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

Effective Date:

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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))

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.

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.‖