Each MCO is contractually required to "make available an expedited informal and formal grievance procedure for member grievances that cannot be delayed without risking permanent damage to the member's health," and the expedited review must be completed within 72 hours. Members are notified by their MCO. Each MCO has a member handbook that gives guidance on this issue. For example, the MDwise MCO member handbook states: "In an emergency, grievances will be handled quickly. This is called an "expedited" grievance or appeal. If your case can be expedited, we will review your case and notify you of a decision within 72 hours. Call us at (317) 630-2831 or 1-800-356-1204 to see if this can be done." The review process is in compliance with Indiana’s health insurance law, I.C. 27-13-10.

Premium Assistance Programs

12.3 If providing coverage through a group health plan that does not meet the requirements of enrollees have the option to obtain health benefits coverage other than through the group health plan at initial enrollment and at each redetermination of eligibility.

(factsheet)Indiana CHIP compiled state plan: Factsheet (approved March 14, 2010, effective January 1, 2010)#

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INDIANA “HOOSIER HEALTHWISE” TITLE XXI PROGRAM FACT SHEET

Name of Plan:

Hoosier Healthwise

Date Phase I Plan Approved: June 26, 1998 Date Phase I Plan Effective: October 1, 1997

Date Amendment #1 Submitted: September 22, 1999 Date Amendment #1 Approved: December 22, 1999 Date Amendment #1 Effective: January 1, 2000

Date Amendment #2 Submitted: September 6, 2002 Date Amendment #2 Approved: November 26, 2002 Date Amendment #2 Effective: January 1, 2000

Date Amendment #3 Submitted: August 24, 2004

Date Amendment #3 Approved: Withdrawn May 30, 2006

Date Amendment #4 Submitted: October 4, 2005 Date Amendment #4 Approved: June 23, 2006 Date Amendment #4 Effective: October 1, 2005

Date Amendment #5 Submitted: September 27, 2007 Date Amendment #5 Withdrawn: October 15, 2007 Date Amendment #5 Effective:

Date Amendment #6 Submitted: January 31, 2008 Date Amendment #6 Approved: May 2, 2008 Date Amendment #6 Effective: January 1, 2008

Date Amendment #7 Submitted: September 18, 2009 Date Amendment #7 Approved: December 3, 2009 Date Amendment #7 Effective: July 10, 2010

Date Amendment #8 Submitted: January 14, 2010 Date Amendment #8 Approved: March 16, 2010 Date Amendment #8 Effective: January 1, 2010

Date Amendment #9 Submitted: June 29, 2010 Date Amendment #9 Approved: February 17, 2011 Date Amendment #9 Effective: Revised the effective dates of: • mental health services expansion (SPA #8) to July 1, 2009, and • expansion to 300 percent of the FPL (SPA # 7) to July 1, 2011.

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Background

• On April 17, 1998, Indiana submitted a title XXI State Plan to expand Medicaid eligibility to children under the state's Medicaid title XIX State Plan. Under Phase 1, the State expanded Medicaid eligibility to include:

- Effective October 1, 1997, children born before October 1, 1983, from the ages of 14 through 18 in families with annual incomes through 100 percent of the Federal Poverty Level (FPL).

- Effective July 1, 1998, children ages 0 through 18 in families with annual incomes through 150 percent of the FPL.

• Indiana's current Medicaid State Plan covers infants through 150 percent of the FPL, children under 6 through 133 percent of the FPL, and children 6 through 18 through 100 percent of the FPL.

Amendments

• On September 22, 1999, Indiana submitted an amendment to expand health insurance coverage through a separate child health program. This Phase II amendment will provide coverage to children less than 19 years of age in families with annual incomes greater than 150 percent of the FPL and not more than 200 percent of the FPL.

• Indiana submitted its second amendment on September 9, 2002, to update its State Children’s Health Insurance Program (SCHIP) state plan to indicate compliance with the final SCHIP regulations. This amendment also revises the redetermination process so that children remain eligible as long as they meet income and other eligibility requirements. Eligibility is redetermined at 12 months if SCHIP is the only State program the child is enrolled in, or every 3 to 6 months if the child is enrolled in SCHIP plus other state programs.

• Indiana submitted its third amendment on August 24, 2004, to fund clinical messaging software and data repository development for their proposed Information Exchange (IHIE) health services initiative. This amendment was withdrawn on May 30, 2006.

• Indiana submitted its fourth amendment on October 4, 2005, to increase monthly premiums for families with incomes above 150 percent to 200 percent of the FPL. This will double the premium previously paid by families.

• Indiana submitted its fifth amendment on September 27, 2007, a contingency plan, to move the SCHIP separate program in its current form to the Medicaid expansion program. The State withdrew the amendment on October 15, 2007.

• Indiana submitted its sixth amendment on January 31, 2008 to increase the income limit to 250% FPL and associated premiums, implement 12 month continuous eligibility for

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children under age 3, add telemedicine to the benefit package, and remove the signature requirement for premium payment.

• Indiana submitted its seventh amendment on September 18, 2009 to increase the income eligibility limit from 250 to 300 percent of the FPL.

• Indiana submitted its eighth amendment on January 14, 2010 to permit Indiana to use administrative funds for a comprehensive study with the goal of developing a strategy to improve access to specialty care for low income children and this SPA also expand mental health services. This SPA has a retroactive effective date of January 1, 2010.

• Indiana submitted its ninth amendment on June 29, 2010 to revise: the effective date of the mental health services expansion to July 1, 2009, and the effective date for the planned expansion to 300 percent of the FPL to July 1, 2011.

Children Covered Under the Program

• The State reported that 77,383 children were ever enrolled in Hoosier Healthwise in FFY 2008. Administration

• Phase I and Phase II are administered by the Office of Medicaid Planning and Policy, Indiana Family and Social Services Administration.

Health Care Delivery System

• The State currently has an approved 1915(b) waiver titled, "Hoosier Healthwise" comprised of a Primary Care Case Management system and a Risk-Based Managed Care system. Primary medical providers provide preventive and primary medical care, and furnish authorizations and referrals for most specialty services.

• Phase I children are and Phase II children are integrated into these managed care networks, thereby assuring they have a medical home.

Benefit Package

• Children eligible for Phase I receive the full Medicaid benefit package.

• Children eligible for Phase II receive benchmark-equivalent coverage. The Phase II benefit package is at least actuarially equivalent to the children's health insurance coverage provided by the standard Blue Cross/Blue Shield preferred provider option service benefit plan offered under the Federal Employees Health Benefits Program.

Cost Sharing

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• Families of Phase I children are not subject to cost sharing.

• Families of Phase II children will be subject to cost sharing in the form of sliding-scale premiums and co-payments for certain services. To ensure that cost sharing does not exceed 5 percent of the family's yearly income, families will use the "shoe-box" approach. Refer to Tables A and B below for cost sharing schedules.

• American Indian children are not subject to cost sharing.

TABLE A: PREMIUMS

Income (as a percent of the FPL) Monthly One Child Monthly Two or More Children above 150 through 175 percent $22 $33 above 175 through 200 percent $33 $50 above 200 through 225 percent $42 $53 above 225 through 250 percent $53 $70 above 250 up to and including 275 percent $62 $73 above 275 up to and including 300 percent $73 $90

TABLE B: CO-PAYMENTS

Service Co-payment Prescription Drugs C Generic, Compound and Sole-Source $3 Prescription Drugs C Brand Name $10 Emergency Ambulance Transportation $10

State Action to Avoid Crowd Out

• Since Phase I limits family income to 150 percent of the FPL, the possibility of crowd out is reduced as many of the lower income families do not have the option of employer-based health insurance.

• Poverty level children with other insurance are covered by the state under the regular Medicaid matching rate, thereby reducing the incentive for families to drop coverage.

• Phase II minimizes crowd out by requiring that applicants be uninsured for 3 months before they are allowed to enroll in Phase II. Those who lose coverage involuntarily are exempted from this requirement.

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• In addition, Phase I and Phase II parents must attest to the lack of current coverage and indicate when the child last had coverage at the time of application or recertification.

• Denial reasons are tracked, resulting in: (1) a count of applicants who were denied because they voluntarily dropped coverage but did not wait the required 3 months before applying, (2) a count of applicants who were denied because they currently carry private insurance, and (3) a count of currently enrolled children who are denied because they gained private coverage rendering them ineligible for SCHIP.

Outreach Activities

• Division of Family and Children (DFC) Central Office efforts include: analyzing the number of uninsured children per county; developing a simplified shortened Hoosier Healthwise application form; including Hoosier Healthwise on a joint application that allows families to apply for Hoosier Healthwise at the same time that they apply for other programs; developing program brochures, posters, and mail-in application booklets in English and Spanish; de-linking Hoosier Healthwise from TANF in the computer system; redesigning the membership card so that enrollees can be proud to carry the card; undertaking a media campaign designed to inform the public about the availability of the Hoosier Healthwise program; creating a new training curriculum for caseworkers and other individuals; coordinating the outreach campaign among various state agencies; and establishing a significant presence at Indiana Black Expo and the state and county fairs.

• DFC Central Office also met with representatives of hospitals, schools, health centers and social service agencies to discuss collaborative outreach and enrollment center opportunities. These discussions led to the development models that can be used in different communities and settings. These models range from a co-location to a partnership where a facility hires a full-time employee to collect the necessary application information.

• Each DFC director was given county-specific enrollment targets and a list of individuals and entities to contact to discuss outreach and enrollment center opportunities. The county directors worked with these and other potential partners in their individual communities to design enrollment centers that met the needs of the individual communities and partners.

• County directors also developed local outreach plans geared to the specific communities. These plans were developed with input from the local office staff, welfare planning councils, health departments, health care providers, Step Ahead Councils, and other community planning boards that address children's issues.

• The State contracted with Black Expo, the Indiana Minority Health Coalition, and the Wishard Hospital Hispanic Health Access Initiative to develop culturally sensitive materials and to implement outreach initiatives. The Consolidated Outreach Project continues was also utilized to provide outreach for children in families of migrant farm workers.

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Financial Information

Total FFY '10 SCHIP Allotment -- $144,185,508 FFY '10 Enhanced Federal Matching Rate – 76.15 percent

Last date updated: March 14, 2011

(current-state-plan)Indiana CHIP compiled state plan: Current State Plan (approved March 14, 2010, effective January 1, 2010)#

(current-state-plan)Indiana CHIP compiled state plan: Current State Plan (approved March 14, 2010, effective January 1, 2010)#

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(factsheet)Indiana CHIP compiled state plan: Factsheet (approved March 14, 2010, effective January 1, 2010)#

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