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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: 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.