CHAPTER 2. ELIGIBILITY
IC 12-15-2
Chapter 2. Eligibility
IC 12-15-2-0.5
Provisions not limiting health care assistance
Sec. 0.5. (a) This section applies to a person who qualifies forassistance:
(1) under sections 13 through 16 of this chapter;
(2) under section 6 of this chapter when the person becomesineligible for medical assistance under IC 12-14-2-5.1 orIC 12-14-2-5.3; or
(3) as an individual with a disability if the person is less thaneighteen (18) years of age and otherwise qualifies forassistance.
(b) Notwithstanding any other law, the following may not beconstrued to limit health care assistance to a person described insubsection (a):
(1) IC 12-8-1-13.
(2) IC 12-14-1-1.
(3) IC 12-14-1-1.5.
(4) IC 12-14-2-5.1.
(5) IC 12-14-2-5.2.
(6) IC 12-14-2-5.3.
(7) IC 12-14-2-17.
(8) IC 12-14-2-18.
(9) IC 12-14-2-20.
(10) IC 12-14-2-21.
(11) IC 12-14-2-24.
(12) IC 12-14-2-25.
(13) IC 12-14-2-26.
(14) IC 12-14-2.5.
(15) IC 12-14-5.5.
(16) Section 21 of this chapter.
As added by P.L.46-1995, SEC.31. Amended by P.L.2-2005, SEC.48;P.L.99-2007, SEC.94; P.L.161-2007, SEC.34; P.L.1-2010, SEC.58.
IC 12-15-2-1
"Federal income poverty level" defined
Sec. 1. As used in this chapter, "federal income poverty level"means the nonfarm income official poverty line as determinedannually by the federal Office of Management and Budget.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-2
Determination and certification of eligibility and effective date ofassistance
Sec. 2. The county office shall determine eligibility and shallcertify to the office at the time and in the manner required by theoffice a list of individuals who have been found eligible to receiveMedicaid and the effective date for the payment of assistance under
this chapter. The date must be one (1) month before the first day ofthe month in which the application or request is made.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.110;P.L.5-1993, SEC.123.
IC 12-15-2-3
Individuals eligible; receipt of monthly assistance payments ormedical services; eligibility for medical services under aid todependent children assistance category or under statesupplemental assistance program for aged, blind, or disabled
Sec. 3. An individual who:
(1) is receiving monthly assistance payments or medicalservices; or
(2) would be eligible to receive medical services under the aidto dependent children assistance category or under the statesupplemental assistance program for the aged, blind, ordisabled;
is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-4
Individuals eligible; eligible under another approved state plan butfor plan condition or requirement prohibited in Medicaid programunder Social Security Act
Sec. 4. An individual who would be eligible for aid or assistanceunder one (1) of the other approved state plans except for aneligibility condition or other requirement in the plan that isspecifically prohibited in a Medicaid program under Title XIX of thefederal Social Security Act (42 U.S.C. 1396 et seq.) is eligible toreceive Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-5
Individuals eligible; recipients of old age assistance, blindassistance, or disabled assistance payments as of December 31,1973
Sec. 5. An individual who:
(1) was receiving assistance payments in the old age assistance,blind assistance, or disabled assistance categories as ofDecember 31, 1973; and
(2) continues to remain eligible under state laws and rules;
is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-6
Individuals eligible; Supplemental Security Income assistance andSocial Security Disability Insurance recipients
Sec. 6. (a) Subject to subsection (b), an individual who:
(1) is receiving monthly assistance payments under the federalSupplemental Security Income program; and (2) meets the income and resource requirements established bystatute or the office unless the state is required to providemedical assistance to the individual under 42 U.S.C. 1396a(f)or under 42 U.S.C. 1382h;
is eligible to receive Medicaid.
(b) An individual who is receiving monthly disability assistancepayments under the federal Supplemental Security Income programor the federal Social Security Disability Insurance program mustmeet the eligibility requirements specified in IC 12-14-15 unless thestate is required to provide medical assistance to the individual under42 U.S.C. 1382h.
(c) The office may not apply a spend down requirement to anindividual who is eligible for medical assistance under 42 U.S.C.1382h.
As added by P.L.2-1992, SEC.9. Amended by P.L.287-2001, SEC.5;P.L.218-2003, SEC.2.
IC 12-15-2-6.5
Medicaid buy-in program
Sec. 6.5. Notwithstanding section 6 of this chapter, beginning July1, 2002, an individual who meets the requirements of IC 12-15-41 iseligible for Medicaid.
As added by P.L.287-2001, SEC.6.
IC 12-15-2-7
Individuals eligible; children in families receiving TANF assistance
Sec. 7. A child in a family who receives TANF assistance and isless than twenty-one (21) years of age but not otherwise eligible tobe included in section 2 or 3 of this chapter is eligible to receiveMedicaid.
As added by P.L.2-1992, SEC.9. Amended by P.L.161-2007, SEC.35.
IC 12-15-2-8
Individuals eligible; patients in medical institutions or institutionsfor mentally retarded
Sec. 8. An individual who:
(1) has been found eligible for Medicaid under section 2, 3, 4,5, or 6 of this chapter; and
(2) is a patient in an institution for the mentally retarded or whois a patient in a medical institution, as long as the institution orthat part of the institution in which the patient resides qualifiesas an intermediate care facility for mental retardation underTitle XIX of the federal Social Security Act (42 U.S.C. 1396 etseq.);
is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-9
Individuals eligible; patients in institutions for mentally diseased;definition Sec. 9. (a) As used in this section, "institution for the mentallydiseased" includes a facility that meets the requirements andregulations under 42 U.S.C. 1396 et seq.
(b) Except as provided in subsections (c) and (d), an individualwho:
(1) is less than twenty-one (21) years of age or at least sixty-five(65) years of age who has been found to be eligible forMedicaid under section 2, 3, 4, 5, or 6 of this chapter; and
(2) is a patient in an institution for the mentally diseased;
is eligible to receive Medicaid.
(c) Psychiatric services may extend until twenty-two (22) years ofage or until treatment has ended, whichever occurs first.
(d) Intermediate care facility services may be provided in a mentalhealth institution.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-10
Individuals eligible; long term care program participants
Sec. 10. An individual who:
(1) is at least sixty-five (65) years of age;
(2) participates in the Indiana long term care program underIC 12-15-39.6; and
(3) satisfies the requirements under IC 12-15-39.6-8;
is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9. Amended by P.L.24-1997, SEC.45.
IC 12-15-2-11
Individuals eligible; qualified pregnant women
Sec. 11. A qualified pregnant woman (as defined in 42 U.S.C.1396d(n)(1)) is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-12
Individuals eligible; qualified children
Sec. 12. A qualified child (as defined in 42 U.S.C. 1396d(n)(2))is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9.
IC 12-15-2-13
Individuals eligible; pregnant women with limited family incomes;income limitations; covered services; duration of assistance
Sec. 13. (a) A pregnant woman:
(1) who is not described in 42 U.S.C. 1396a(a)(10)(A)(i); and
(2) whose family income does not exceed the income levelestablished in subsection (b);
is eligible to receive Medicaid.
(b) A pregnant woman described in this section is eligible toreceive Medicaid, subject to subsections (c) and (d) and 42 U.S.C.1396a et seq., if her family income does not exceed two hundredpercent (200%) of the federal income poverty level for the same size
family.
(c) Medicaid made available to a pregnant woman described inthis section is limited to medical assistance for services related topregnancy, including prenatal, delivery, and postpartum services, andto other conditions that may complicate pregnancy.
(d) Medicaid is available to a pregnant woman described in thissection for the duration of the pregnancy and for the sixty (60) daypostpartum period that begins on the last day of the pregnancy,without regard to any change in income of the family of which sheis a member during that time.
(e) The office may apply a resource standard in determining theeligibility of a pregnant woman described in this section.
As added by P.L.2-1992, SEC.9. Amended by P.L.46-1995, SEC.32;P.L.119-1997, SEC.1; P.L.218-2007, SEC.9.
IC 12-15-2-13.5
Eligibility for women screened and in need of treatment for breastor cervical cancer
Sec. 13.5. (a) A woman:
(1) who is not eligible for Medicaid under any other section ofthis chapter;
(2) who is less than sixty-five (65) years of age;
(3) who has been:
(A) screened for breast or cervical cancer through the breastand cervical cancer screening program or by anotherprovider under the federal Breast and Cervical CancerMortality Prevention Act of 1990 (42 U.S.C. 300k); and
(B) determined to need treatment for breast or cervicalcancer;
(4) who is not otherwise covered under credible coverage (asdefined in 42 U.S.C. 300gg(c)); and
(5) whose family income does not exceed two hundred percent(200%) of the federal income poverty level for the same sizefamily;
is eligible for Medicaid.
(b) Medicaid made available to a woman described in subsection(a) is limited to the duration of treatment required for breast orcervical cancer.
As added by P.L.152-2001, SEC.2. Amended by P.L.107-2009,SEC.1.
IC 12-15-2-14
Minors with limited family income
Sec. 14. (a) An individual:
(1) who is less than nineteen (19) years of age;
(2) who is not described in 42 U.S.C. 1396a(a)(10)(A)(I); and
(3) whose family income does not exceed the income levelestablished in subsection (b);
is eligible to receive Medicaid.
(b) An individual described in this section is eligible to receive
Medicaid, subject to 42 U.S.C. 1396a et seq., if the individual'sfamily income does not exceed one hundred fifty percent (150%) ofthe federal income poverty level for the same size family.
(c) The office may apply a resource standard in determining theeligibility of an individual described in this section.
As added by P.L.2-1992, SEC.9. Amended by P.L.46-1995, SEC.33;P.L.119-1997, SEC.2; P.L.273-1999, SEC.171.
IC 12-15-2-15
Repealed
(Repealed by P.L.273-1999, SEC.182.)
IC 12-15-2-15.5
Repealed
(Repealed by P.L.273-1999, SEC.182.)
IC 12-15-2-15.6
Repealed
(Repealed by P.L.1-2001, SEC.51.)
IC 12-15-2-15.7
Repealed
(Repealed by P.L.107-2002, SEC.32.)
IC 12-15-2-15.8
Continuous eligibility to three years of age
Sec. 15.8. After an individual who is less than three (3) years ofage is determined to be eligible for Medicaid under section 14 of thischapter, the individual is not required to submit eligibilityinformation more frequently than once in a twelve (12) month perioduntil the child becomes three (3) years of age.
As added by P.L.218-2007, SEC.10.
IC 12-15-2-16
Eligibility of individuals under 18 years of age
Sec. 16. An individual:
(1) who is less than eighteen (18) years of age;
(2) who is described in 42 U.S.C. 1396a(a)(10)(A)(ii); and
(3) who is:
(A) a child in need of services (as defined in IC 31-34-1);
(B) a child placed in the custody of the department of childservices under IC 31-35-6-1 (or IC 31-6-5-5 before itsrepeal); or
(C) a child placed under the supervision or in the custody ofthe department of child services by an order of the court;
is eligible to receive Medicaid.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.111;P.L.5-1993, SEC.124; P.L.1-1997, SEC.60; P.L.145-2006, SEC.86;P.L.146-2008, SEC.387.
IC 12-15-2-17
Exclusion of resources in determining eligibility for Medicaid;conditions
Sec. 17. (a) Except as provided in subsections (b) and (d), if anapplicant for or a recipient of Medicaid:
(1) establishes one (1) irrevocable trust that has a value of notmore than ten thousand dollars ($10,000), exclusive of interest,and is established for the sole purpose of providing money forthe burial of the applicant or recipient;
(2) enters into an irrevocable prepaid funeral agreement havinga value of not more than ten thousand dollars ($10,000); or
(3) owns a life insurance policy with a face value of not morethan ten thousand dollars ($10,000) and with respect to whichprovision is made to pay not more than ten thousand dollars($10,000) toward the applicant's or recipient's funeral expenses;
the value of the trust, prepaid funeral agreement, or life insurancepolicy may not be considered as a resource in determining theapplicant's or recipient's eligibility for Medicaid.
(b) Subject to subsection (d), if an applicant for or a recipient ofMedicaid establishes an irrevocable trust or escrow underIC 30-2-13, the entire value of the trust or escrow may not beconsidered as a resource in determining the applicant's or recipient'seligibility for Medicaid.
(c) If an applicant for or a recipient of Medicaid owns resourcesdescribed in subsection (a) and the total value of those resources ismore than ten thousand dollars ($10,000), the value of thoseresources that is more than ten thousand dollars ($10,000) may beconsidered as a resource in determining the applicant's or recipient'seligibility for Medicaid.
(d) In order for a trust, an escrow, a life insurance policy, or aprepaid funeral agreement to be exempt as a resource in determiningan applicant's or a recipient's eligibility for Medicaid under thissection, the applicant or recipient must designate the office or theapplicant's or recipient's estate to receive any remaining amountsafter delivery of all services and merchandise under the contract asreimbursement for Medicaid assistance provided to the applicant orrecipient after fifty-five (55) years of age. The office may receivefunds under this subsection only to the extent permitted by 42 U.S.C.1396p. The computation of remaining amounts shall be made as ofthe date of delivery of services and merchandise under the contractand must be the excess, if any, derived from:
(1) growth in principal;
(2) accumulation and reinvestment of dividends;
(3) accumulation and reinvestment of interest; and
(4) accumulation and reinvestment of distributions;
on the applicant's or recipient's trust, escrow, life insurance policy,or prepaid funeral agreement over and above the seller's current retailprice of all services, merchandise, and cash advance items set forthin the applicant's or recipient's contract.
As added by P.L.2-1992, SEC.9. Amended by P.L.113-1996, SEC.1;
P.L.272-1999, SEC.39; P.L.178-2002, SEC.80.
IC 12-15-2-18
Financial resources; state or federal higher education awards
Sec. 18. Except as provided by federal law, if an individualreceives a state or federal higher education award that is paid directlyto an approved postsecondary educational institution for theindividual's benefit:
(1) the individual is not required to report that award as incomeor as a resource of the individual when applying for Medicaid;and
(2) the award may not be considered as income or a resource ofthe individual in determining initial or continuing eligibility forMedicaid.
As added by P.L.2-1992, SEC.9. Amended by P.L.2-2007, SEC.160.
IC 12-15-2-19
Acquisition of property, income, or resources; notification ofcounty office; alteration or cancellation of assistance; recovery ofexcess assistance
Sec. 19. (a) If, while receiving Medicaid, a recipient becomes theowner of any:
(1) property;
(2) income; or
(3) resources;
in excess of the amount owned when the recipient's eligibility wasdetermined, the recipient shall immediately notify the county officeof the receipt of possession of the property or income.
(b) After an investigation of circumstances under subsection (a),the county office shall recommend to the office the cancellation oralteration of the amount of Medicaid in accordance with thecircumstances.
(c) Assistance paid after the recipient acquires possession of:
(1) property;
(2) income; or
(3) resources;
in excess of the recipient's needs is recoverable by the office from therecipient or the estate of the recipient.
(d) However, an eligible individual is not required to notify thedivision or county office of a Holocaust victim's settlement paymentreceived by the individual. A county office may not cancel or alterthe amount of Medicaid received by the individual after theindividual's receipt of the payment. Assistance paid after theindividual's receipt of the payment is not recoverable by the officefrom the individual or the estate of the individual.
As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.112;P.L.5-1993, SEC.125; P.L.128-1999, SEC.20.
IC 12-15-2-20
Ineligibility after conviction Sec. 20. (a) This section does not apply to a provider (as definedin IC 12-7-2-149.1(2)).
(b) A person convicted of an offense under IC 35-43-5-7.1 isineligible to receive Medicaid assistance under this article for ten(10) years after the conviction.
As added by P.L.46-1995, SEC.36. Amended by P.L.241-2003,SEC.3.
IC 12-15-2-21
Ineligibility due to noncompliance
Sec. 21. Notwithstanding any other provision of this article, aperson who is ineligible for assistance under IC 12-14-2 because ofnoncompliance with IC 12-14-2-21, IC 12-14-2-24, IC 12-14-2-26,or IC 12-14-5.5 is ineligible for Medicaid under this article.
As added by P.L.46-1995, SEC.37.
IC 12-15-2-22
Determination of eligibility; certain equity value in motor vehiclemay not be considered
Sec. 22. When the office applies a resource standard to determinean applicant's or a recipient's eligibility for Medicaid under thischapter, the office may not consider five thousand dollars ($5,000)of equity value (as defined in 470 IAC 10.1-3-1) in one (1) motorvehicle belonging to:
(1) the applicant or recipient; or
(2) a member of the applicant's or recipient's family.
As added by P.L.126-1998, SEC.2.
IC 12-15-2-23
Look back; exemption of certain contributions; disregard iftransfer follows a pattern; applicability
Sec. 23. (a) This section is effective beginning October 1, 2009.
(b) Except as provided in subsection (c), when the office conductsa look back (as described in 42 U.S.C. 1396p(c)) to determine, forpurposes of eligibility, whether an individual improperly transferredassets, the office shall not consider in total one thousand twohundred dollars ($1,200) per year of contributions made by theindividual to a:
(1) family member; or
(2) nonprofit organization;
as an improper transfer.
(c) The office may disregard a contribution by an individual if theindividual can demonstrate that the transfer follows a pattern thatexisted for at least three (3) years before applying for Medicaid orwas not for the purpose of fraud.
(d) Any rule adopted by the office of the secretary concerning atransfer of property may not apply to a transfer of property thatoccurred before the effective date of the rule.
As added by P.L.14-2009, SEC.1.
IC 12-15-2-23.5
Prohibition on certain penalties against noninstitutionalizedindividual; implementation of federal act
Sec. 23.5. (a) This section is effective beginning October 1, 2009.
(b) The office may not implement the optional provision allowedin 42 U.S.C 1396p(c)(1)(A) to apply penalties specified in 42 U.S.C.1396p(c)(1)(A) to a noninstitutionalized individual or the spouse ofthe noninstitutionalized individual for the disposal of assets for lessthan fair market value.
(c) In implementing the federal Deficit Reduction Act of 2005, theoffice shall comply with the following:
(1) A rule adopted may not apply to the transfer of property oranother transaction that occurred before the passage of the rule.
(2) The office may not require an individual to return all assetsin order to reduce a penalty period for the transfer of assets. Theoffice shall allow a penalty period to be proportionally reducedfor a partial return of assets.
As added by P.L.14-2009, SEC.2.
IC 12-15-2-24
Eligibility; community spouse resource requirements
Sec. 24. (a) This section applies to determining eligibility for anindividual who:
(1) resides in a nursing facility or another medical institution;and
(2) has a community spouse.
(b) In determining eligibility for an individual described insubsection (a), the office shall, beginning in calendar year 2006, usethe greater of the following community spouse resource allowances:
(1) Nineteen thousand twenty dollars ($19,020), subject to anadjustment described in 42 U.S.C. 1396r-5(g).
(2) The lesser of:
(A) the spousal share computed under 42 U.S.C.1396r-5(c)(1); or
(B) ninety-five thousand one hundred dollars ($95,100),subject to an adjustment described in 42 U.S.C. 1396r-5g.
(3) An amount established by a court order or an administrativehearing if the community spouse's income is less than theminimum monthly needs allowance established under 42 U.S.C.1396r-5(d)(3) and an increased amount is necessary to increasethe community spouse's income to the minimum monthly needsallowance.
(c) An institutionalized spouse shall not be ineligible for theprogram because of resources if:
(1) the institutionalized spouse:
(A) establishes that the individual has a right to receivesupport from the community spouse; and
(B) assigns to the office the right to receive support from thecommunity spouse; or
(2) the office determines that the denial of eligibility would
result in an undue hardship to the institutionalized spouse.
(d) The office shall adopt rules under IC 4-22-2 to calculate theamount of resources necessary to provide income to the communityspouse under subsection (b).
As added by P.L.246-2005, SEC.102.
IC 12-15-2-25
Eligibility; retention of income to support community spouse
Sec. 25. (a) This section applies to an individual who:
(1) is eligible for Medicaid;
(2) resides in a nursing facility or another medical institution;and
(3) has a community spouse.
(b) An individual described in subsection (a) is entitled to retainan income allowance for the purpose of supporting a communityspouse if:
(1) the community spouse's income is less than the minimummonthly needs allowance established under 42 U.S.C.1396r-5(d)(3); and
(2) an increased amount is necessary to increase the communityspouse's income to the minimum monthly needs allowance.
(c) If either spouse establishes that a higher allowance is neededdue to exceptional circumstances resulting in significant financialduress, the minimum monthly needs allowance may be increasedafter an administrative hearing or by a court order.
(d) The office shall adopt rules under IC 4-22-2 setting forth themanner in which the office will determine the existence ofexceptional circumstances resulting in significant financial duressunder subsection (c).
As added by P.L.246-2005, SEC.103.