CHAPTER 41. MEDICAID BUY-IN PROGRAM FOR WORKING INDIVIDUALS WITH DISABILITIES
IC 12-15-41
Chapter 41. Medicaid Buy-In Program for Working IndividualsWith Disabilities
IC 12-15-41-1
"Buy-in program" defined
Sec. 1. As used in this chapter, "buy-in program" refers to theMedicaid buy-in program for working individuals with disabilitiesestablished by section 3 of this chapter.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-2
"Countable resources" defined
Sec. 2. As used in this chapter, "countable resources" means allcash, other liquid assets, real property, and personal property ownedby an applicant for or a recipient of Medicaid under this chapter, orthe spouse of an applicant or a recipient, that could be converted tocash to be used for support or maintenance, except the following:
(1) All resources disregarded by the office under this article forthe purpose of determining eligibility for Medicaid.
(2) Any resource eligible for exclusion under 42 U.S.C.1396a(r)(2), including a retirement account established under26 U.S.C. 220 and held by either the applicant or recipient orthe applicant's or recipient's spouse.
(3) Subject to approval by the office, not more than twentythousand dollars ($20,000) in independence and self-sufficiencyaccounts held by the applicant or recipient for the sole purposeof purchasing goods or services, including assistive technologyand personal assistance, that:
(A) will increase the employability or independence of theapplicant or recipient; and
(B) are not services to which the recipient is entitled underMedicaid or any other publicly funded program.
In determining the types of accounts to be approved under thissubdivision, the office shall consider any recommendationsmade by the Medicaid work incentives council established byIC 12-15-42-1.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-3
Establishment
Sec. 3. The Medicaid buy-in program for working individualswith disabilities is established to provide, beginning July 1, 2002,Medicaid to individuals who are disabled and employed, asauthorized under Section 201 of the federal Ticket to Work andWork Incentives Improvement Act of 1999 (P.L. 106-170, 42 U.S.C.1396 et seq.).
As added by P.L.287-2001, SEC.9.
IC 12-15-41-4 Exemptions from eligibility requirements
Sec. 4. To participate in the buy-in program beginning July 1,2002, an individual must meet the eligibility requirements underIC 12-15-2-6, except as follows:
(1) The individual has a severe medically determinableimpairment without regard to the individual's employmentstatus.
(2) The individual must be at least sixteen (16) years of age butnot more than sixty-four (64) years of age.
(3) The individual must be engaged in a substantial andreasonable work effort as determined by the office and aspermitted by federal law.
(4) The individual does not have countable resources thatexceed the resource limits for the federal Supplemental SecurityIncome program (42 U.S.C. 1382).
(5) The individual's annual gross income does not exceed threehundred fifty percent (350%) of the federal income povertylevel for an individual. In determining an individual's incomeunder this subdivision, the office may not consider thefollowing:
(A) The income of the individual's spouse.
(B) Income disregarded under the state Medicaid plan'sfinancial methodology, including income disregarded underthe federal Supplemental Security Income program (42U.S.C. 1382) as impairment related work expenses (IRWE).
As added by P.L.287-2001, SEC.9.
IC 12-15-41-5
Continued eligibility requirements after change in circumstances
Sec. 5. An individual who is enrolled in the buy-in program andwho no longer meets the eligibility requirements set forth in section4 of this chapter due to an improvement in the individual's medicalcondition continues to be eligible for Medicaid coverage under thebuy-in program if the individual meets the following requirements:
(1) The individual continues to have a severe medicallydeterminable impairment, as determined by the office and asallowed by federal law.
(2) The individual is employed and earning a monthly wage thatis not less than the federal minimum hourly wage times forty(40).
(3) The individual does not have income or countable resourcesin excess of the limits established under section 4 of thischapter.
(4) The individual is at least sixteen (16) years of age and lessthan sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharingrequired under this chapter.
(6) The individual meets all other eligibility requirements underthis chapter.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-6
Continued eligibility if unable to maintain employment
Sec. 6. (a) An individual who is enrolled in the buy-in programand who is unable to maintain employment for involuntary reasons,including temporary leave due to a health problem or involuntarytermination, continues to be eligible for Medicaid coverage under thebuy-in program if the individual meets the following requirements:
(1) Within sixty (60) days after the date on which the individualbecomes unemployed, the individual, or an authorizedrepresentative of the individual, submits a written request to theoffice that the individual's Medicaid coverage be continued.
(2) The individual maintains a connection to the workforceduring the individual's continued eligibility period byparticipating in at least one (1) of the following activities:
(A) Enrollment in a state or federal vocational rehabilitationprogram.
(B) Enrollment or registration with the office of workforcedevelopment.
(C) Participation in a transition from school to workprogram.
(D) Participation with an approved provider of employmentservices.
(E) Provision of documentation from the individual'semployer that the individual is on temporary involuntaryleave.
(3) The individual does not have income or countable resourcesin excess of the limits established under section 4 of thischapter.
(4) The individual is at least sixteen (16) years of age and lessthan sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharingrequired under this chapter.
(6) The individual meets all other eligibility requirements underthis chapter.
(b) The office shall continue Medicaid coverage under the buy-inprogram for an individual described in subsection (a) for up to twelve(12) months from the date of the individual's involuntary loss ofemployment.
(c) If an individual is ineligible for continued coverage under thebuy-in program because the individual:
(1) fails to meet the requirements of subsection (a); or
(2) has already met twelve (12) months of continuing eligibilityunder this section;
the individual must meet the eligibility requirements of IC 12-15-2-6to continue to be eligible for Medicaid.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-7
Sliding scale of premiums
Sec. 7. (a) The office shall develop a sliding scale of premiums
for individuals participating in the buy-in program.
(b) The sliding scale of premiums required under subsection (a)must:
(1) be based on the annual gross income of the individual and,if married, the individual's spouse; and
(2) provide for a minimum monthly premium of twenty-fivedollars ($25) and a maximum monthly premium of two hundredseventy-five dollars ($275).
(c) Subject to the minimum and maximum amounts described insubsection (b), the office may annually adjust the scale of premiumsadopted under this section.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-8
Premiums
Sec. 8. (a) An individual whose gross annual income, includingthe gross annual income of the individual's spouse, if married, is lessthan one hundred fifty percent (150%) of the federal income povertylevel for the size of the individual's or couple's family may not berequired to pay a premium to participate in the buy-in program.
(b) An individual whose gross annual income, including the grossannual income of the individual's spouse, if married, is at least onehundred fifty percent (150%) but not more than three hundred fiftypercent (350%) of the federal income poverty level for the size of theindividual's or couple's family, must pay a monthly premium in anamount equal to:
(1) the lesser of:
(A) the amount prescribed by the sliding scale developed bythe office under section 7 of this chapter; or
(B) seven and one-half percent (7 1/2%) of the individual'sor couple's gross annual income divided by twelve (12);minus
(2) the monthly amount of any premium paid by the individual,the individual's spouse, or the individual's parent for healthinsurance that covers the individual.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-9
Annual review of premiums; adjustment of premiums
Sec. 9. (a) The office shall annually review the amount of thepremium that an individual is required to pay under section 8 of thischapter.
(b) In addition to the annual review required under subsection (a),the office shall adjust the premium that an individual is required topay under section 8 of this chapter if:
(1) a change in the individual's income or family size isverified; and
(2) the sliding scale adopted under section 7 of this chapterapplied to the individual's changed circumstances prescribes apremium for the individual that is different from the premium
the individual is paying.
As added by P.L.287-2001, SEC.9. Amended by P.L.26-2003, SEC.3.
IC 12-15-41-10
Administrative procedures regarding premiums
Sec. 10. To the greatest extent possible, the office shall use thesame administrative procedures regarding premiums for the buy-inprogram as are used for the children's health insurance programestablished under IC 12-17.6, including:
(1) the effect of nonpayment of a premium; and
(2) the collection of premiums.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-11
Annual redetermination of disability
Sec. 11. (a) The office shall establish criteria to base the annualredetermination of disability required under 405 IAC 2-2-3(b) for anindividual participating in the buy-in program on the individual'smedical evidence, including evidence of physical or mentalimpairment.
(b) In conducting the annual redetermination described insubsection (a), the office may not determine that an individualparticipating in the buy-in program is no longer an individual with adisability based solely on the individual's:
(1) participation in employment;
(2) earned income; or
(3) income from self-employment.
As added by P.L.287-2001, SEC.9. Amended by P.L.99-2007,SEC.96.
IC 12-15-41-12
Home health care services; cost sharing
Sec. 12. Except as otherwise provided in this chapter, anindividual participating in the buy-in program:
(1) shall receive the same benefits, including home health careservices; and
(2) is subject to the same requirements, including cost sharing;
as an individual receiving Medicaid under IC 12-15-2-6.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-13
Criteria for determining effectiveness of buy-in program andcontinued Medicaid coverage
Sec. 13. (a) The office shall establish criteria to determine theeffectiveness of:
(1) the buy-in program; and
(2) continued Medicaid coverage through Section 1619 of thefederal Social Security Act (42 U.S.C. 1382h).
(b) The criteria required under subsection (a) must include thefollowing: (1) The number of individuals with disabilities who are:
(A) enrolled in the buy-in program; or
(B) receiving Medicaid through Section 1619 of the federalSocial Security Act (42 U.S.C. 1382h).
(2) State revenues resulting from premiums paid by participantsin the buy-in program.
(3) State costs incurred as a result of implementing the buy-inprogram, including administrative costs and costs of providingservices.
(c) In addition to the criteria required under subsection (b), theoffice may establish criteria to determine the following:
(1) Comparative costs of Medicaid funded services forparticipants in the buy-in program and work incentives createdthrough Section 1619 of the federal Social Security Act (42U.S.C. 1382h) before and after employment.
(2) The number of Supplemental Security Income and SocialSecurity Disability Insurance recipients in Indiana who are nolonger dependent on, or who have reduced dependence on,public assistance or health care entitlement services, other thanMedicaid or the children's health insurance program, due toparticipation in the buy-in program or work incentives createdthrough Section 1619 of the federal Social Security Act (42U.S.C. 1382h).
(3) The number of individuals with severe disabilities who areno longer dependent on, or who have reduced dependence on,public benefits or services, other than Medicaid or the children'shealth insurance program, due to income or support servicesreceived through participation in the buy-in program or workincentives created through Section 1619 of the federal SocialSecurity Act (42 U.S.C. 1382h).
(4) The change in the number of buy-in program participants orparticipants in work incentives created through Section 1619 ofthe federal Social Security Act (42 U.S.C. 1382h) who havehealth care needs and related services covered though employerbased benefit programs.
(d) In evaluating the effectiveness of the state's work incentiveinitiatives for individuals with disabilities, the office:
(1) shall collaborate with other state agencies on datacollection; and
(2) may consult with an independent contractor to collect dataon the criteria listed under subsection (b).
(e) The office shall provide an annual report of its evaluationunder this section to the council not later than October 1 each year,beginning in 2003.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-14
Funding for program
Sec. 14. Funding for the buy-in program shall be from fundsappropriated by the general assembly, premiums paid, and any
federal matching funds available to the program.
As added by P.L.287-2001, SEC.9.
IC 12-15-41-15
Adoption of rules
Sec. 15. (a) The office shall adopt rules under IC 4-22-2 toimplement this chapter.
(b) The office may adopt emergency rules under IC 4-22-2-37.1to implement this chapter on an emergency basis.
(c) In adopting rules under this section, the office shall:
(1) submit proposed rules to the council; and
(2) consider any recommendations of the council beforeadopting final rules.
As added by P.L.287-2001, SEC.9.