Medicaid Coverage Protections Q & A’s

No, there are no requirements to have work activity, educational activity, or any other similar requirement to qualify for Medicaid, including HIP, in Indiana.

Marketplace plans are affordable. Four out of five enrollees can find plans that cost less than $10 a month. Marketplace plans are also comprehensive, and most plans cover prescription drugs, doctor visits, urgent care, hospital visits and more.

Yes, individuals may voluntarily withdraw from Medicaid, including HIP, at any time. To do so, please write down the individual’s full name, date of birth, last four numbers of their Social Security Number and their case number, if known, and either upload it to their Benefits Portal account by clicking here, fax it to 800-403-0864, or mail it to FSSA Document Center, PO Box 1810, Marion, IN 46952.

Individuals may also take their request to the Division of Family Resources office in their county. The locations of these offices are available by clicking here or by calling 800-403-0864.

Individuals can find a tool with the income limits for most types of Medicaid, by clicking here. Please scroll to the bottom of the page and click on Adults, Pregnant Women, or Children Under 19.

Yes, during the 12-month return to normal operations period, we will continue to accept self-attestation for most application questions. If we need more information before we can approve your application, we will send you a request for what we need.  If we can approve you based on your answers to the application questions, we will approve your application first and then request any documentation we need to confirm your continuing eligibility.

Yes, as long as both the applicant/member and the prospective Authorized Representative are on the call and listen to and agree to all of the requirements that the eligibility worker goes over with them, Authorized Representatives can still be established over the phone via a call with 800-403-0864.

Detailed instructions on how to appeal a decision are included at the end of every eligibility notice.  A copy of the instructions (with placeholders for information that would be case-specific) is available by clicking here.

Yes, FSSA will provide instructions on how to upload documentation. A video on using the Benefits Portal is available on the FSSA YouTube channel.

The warning notices sent in February only went to renewals that occur in April. These individuals will receive their renewal/redetermination request in March. For individuals with renewals in May, the warning notice will be sent in March and the renewal/redetermination request will be sent in April. This process will continue until all PHE renewals are complete.

The final closure notice is sent at least 13 days prior to the effective date of closure. It does not include a new deadline, but if information is returned prior to the effective date of closure listed on the notice, the member may potentially avoid closure if they are still eligible.

If the closure was due to not returning information at redetermination, there is an additional 90-day period, starting from the last day of the redetermination month, where the member can return the information and regain eligibility if they continue to meet eligibility requirements.

If the state has enough recent and reliable information to auto-renew a member’s eligibility, they will receive an approval notice that includes the information the state used to make the decision and request the member to report any changes. The member will not need to take action if the information on the notice is correct.

Some members such as those who currently receive SSI; members who are pregnant or in the 12-month postpartum period; or foster children, those receiving adoption assistance, or former foster children who are less than 26 years old do not typically have to complete annual redeterminations.

All other members will receive a redetermination packet in the mail. Examples of the packets are available by clicking here.

Individuals who are living with a disability and require additional services but do not want to be served in an institutional setting may be eligible for one of Indiana’s Home and Community-Based Waivers. Approval for an HCBS Waiver also increases the income limit used to determine Medicaid eligibility. You can find general information about the waivers which are available here.

For assistance in applying for the Aged & Disabled or Traumatic Brain Injury Waivers, please contact your local INconnect Alliance member here.  
For assistance in applying for the Family Supports or Community Integration & Habilitation Waivers, please contact your local Bureau of Disabilities Services here.

Indiana also has a program to support working individuals with disabilities, called MEDWorks. Working adults up to age 65 can qualify for this program if they have a disability, have earned income from a job, and are over the income limit for standard disability Medicaid. There are monthly premiums based on income for most individuals in MEDWorks. If your income has increased during the course of the public health emergency, as long as your disability status and earned income are known to FSSA, you would not need to separately request this program (if you qualify you will be moved from standard disability Medicaid to MEDWorks). If you have questions about the program or are not sure if FSSA has all of your updated information, you can call 800-403-0864 for more information.

• 3 - Renew Medicaid eligibility for individuals with no income and no data returned on an ex parte basis
• 5 - Renew Medicaid for individuals for whom information from the Asset Verification System is not returned or is not returned within a reasonable timeframe
• 12 - Permit managed care plans to provide assistance to enrollees to complete and submit Medicaid renewal forms
• 13 - Permit the designation of an authorized representative for the purposes of signing an application or renewal form via the telephone without a signed designation from the applicant or beneficiary  (Indiana already allowed this)
• 15 - Send lists to managed care plans and providers for individuals who are due for renewal and those who have not responded
• 17 - Use managed care plans and all available outreach modalities (phone call, email, text) to contact enrollees when renewal forms are mailed and when they should have received them by mail
• 20 - Reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently redetermined eligible for Medicaid during a 90-day Reconsideration Period (Due to state law, this does not apply to the Healthy Indiana Plan – reinstatement will go forward for HIP members)
• 21 - Extend the 90-day reconsideration period for MAGI and/or add or extend a reconsideration period for non-MAGI populations during the unwinding period  (Indiana gives the 90-day reconsideration period to both MAGI and non-MAGI members)
• 22 - Extend automatic reenrollment into a Medicaid managed care plan to up to 120 days after a loss of Medicaid coverage (Indiana extended to 90 days)
• 23 - Extend the amount of time managed care plans have to conduct outreach to individuals recently terminated for procedural reasons

Yes, it is a real text message from DFR. Members will be receiving the messages below from the number 468311. They will receive three texts, five minutes apart, on the topic listed below. Members may opt out of receiving the texts at any time by replying STOP.

Topic: You should have received a redetermination packet messages:

• Message 1: Indiana Family & Social Services Administration has an update on your health coverage. Reply STOP at any time to stop receiving texts on this topic.
• Message 2: You should have received a redetermination packet that must be completed to determine if you are eligible. If you did not receive a packet, call 800-403-0864.
• Message 3: For more info on your health coverage, please click here: https://lnks.gd/2/22d6dTN
  FSSA will not ask for any payment. Msg&Data rates may apply.

Yes, DFR is calling members calls requesting redetermination paperwork. The phone call you receive will have the following message:

This is the Indiana Family and Social Services Administration, calling with an important message.
At this time, FSSA has not yet received redetermination paperwork for the Medicaid or HIP member whose benefit period is set to expire.  However, if you return your documentation to FSSA, your benefits may remain open, if you qualify.  Please review the notice you received about redetermination of your benefits and if you believe you still qualify for HIP or Medicaid this year, return your paperwork as soon as possible to FSSA.  Redetermination packets can be completed online or uploaded to the benefits portal at fssabenefits.in.gov, or you can fax them to 800-403-0864, or mail them to FSSA Document Center, PO Box 1810, Marion, IN 46952.  You can also drop them off at your local DFR office.  If you did not receive your notice or you no longer have it, you can access a copy of the notice at FSSABenefits.in.gov.  It will take a few days to process documents once they have been received by FSSA. If you have recently returned all of your redetermination paperwork, please disregard this message. If you have any questions, please call 800-403-0864, Monday through Friday,  8:00 AM to 4:30 PM.

If you would like to stop receiving phone calls from FSSA regarding important information on your case, please call 800-403-0864 and choose option 9 to opt out of the automated calling program.

Yes, DFR is emailing members requesting redetermination paperwork. The email you receive will have the following subject and message:

FSSA Benefits Portal Important Information

At this time, FSSA has not yet received redetermination paperwork for the Medicaid or HIP member whose benefit period is set to expire.  However, if you return your documentation to FSSA, your benefits may remain open, if you qualify.  Please review the notice you received about redetermination of your benefits and if you believe you still qualify for HIP or Medicaid this year, return your paperwork as soon as possible to FSSA.  Redetermination packets can be completed online or uploaded to the benefits portal at fssabenefits.in.gov, or you can fax them to 800-403-0864, or mail them to FSSA Document Center, PO Box 1810, Marion, IN, 46952.  You can also drop them off at your local DFR office.  If you did not receive your notice or you no longer have it, you can access a copy at fssabenefits.in.gov.  It will take a few days to process documents once they have been received by FSSA.  If you have recently returned all of your redetermination paperwork, please disregard this message.  If you have any questions, please call 800-403-0864, Monday through Friday, 8:00 a.m. to 4:30 p.m.

No, the Social Security Number is a required field in the FSSA Benefits Portal.

Immigrants who only qualify for HIP with limited emergency-services-only are not required to make any financial contribution. The month of authorization is viewed as the month the payment would have been made had the person been subject to POWER account contributions. There is no retroactive coverage for any individual receiving emergency services under HIP. (Reference 3515.20.00 policy manual, https://www.in.gov/fssa/ompp/forms-documents-and-tools2/medicaid-eligibility-policy-manual/)

MRT, Medical Review Team, provides limited coverage for members that are pending Medicaid Disability that might require additional testing or medical documentation before disability coverage can be established. The member does not have actual Medicaid coverage until a decision is made from the Medical Review Team and eligibility has been established.

Indiana is following a 12-month plan to return to normal operations.

Individuals who have remained eligible under normal rules during the public health emergency will be subject to standard requirements starting in April 2023; this could include returning information when income increases or after starting a new job, for example.  Individuals who have only remained eligible due to the special rules we have been using since March 2020 will be reevaluated when their annual redetermination comes due.  People who remain qualified after they have completed their annual Eligibility Review and Redetermination process will retain coverage.

April is when the process begins. If members are not eligible after redetermination or do not provide the information needed, the first day they will no longer have coverage would be May 1. Indiana is taking 12 months to complete this process, and members will be reassessed when their annual redetermination is due.

Yes, they can complete their redetermination at fssabenefits.in.gov

If they need assistance, they can call 1-800-403-0864 and press option 6 to reach the benefits portal help desk to assist them. Members can also recover their log-in information, including resetting their password, by following instructions on the log-in screen on the portal.

This depends on ot her programs they're on and the current circumstances around that case.

May 2024 is when the 12-month return to normal operations is complete and no more members are protected by continuous enrollment rules from the original federal public health emergency.

We cannot provide this information to unauthorized representatives; however, we do make an agency portal available.  Once authorized, registered agencies may access the portal to check the case status for each of the individuals they support. For more information or to sign up for the agency portal, please click here.

We will  be using the annual renewal date for everyone, which is set one year from their initial Medicaid approval or one year from their last annual redetermination.

Disenrollment notices are sent at least 13 days prior to the effective date of coverage termination. If the disenrollment is due to not returning requested information, the missing documents can be provided prior to the effective date of termination and closure may be avoided if the member is still eligible.

For annual redeterminations only, individuals who don’t respond by the due date have up to 90 days to return the missing information and potentially regain coverage without submitting a new application.

Yes, all mail is sent “Return Service Requested.” Anything that cannot be forwarded is returned to FSSA.

This would depend on what kind of coverage the member is receiving. The Healthy Indiana Plan does not have retroactive coverage, so someone on HIP needs to take action to update their information as soon as possible. If they provide the needed information before the effective date of closure, then they can avoid a gap in coverage. For other individuals that are in categories that always offer retroactive coverage , then they can avoid a gap in coverage.

Yes.

In January 2023, CMS announced a Marketplace Special Enrollment Period for qualified individuals and their families who lose Medicaid or CHIP coverage due to the end of the continuous enrollment protections. This SEP, referred to as the “Unwinding SEP,” will allow individuals and families in Marketplaces served by HealthCare.gov to enroll in Marketplace health insurance coverage outside of the annual open enrollment period. In March 2024, CMS extended this SEP to last through Nov. 30, 2024 Click here for more information. Click here for more information.

We encourage members to start the process on their own, although they may also receive communication. Click here to find a navigator to help.

Fast track will restart at the same time POWER Accounts, cost share, and premiums are re-started on Aug. 1, 2024.

A special notice will go out to individuals when their cost share resumes. It explains what a Power Account is and how the contribution is determined, and connects the member to a managed care entity for questions about the logistics of making the payment.

Indiana residents may use a mailing address of their choosing if they have made arrangements with a friend, family member, or community organization to hold their mail until they can pick it up. Members who do not have an address where they can receive mail may use the address of their local Division of Family Resources office. DFR can work with the resident to help them determine which local office address to use. Notices and requests will be held for them for 30 days after the mail date and can be picked up during business hours (8 a.m. to 4:30 p.m., M-F). Please note: most requests for information will have a 13-day deadline for response, so it is important that they check for mail frequently.

If you find out that you are no longer eligible for coverage through the Medicaid program, you could check to see if you qualify for coverage through the Federal Marketplace online at HealthCare.gov or by calling 800-318-2596. If you are over 65, you could look into coverage through the federal Medicare program at Medicare.gov or by calling 800-MEDICARE. Indiana’s State Health Insurance Program can also help you with any questions you have about Medicare. Find them online at medicare.in.gov or call 800-452-4800.

There are also specially trained and certified professionals throughout Indiana who can help you find the right health coverage for you. These are called navigators and application organizations. You can find help in your area by clicking here.

In January 2023, CMS announced a Marketplace Special Enrollment Period for qualified individuals and their families who lose Medicaid or CHIP coverage due to the end of the continuous enrollment protections. This SEP, referred to as the “Unwinding SEP,” will allow individuals and families in Marketplaces served by HealthCare.gov to enroll in Marketplace health insurance coverage outside of the annual open enrollment period. In March 2024, CMS extended this SEP to last through Nov. 30, 2024. Click here for more information.

Presumptive Eligibility (immediate coverage) is available through certain qualified providers. The applicant will answer questions such as citizenship, residency, family size and household income. The application is available 24 hours a day, seven days a week.  To learn more about Presumptive Eligibility rules, click here, and to find an active qualified provider use the IHCP Provider Locator (select Yes for “Show only Presumptive Eligibility Qualified Providers?”) by clicking here.

Pharmacists are not a qualified provider, however, members who have received presumptive eligibility with other providers should have pharmacy coverage.

FSSA receives updates on any kind of Social Security income which should automatically be in a member’s file. In rare situations, proof of Social Security income may be requested from the member.

No.

FSSA needs information from the past 30 days. If the last income information we have for a member was two years ago, and they have a new job, but didn’t verify it, FSSA may need verification if the member stills has the job or if it ended. FSSA does not need to know their earnings from then, but we need to know how it is impacting the member now.

Long-term care residents will be required to complete redetermination if FSSA cannot renew them automatically. If asset information needs to be updated, they will receive a mailer. Their authorized representative will also receive a full copy to assist in the process.

FSSA must send that notice 13 days before the effective date, however termination would depend on the time of month. If early in the month, a member would receive a letter saying benefits would end as of the first of the next month. If it was later in the month, such as the 27^th, a member would be bumped out one more month to ensure they had 13 days’ notice before effective date of the end of coverage.

Yes, this information is in our policy manual. Members need to provide identifying information on themselves and give as many details as they can. If signed and dated, they can submit this to FSSA, and we use the information and move forward with their case.

It depends on the type of form a member receives. Read it carefully. If nothing has changed, the member does not need to return anything. If the mailer says information needs to be returned, the member needs to return the form and information .

Redetermination dates are calculated on the individual level and not the household/family level. However, when a family has identical household members and countable income (for example, a mother and her three children), then in some cases after one member of the family is successfully redetermined, FSSA will set all of the household members for a new 12-month period (in effect, syncing their redetermination dates). If this happens, approval notices will be sent to each household member with their new redetermination period. In general, members are required to report changes within 10 days, so updated information should always be submitted timely. When case information is kept up-to-date, it greatly increases the chance that individuals in the case will qualify for ex parte (auto-) renewal in the future.

FSSA has met with several provider groups, hospitals, pharmacies, health associations, and community organizations to ensure they understand this redetermination process and encourage them to use our website materials made available to communicate with their members.

For most Medicaid members who are not in Hoosier Healthwise (non-disabled children up to age 19, pregnant/postpartum individuals) or the Healthy Indiana Plan (non-disabled adults age 19 to 64) the answer is yes. You are now required to verify resources due to the ending of the public health emergency.  If you are required to verify your assets, your renewal mailer or other request for information you receive will specifically ask about them.

AVS, or Asset Verification System, was implemented in December 2020 as required by federal law. This is an electronic data system used to verify any asset or resources that belong to an applicant/member and their spouse. We are required to use AVS for all Medicaid members who are in categories that include a resource (asset) test, which includes our aged, blind, and disabled categories and categories which help pay for Medicare expenses.

An Authorized Representative agreement can be set up using the barcoded form, signed by AR and applicant/member or over the telephone via a three way call which will be recorded by the Division of Family Resources. Authorized Representatives are allowed to complete any action for the member/client such as filing out, signing, and returning the renewal form. ARs are also required to be familiar with the member’s circumstances and the member/client is responsible for any discrepancies.

A member has 13 days to provide more information on the asset in question.

Please read your mailer carefully as it will state whether you only need to return it if there are changes to the information, we have listed for you, or if you are required to return it with updated information in order to keep your coverage.  A Must Return mailer will say “If you do not complete, sign and return this form your coverage will be discontinued.” The member must return the mailer along with the documentation that has been requested. Please make sure to sign the mailer.

Renewals can be mailed, faxed, or dropped off at any local DFR office. You can also upload them to the Benefits Portal by following the instructions available here.  You can find your local DFR office here.

FSSA can give providers the scheduled renewal dates for these members that are at the highest rate for disenrollment. Providers will need to send the list of RIDs to PHEStakeholders@fssa.in.gov.  All members can find their scheduled renewal date on their Benefits Portal account or by calling 800-403-0864.

The mailer can be turned in up to 90 days after a closure at renewal time.  For all members, except those in the Healthy Indiana Plan, coverage can be reinstated showing no gaps as long as member was eligible. The HIP program does not offer retroactive coverage, so it’s important for HIP members to return their renewal information as soon as possible.  If a HIP member is found eligible in the 90-day reconsideration period, coverage will begin again going forward.

If the member is in a long-term care facility or on a Home-and Community-Based Services Waiver and they do not qualify due to being over the asset/resource limit, DFR will suspend Medicaid coverage for up to 60 days. Coverage cannot be used but they will remain in the system. Members will then have the opportunity to spend the excess resources to get back under the limit without the member having to reapply. The excess funds cannot be given away for nothing in return.  Coverage will not backdate due to member not being within the income guidelines.

Reach out to DFR at 800-403-0864 and let them know that you just received the mailer or request for information so they can take the appropriate action.

Medicaid cost-sharing involves certain Medicaid members contributing a small percentage of the cost to maintain their coverage. This can include copays paid directly at the time of medical services and monthly contributions/premiums paid by invoice. Copays only apply to members in the Healthy Indiana Plan (HIP) and Children’s Health Insurance Plan (CHIP). Monthly contributions/premiums apply to HIP, CHIP, and MEDWorks (Medicaid for working individuals who have a disability). Copayments for HIP and CHIP will begin July 1, 2024, and invoices for HIP, CHIP, and MEDWorks monthly payments will be sent in early July for August’s benefits.

Yes, but cost-sharing for Medicaid coverage has been suspended for nearly four years due to federal public health emergency orders. It is now returning on July 1, 2024, requiring some members to share a portion of the coverage cost.

If you are a HIP member, you will receive an invoice from your health plan (Anthem, CareSource, MDwise, MHS). If you are or have a child in CHIP or if you receive MEDWorks coverage and are required to pay premiums, you will receive a bill from the premium vendor in July.

Medicaid members can check their status online in their benefits portal account (fssabenefits.in.gov) to determine if they are required to pay monthly contributions/premiums. Eligibility notices from FSSA and monthly invoices will also be provided by the member’s health plan (for HIP members) or the premium vendor (for CHIP and MEDWorks members) to keep members informed.

Cost-sharing is set to resume July 1, 2024. HIP and CHIP members should be prepared to pay a small copay at the time of medical services. HIP, CHIP, and MEDWorks members should also watch for an invoice in the mail and pay the amount due by the date given in order to maintain their coverage.

Yes, the way Medicaid cost-share operates copay is comparable to a copay in traditional health insurance programs. Members pay copays directly at the time of medical services.

Contributions (in HIP) and premiums (in CHIP and MEDWorks) are comparable to monthly premiums charged for traditional health insurance to ensure coverage stays active.

The specific percentage of the cost that members will need to contribute will vary. Checking one's status online at fssabenefits.in.gov will provide personalized information about monthly contribution/premium amounts. Members can find more information on copay amounts by calling the “member services” number on the back of their Medicaid card.

• Copayments in CHIP range from $3 to $10, and monthly premiums range from $22 to $70 based on income and family size.
• MEDWorks monthly premiums range from $48 to $254 based on income and whether married members are both on MEDWorks.
• Copayments in HIP Basic range from $4 to $75, and monthly contributions range from $1 to $20 based on income and family size.

Yes, assistance programs are available for those facing financial difficulties. Members are encouraged to reach out to their health plan (Anthem, CareSource, MDwise, MHS, UHC) for support and guidance.

Copays will apply to members in HIP and CHIP.  Contributions/premiums apply to all Medicaid members in HIP and CHIP, and to MEDWorks members with income above 150% of the Federal Poverty Level.  These Medicaid categories are for individuals or families with slightly higher income than other Medicaid programs. It's important for everyone to be aware of this change and take necessary steps to maintain their coverage.

Healthcare providers are encouraged to educate their patients about the return of cost-sharing. They can also assist in explaining the process and checking online statuses.

Failure to contribute to the cost-share may impact Medicaid coverage. It is crucial for members to stay informed, pay attention to invoices and call the “member services” number on the back of their Medicaid card if they have any questions or concerns.

Medicaid members have 90 days after a closure for failure to complete redetermination to return their paperwork.  If they are found to be eligible, their coverage will restart back to the date of closure and there will be no effective coverage gap.  This is not an automated process and there will be some processing time required.

The only exception is for HIP coverage, which does not allow for retroactive coverage per state law.  HIP members still receive the 90-day reconsideration period, but if they are found eligible, their coverage will restart going forward only.

Benefits might be reduced or terminated if the amount is not paid. Members are allotted a 60-day grace period.

Yes, all of the health plans allow members (and/or third parties on behalf of the member) to set up automatic payments for their monthly POWER account contributions.

Fast Track payments will return on Aug. 1, 2024

The first closures for nonpayment will occur Oct.1, 2024.

New HIP Applicants

Most new applicants who start in HIP will be approved conditionally.  A conditionally approved applicant is someone who has been determined eligible for coverage, but their coverage will not be activated until they make their first payment.  Applicants are given 60 days to make their first payment.

Applicants can choose to pay a $10 “Fast Track” payment on their application, or they will receive a regular invoice from their health plan.
For approved applicants who pay their POWER Account Contribution (PAC), their coverage will be activated as of the first of the month in which they make the PAC payment (HIP does not have retroactive coverage).

If a conditionally approved HIP applicant fails to pay their PAC in the allowed time:

• Those with income under 100% Federal Poverty Level (FPL)  will be activated in Basic coverage
• Those with income over 100% FPL will be disenrolled and will not have coverage

Check this link for more information about the difference between HIP Plus and HIP Basic.

Active HIP Members

HIP members who have made their PAC payment and had their coverage activated must continue to make their ongoing monthly payments within the allowed time (60 days), or:

• Those with income under 100% FPL will be moved to Basic coverage
• Those with income over 100% FPL will be disenrolled and will no longer have coverage

There are no lockout periods in HIP and individuals denied or disenrolled for any reason may reapply at any time.
Note: Medically Frail members with income over 100% who don’t pay PACS are not disenrolled; they retain Plus coverage but must pay copayments and their unpaid PACs accrue as debt (but this will not cause their coverage to end).

Members Currently in HIP Basic Coverage

All HIP members who are in Basic coverage will have the opportunity to buy up to Plus coverage (called a “Potential Plus” period) if their income increases above 100% FPL, or at each annual renewal, or if they earn certain credits from their health plan.

As part of our cost-share resumption process, all HIP Basic members will be given a special Potential Plus period starting in August 2024.  The Potential Plus period lasts 60 days.
Check this link for more information about the difference between HIP Plus and HIP Basic.

All new applicants who start in CHIP (Package C) will be approved conditionally.  A conditionally approved applicant is someone who has been determined eligible for coverage, but their coverage will not be activated until they make their first payment.  They will receive an invoice from the Premium Vendor and will  have 60 days to make their first payment.

For conditionally approved applicants who pay their first premium, their coverage will be activated as of the first day of the application month. CHIP (Package C) does not provide retroactive coverage.

Ongoing CHIP members who stop paying cannot be disenrolled during a continuous eligibility period (the 12 months between approval and renewal); however, when they are due for their annual renewal, they can be disenrolled for a prior nonpayment that happened earlier in the year.

CHIP members who are disenrolled for nonpayment and reapply must catch up on all of their missed payments or serve a 90-day lockout period before coverage (if approved) can be reactivated.

New applicants with income at or above 150% FPL who are approved for MEDWorks will be approved conditionally.  A conditionally approved applicant is someone who has been determined eligible for coverage, but their coverage will not be activated until they make their first payment.  They will receive an invoice from the Premium Vendor and will have 60 days to make their first payment.

For conditionally approved applicants who pay their first premium, their coverage can begin up to three months prior to the application month if they were eligible in all of those retroactive months.

MEDWorks members who are disenrolled for nonpayment and reapply must catch up on all of their missed payments or serve a two-year lockout period before coverage (if approved) can be reactivated.

Members will have all of 2025 to cease their tobacco use. The soonest time that the tobacco surcharge could be assessed is Jan. 1, 2026.

• 1 - Renew Medicaid eligibility based on financial findings from the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF).
• 3 - Renew Medicaid eligibility for individuals with no income and no data returned on an ex parte basis
• 5 - Renew Medicaid for individuals for whom information from the Asset Verification System is not returned or is not returned within a reasonable timeframe
• 9 - Suspend the requirements to apply for other benefits under 42 CFR 435.608 at renewal.
• 10 - Suspend the requirement to cooperate with the agency in establishing the identity of a child's parents and in obtaining medical support at renewal.
• 11 - Renew eligibility if able to do so based on available information and establish a new eligibility period whenever contact is made with hard-to-reach populations (e.g., homeless).
• 12 - Permit managed care plans to provide assistance to enrollees to complete and submit Medicaid renewal forms
• 13 - Permit the designation of an authorized representative for the purposes of signing an application or renewal form via the telephone without a signed designation from the applicant or beneficiary. Note: Indiana already allowed this.
• 15 - Send lists to managed care plans and providers for individuals who are due for renewal and those who have not responded
• 17 - Use managed care plans and all available outreach modalities (phone call, email, text) to contact enrollees when renewal forms are mailed and when they should have received them by mail
• 20 - Reinstate eligibility effective on the individual’s prior termination date for individuals who were disenrolled based on a procedural reason and are subsequently re-determined eligible for Medicaid during a 90-day Reconsideration Period. Note: Due to state law, this does not apply to the Healthy Indiana Plan – reinstatement will go forward for HIP members.
• 21 - Extend the 90-day reconsideration period for MAGI and/or add or extend a reconsideration period for non-MAGI populations during the unwinding period. Note: Indiana gives the 90-day reconsideration period to both MAGI and non-MAGI members.
• 22 - Extend automatic reenrollment into a Medicaid managed care plan to up to 120 days after a loss of Medicaid coverage (Indiana extended to 90 days)
• 23 - Extend the amount of time managed care plans have to conduct outreach to individuals recently terminated for procedural reasons