IC 12-15-2-0.5 Provisions not limiting health care assistance
Sec. 0.5. (a) This section applies to a person who qualifies for
assistance:
(1) under sections 13 through 16 of this chapter;
(2) under section 6 of this chapter when the person becomes
ineligible for medical assistance under IC 12-14-2-5.1 or
IC 12-14-2-5.3; or
(3) as an individual with a disability if the person is less than
eighteen (18) years of age and otherwise qualifies for
assistance.
(b) Notwithstanding any other law, the following may not be
construed to limit health care assistance to a person described in
subsection (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 determined
annually 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 of
assistance
Sec. 2. The county office shall determine eligibility and shall
certify to the office at the time and in the manner required by the
office a list of individuals who have been found eligible to receive
Medicaid and the effective date for the payment of assistance under
this chapter. The date must be one (1) month before the first day of
the 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 or
medical services; eligibility for medical services under aid to
dependent children assistance category or under state
supplemental assistance program for aged, blind, or disabled
Sec. 3. An individual who:
(1) is receiving monthly assistance payments or medical
services; or
(2) would be eligible to receive medical services under the aid
to dependent children assistance category or under the state
supplemental assistance program for the aged, blind, or
disabled;
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 but
for plan condition or requirement prohibited in Medicaid program
under Social Security Act
Sec. 4. An individual who would be eligible for aid or assistance
under one (1) of the other approved state plans except for an
eligibility condition or other requirement in the plan that is
specifically prohibited in a Medicaid program under Title XIX of the
federal Social Security Act (42 U.S.C. 1396 et seq.) is eligible to
receive Medicaid. As added by P.L.2-1992, SEC.9.
IC 12-15-2-5 Individuals eligible; recipients of old age assistance, blind
assistance, 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 of
December 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 and
Social Security Disability Insurance recipients
Sec. 6. (a) Subject to subsection (b), an individual who:
(1) is receiving monthly assistance payments under the federal
Supplemental Security Income program; and
(2) meets the income and resource requirements established by
statute or the office unless the state is required to provide
medical 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 assistance
payments under the federal Supplemental Security Income program
or the federal Social Security Disability Insurance program must
meet the eligibility requirements specified in IC 12-14-15 unless the
state is required to provide medical assistance to the individual under
42 U.S.C. 1382h.
(c) The office may not apply a spend down requirement to an
individual 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 July
1, 2002, an individual who meets the requirements of IC 12-15-41 is
eligible 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 is
less than twenty-one (21) years of age but not otherwise eligible to
be included in section 2 or 3 of this chapter is eligible to receive
Medicaid. 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 institutions
for 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 who
is a patient in a medical institution, as long as the institution or
that part of the institution in which the patient resides qualifies
as an intermediate care facility for mental retardation under
Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.);
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 mentally
diseased" includes a facility that meets the requirements and
regulations under 42 U.S.C. 1396 et seq.
(b) Except as provided in subsections (c) and (d), an individual
who:
(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 for
Medicaid 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 of
age or until treatment has ended, whichever occurs first.
(d) Intermediate care facility services may be provided in a mental
health 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 under
IC 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 level
established in subsection (b);
is eligible to receive Medicaid.
(b) A pregnant woman described in this section is eligible to
receive Medicaid, subject to subsections (c) and (d) and 42 U.S.C.
1396a et seq., if her family income does not exceed two hundred
percent (200%) of the federal income poverty level for the same size
family.
(c) Medicaid made available to a pregnant woman described in
this section is limited to medical assistance for services related to
pregnancy, including prenatal, delivery, and postpartum services, and
to other conditions that may complicate pregnancy.
(d) Medicaid is available to a pregnant woman described in this
section for the duration of the pregnancy and for the sixty (60) day
postpartum period that begins on the last day of the pregnancy,
without regard to any change in income of the family of which she
is a member during that time.
(e) The office may apply a resource standard in determining the
eligibility 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 breast
or cervical cancer
Sec. 13.5. (a) A woman:
(1) who is not eligible for Medicaid under any other section of
this 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 breast
and cervical cancer screening program or by another
provider under the federal Breast and Cervical Cancer
Mortality Prevention Act of 1990 (42 U.S.C. 300k); and
(B) determined to need treatment for breast or cervical
cancer;
(4) who is not otherwise covered under credible coverage (as
defined 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 size
family;
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 or
cervical 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 level
established 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's
family income does not exceed one hundred fifty percent (150%) of
the federal income poverty level for the same size family.
(c) The office may apply a resource standard in determining the
eligibility 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 of
age is determined to be eligible for Medicaid under section 14 of this
chapter, the individual is not required to submit eligibility
information more frequently than once in a twelve (12) month period
until 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 child
services under IC 31-35-6-1 (or IC 31-6-5-5 before its
repeal); or
(C) a child placed under the supervision or in the custody of
the 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 an
applicant for or a recipient of Medicaid:
(1) establishes one (1) irrevocable trust that has a value of not
more than ten thousand dollars ($10,000), exclusive of interest,
and is established for the sole purpose of providing money for
the burial of the applicant or recipient;
(2) enters into an irrevocable prepaid funeral agreement having
a value of not more than ten thousand dollars ($10,000); or
(3) owns a life insurance policy with a face value of not more
than ten thousand dollars ($10,000) and with respect to which
provision 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 insurance
policy may not be considered as a resource in determining the
applicant's or recipient's eligibility for Medicaid.
(b) Subject to subsection (d), if an applicant for or a recipient of
Medicaid establishes an irrevocable trust or escrow under
IC 30-2-13, the entire value of the trust or escrow may not be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(c) If an applicant for or a recipient of Medicaid owns resources
described in subsection (a) and the total value of those resources is
more than ten thousand dollars ($10,000), the value of those
resources that is more than ten thousand dollars ($10,000) may be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(d) In order for a trust, an escrow, a life insurance policy, or a
prepaid funeral agreement to be exempt as a resource in determining
an applicant's or a recipient's eligibility for Medicaid under this
section, the applicant or recipient must designate the office or the
applicant's or recipient's estate to receive any remaining amounts
after delivery of all services and merchandise under the contract as
reimbursement for Medicaid assistance provided to the applicant or
recipient after fifty-five (55) years of age. The office may receive
funds under this subsection only to the extent permitted by 42 U.S.C.
1396p. The computation of remaining amounts shall be made as of
the date of delivery of services and merchandise under the contract
and 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 retail
price of all services, merchandise, and cash advance items set forth
in 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 individual
receives a state or federal higher education award that is paid directly
to an approved postsecondary educational institution for the
individual's benefit:
(1) the individual is not required to report that award as income
or as a resource of the individual when applying for Medicaid;
and
(2) the award may not be considered as income or a resource of
the individual in determining initial or continuing eligibility for
Medicaid. 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 of
county office; alteration or cancellation of assistance; recovery of
excess assistance
Sec. 19. (a) If, while receiving Medicaid, a recipient becomes the
owner of any:
(1) property;
(2) income; or
(3) resources;
in excess of the amount owned when the recipient's eligibility was
determined, the recipient shall immediately notify the county office
of 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 or
alteration of the amount of Medicaid in accordance with the
circumstances.
(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 the
recipient or the estate of the recipient.
(d) However, an eligible individual is not required to notify the
division or county office of a Holocaust victim's settlement payment
received by the individual. A county office may not cancel or alter
the amount of Medicaid received by the individual after the
individual's receipt of the payment. Assistance paid after the
individual's receipt of the payment is not recoverable by the office
from 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 defined
in IC 12-7-2-149.1(2)).
(b) A person convicted of an offense under IC 35-43-5-7.1 is
ineligible 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, a
person who is ineligible for assistance under IC 12-14-2 because of
noncompliance 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 vehicle
may not be considered
Sec. 22. When the office applies a resource standard to determine
an applicant's or a recipient's eligibility for Medicaid under this
chapter, 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) motor
vehicle 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 if
transfer 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 conducts
a look back (as described in 42 U.S.C. 1396p(c)) to determine, for
purposes of eligibility, whether an individual improperly transferred
assets, the office shall not consider in total one thousand two
hundred dollars ($1,200) per year of contributions made by the
individual to a:
(1) family member; or
(2) nonprofit organization;
as an improper transfer.
(c) The office may disregard a contribution by an individual if the
individual can demonstrate that the transfer follows a pattern that
existed for at least three (3) years before applying for Medicaid or
was not for the purpose of fraud.
(d) Any rule adopted by the office of the secretary concerning a
transfer of property may not apply to a transfer of property that
occurred 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 noninstitutionalized
individual; 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 allowed
in 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 of
the noninstitutionalized individual for the disposal of assets for less
than fair market value.
(c) In implementing the federal Deficit Reduction Act of 2005, the
office shall comply with the following:
(1) A rule adopted may not apply to the transfer of property or
another transaction that occurred before the passage of the rule.
(2) The office may not require an individual to return all assets
in order to reduce a penalty period for the transfer of assets. The
office shall allow a penalty period to be proportionally reduced
for 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 an
individual 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 in
subsection (a), the office shall, beginning in calendar year 2006, use
the greater of the following community spouse resource allowances:
(1) Nineteen thousand twenty dollars ($19,020), subject to an
adjustment 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 administrative
hearing if the community spouse's income is less than the
minimum monthly needs allowance established under 42 U.S.C.
1396r-5(d)(3) and an increased amount is necessary to increase
the community spouse's income to the minimum monthly needs
allowance.
(c) An institutionalized spouse shall not be ineligible for the
program because of resources if:
(1) the institutionalized spouse:
(A) establishes that the individual has a right to receive
support from the community spouse; and
(B) assigns to the office the right to receive support from the
community 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 the
amount of resources necessary to provide income to the community
spouse 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 retain
an income allowance for the purpose of supporting a community
spouse if:
(1) the community spouse's income is less than the minimum
monthly needs allowance established under 42 U.S.C.
1396r-5(d)(3); and
(2) an increased amount is necessary to increase the community
spouse's income to the minimum monthly needs allowance.
(c) If either spouse establishes that a higher allowance is needed
due to exceptional circumstances resulting in significant financial
duress, the minimum monthly needs allowance may be increased
after an administrative hearing or by a court order.
(d) The office shall adopt rules under IC 4-22-2 setting forth the
manner in which the office will determine the existence of
exceptional circumstances resulting in significant financial duress
under subsection (c). As added by P.L.246-2005, SEC.103.
IC 12-15-2-0.5 Provisions not limiting health care assistance
Sec. 0.5. (a) This section applies to a person who qualifies for
assistance:
(1) under sections 13 through 16 of this chapter;
(2) under section 6 of this chapter when the person becomes
ineligible for medical assistance under IC 12-14-2-5.1 or
IC 12-14-2-5.3; or
(3) as an individual with a disability if the person is less than
eighteen (18) years of age and otherwise qualifies for
assistance.
(b) Notwithstanding any other law, the following may not be
construed to limit health care assistance to a person described in
subsection (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 determined
annually 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 of
assistance
Sec. 2. The county office shall determine eligibility and shall
certify to the office at the time and in the manner required by the
office a list of individuals who have been found eligible to receive
Medicaid and the effective date for the payment of assistance under
this chapter. The date must be one (1) month before the first day of
the 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 or
medical services; eligibility for medical services under aid to
dependent children assistance category or under state
supplemental assistance program for aged, blind, or disabled
Sec. 3. An individual who:
(1) is receiving monthly assistance payments or medical
services; or
(2) would be eligible to receive medical services under the aid
to dependent children assistance category or under the state
supplemental assistance program for the aged, blind, or
disabled;
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 but
for plan condition or requirement prohibited in Medicaid program
under Social Security Act
Sec. 4. An individual who would be eligible for aid or assistance
under one (1) of the other approved state plans except for an
eligibility condition or other requirement in the plan that is
specifically prohibited in a Medicaid program under Title XIX of the
federal Social Security Act (42 U.S.C. 1396 et seq.) is eligible to
receive Medicaid. As added by P.L.2-1992, SEC.9.
IC 12-15-2-5 Individuals eligible; recipients of old age assistance, blind
assistance, 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 of
December 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 and
Social Security Disability Insurance recipients
Sec. 6. (a) Subject to subsection (b), an individual who:
(1) is receiving monthly assistance payments under the federal
Supplemental Security Income program; and
(2) meets the income and resource requirements established by
statute or the office unless the state is required to provide
medical 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 assistance
payments under the federal Supplemental Security Income program
or the federal Social Security Disability Insurance program must
meet the eligibility requirements specified in IC 12-14-15 unless the
state is required to provide medical assistance to the individual under
42 U.S.C. 1382h.
(c) The office may not apply a spend down requirement to an
individual 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 July
1, 2002, an individual who meets the requirements of IC 12-15-41 is
eligible 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 is
less than twenty-one (21) years of age but not otherwise eligible to
be included in section 2 or 3 of this chapter is eligible to receive
Medicaid. 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 institutions
for 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 who
is a patient in a medical institution, as long as the institution or
that part of the institution in which the patient resides qualifies
as an intermediate care facility for mental retardation under
Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.);
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 mentally
diseased" includes a facility that meets the requirements and
regulations under 42 U.S.C. 1396 et seq.
(b) Except as provided in subsections (c) and (d), an individual
who:
(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 for
Medicaid 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 of
age or until treatment has ended, whichever occurs first.
(d) Intermediate care facility services may be provided in a mental
health 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 under
IC 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 level
established in subsection (b);
is eligible to receive Medicaid.
(b) A pregnant woman described in this section is eligible to
receive Medicaid, subject to subsections (c) and (d) and 42 U.S.C.
1396a et seq., if her family income does not exceed two hundred
percent (200%) of the federal income poverty level for the same size
family.
(c) Medicaid made available to a pregnant woman described in
this section is limited to medical assistance for services related to
pregnancy, including prenatal, delivery, and postpartum services, and
to other conditions that may complicate pregnancy.
(d) Medicaid is available to a pregnant woman described in this
section for the duration of the pregnancy and for the sixty (60) day
postpartum period that begins on the last day of the pregnancy,
without regard to any change in income of the family of which she
is a member during that time.
(e) The office may apply a resource standard in determining the
eligibility 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 breast
or cervical cancer
Sec. 13.5. (a) A woman:
(1) who is not eligible for Medicaid under any other section of
this 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 breast
and cervical cancer screening program or by another
provider under the federal Breast and Cervical Cancer
Mortality Prevention Act of 1990 (42 U.S.C. 300k); and
(B) determined to need treatment for breast or cervical
cancer;
(4) who is not otherwise covered under credible coverage (as
defined 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 size
family;
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 or
cervical 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 level
established 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's
family income does not exceed one hundred fifty percent (150%) of
the federal income poverty level for the same size family.
(c) The office may apply a resource standard in determining the
eligibility 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 of
age is determined to be eligible for Medicaid under section 14 of this
chapter, the individual is not required to submit eligibility
information more frequently than once in a twelve (12) month period
until 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 child
services under IC 31-35-6-1 (or IC 31-6-5-5 before its
repeal); or
(C) a child placed under the supervision or in the custody of
the 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 an
applicant for or a recipient of Medicaid:
(1) establishes one (1) irrevocable trust that has a value of not
more than ten thousand dollars ($10,000), exclusive of interest,
and is established for the sole purpose of providing money for
the burial of the applicant or recipient;
(2) enters into an irrevocable prepaid funeral agreement having
a value of not more than ten thousand dollars ($10,000); or
(3) owns a life insurance policy with a face value of not more
than ten thousand dollars ($10,000) and with respect to which
provision 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 insurance
policy may not be considered as a resource in determining the
applicant's or recipient's eligibility for Medicaid.
(b) Subject to subsection (d), if an applicant for or a recipient of
Medicaid establishes an irrevocable trust or escrow under
IC 30-2-13, the entire value of the trust or escrow may not be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(c) If an applicant for or a recipient of Medicaid owns resources
described in subsection (a) and the total value of those resources is
more than ten thousand dollars ($10,000), the value of those
resources that is more than ten thousand dollars ($10,000) may be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(d) In order for a trust, an escrow, a life insurance policy, or a
prepaid funeral agreement to be exempt as a resource in determining
an applicant's or a recipient's eligibility for Medicaid under this
section, the applicant or recipient must designate the office or the
applicant's or recipient's estate to receive any remaining amounts
after delivery of all services and merchandise under the contract as
reimbursement for Medicaid assistance provided to the applicant or
recipient after fifty-five (55) years of age. The office may receive
funds under this subsection only to the extent permitted by 42 U.S.C.
1396p. The computation of remaining amounts shall be made as of
the date of delivery of services and merchandise under the contract
and 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 retail
price of all services, merchandise, and cash advance items set forth
in 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 individual
receives a state or federal higher education award that is paid directly
to an approved postsecondary educational institution for the
individual's benefit:
(1) the individual is not required to report that award as income
or as a resource of the individual when applying for Medicaid;
and
(2) the award may not be considered as income or a resource of
the individual in determining initial or continuing eligibility for
Medicaid. 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 of
county office; alteration or cancellation of assistance; recovery of
excess assistance
Sec. 19. (a) If, while receiving Medicaid, a recipient becomes the
owner of any:
(1) property;
(2) income; or
(3) resources;
in excess of the amount owned when the recipient's eligibility was
determined, the recipient shall immediately notify the county office
of 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 or
alteration of the amount of Medicaid in accordance with the
circumstances.
(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 the
recipient or the estate of the recipient.
(d) However, an eligible individual is not required to notify the
division or county office of a Holocaust victim's settlement payment
received by the individual. A county office may not cancel or alter
the amount of Medicaid received by the individual after the
individual's receipt of the payment. Assistance paid after the
individual's receipt of the payment is not recoverable by the office
from 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 defined
in IC 12-7-2-149.1(2)).
(b) A person convicted of an offense under IC 35-43-5-7.1 is
ineligible 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, a
person who is ineligible for assistance under IC 12-14-2 because of
noncompliance 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 vehicle
may not be considered
Sec. 22. When the office applies a resource standard to determine
an applicant's or a recipient's eligibility for Medicaid under this
chapter, 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) motor
vehicle 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 if
transfer 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 conducts
a look back (as described in 42 U.S.C. 1396p(c)) to determine, for
purposes of eligibility, whether an individual improperly transferred
assets, the office shall not consider in total one thousand two
hundred dollars ($1,200) per year of contributions made by the
individual to a:
(1) family member; or
(2) nonprofit organization;
as an improper transfer.
(c) The office may disregard a contribution by an individual if the
individual can demonstrate that the transfer follows a pattern that
existed for at least three (3) years before applying for Medicaid or
was not for the purpose of fraud.
(d) Any rule adopted by the office of the secretary concerning a
transfer of property may not apply to a transfer of property that
occurred 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 noninstitutionalized
individual; 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 allowed
in 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 of
the noninstitutionalized individual for the disposal of assets for less
than fair market value.
(c) In implementing the federal Deficit Reduction Act of 2005, the
office shall comply with the following:
(1) A rule adopted may not apply to the transfer of property or
another transaction that occurred before the passage of the rule.
(2) The office may not require an individual to return all assets
in order to reduce a penalty period for the transfer of assets. The
office shall allow a penalty period to be proportionally reduced
for 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 an
individual 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 in
subsection (a), the office shall, beginning in calendar year 2006, use
the greater of the following community spouse resource allowances:
(1) Nineteen thousand twenty dollars ($19,020), subject to an
adjustment 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 administrative
hearing if the community spouse's income is less than the
minimum monthly needs allowance established under 42 U.S.C.
1396r-5(d)(3) and an increased amount is necessary to increase
the community spouse's income to the minimum monthly needs
allowance.
(c) An institutionalized spouse shall not be ineligible for the
program because of resources if:
(1) the institutionalized spouse:
(A) establishes that the individual has a right to receive
support from the community spouse; and
(B) assigns to the office the right to receive support from the
community 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 the
amount of resources necessary to provide income to the community
spouse 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 retain
an income allowance for the purpose of supporting a community
spouse if:
(1) the community spouse's income is less than the minimum
monthly needs allowance established under 42 U.S.C.
1396r-5(d)(3); and
(2) an increased amount is necessary to increase the community
spouse's income to the minimum monthly needs allowance.
(c) If either spouse establishes that a higher allowance is needed
due to exceptional circumstances resulting in significant financial
duress, the minimum monthly needs allowance may be increased
after an administrative hearing or by a court order.
(d) The office shall adopt rules under IC 4-22-2 setting forth the
manner in which the office will determine the existence of
exceptional circumstances resulting in significant financial duress
under subsection (c). As added by P.L.246-2005, SEC.103.
IC 12-15-2-0.5 Provisions not limiting health care assistance
Sec. 0.5. (a) This section applies to a person who qualifies for
assistance:
(1) under sections 13 through 16 of this chapter;
(2) under section 6 of this chapter when the person becomes
ineligible for medical assistance under IC 12-14-2-5.1 or
IC 12-14-2-5.3; or
(3) as an individual with a disability if the person is less than
eighteen (18) years of age and otherwise qualifies for
assistance.
(b) Notwithstanding any other law, the following may not be
construed to limit health care assistance to a person described in
subsection (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 determined
annually 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 of
assistance
Sec. 2. The county office shall determine eligibility and shall
certify to the office at the time and in the manner required by the
office a list of individuals who have been found eligible to receive
Medicaid and the effective date for the payment of assistance under
this chapter. The date must be one (1) month before the first day of
the 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 or
medical services; eligibility for medical services under aid to
dependent children assistance category or under state
supplemental assistance program for aged, blind, or disabled
Sec. 3. An individual who:
(1) is receiving monthly assistance payments or medical
services; or
(2) would be eligible to receive medical services under the aid
to dependent children assistance category or under the state
supplemental assistance program for the aged, blind, or
disabled;
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 but
for plan condition or requirement prohibited in Medicaid program
under Social Security Act
Sec. 4. An individual who would be eligible for aid or assistance
under one (1) of the other approved state plans except for an
eligibility condition or other requirement in the plan that is
specifically prohibited in a Medicaid program under Title XIX of the
federal Social Security Act (42 U.S.C. 1396 et seq.) is eligible to
receive Medicaid. As added by P.L.2-1992, SEC.9.
IC 12-15-2-5 Individuals eligible; recipients of old age assistance, blind
assistance, 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 of
December 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 and
Social Security Disability Insurance recipients
Sec. 6. (a) Subject to subsection (b), an individual who:
(1) is receiving monthly assistance payments under the federal
Supplemental Security Income program; and
(2) meets the income and resource requirements established by
statute or the office unless the state is required to provide
medical 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 assistance
payments under the federal Supplemental Security Income program
or the federal Social Security Disability Insurance program must
meet the eligibility requirements specified in IC 12-14-15 unless the
state is required to provide medical assistance to the individual under
42 U.S.C. 1382h.
(c) The office may not apply a spend down requirement to an
individual 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 July
1, 2002, an individual who meets the requirements of IC 12-15-41 is
eligible 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 is
less than twenty-one (21) years of age but not otherwise eligible to
be included in section 2 or 3 of this chapter is eligible to receive
Medicaid. 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 institutions
for 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 who
is a patient in a medical institution, as long as the institution or
that part of the institution in which the patient resides qualifies
as an intermediate care facility for mental retardation under
Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.);
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 mentally
diseased" includes a facility that meets the requirements and
regulations under 42 U.S.C. 1396 et seq.
(b) Except as provided in subsections (c) and (d), an individual
who:
(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 for
Medicaid 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 of
age or until treatment has ended, whichever occurs first.
(d) Intermediate care facility services may be provided in a mental
health 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 under
IC 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 level
established in subsection (b);
is eligible to receive Medicaid.
(b) A pregnant woman described in this section is eligible to
receive Medicaid, subject to subsections (c) and (d) and 42 U.S.C.
1396a et seq., if her family income does not exceed two hundred
percent (200%) of the federal income poverty level for the same size
family.
(c) Medicaid made available to a pregnant woman described in
this section is limited to medical assistance for services related to
pregnancy, including prenatal, delivery, and postpartum services, and
to other conditions that may complicate pregnancy.
(d) Medicaid is available to a pregnant woman described in this
section for the duration of the pregnancy and for the sixty (60) day
postpartum period that begins on the last day of the pregnancy,
without regard to any change in income of the family of which she
is a member during that time.
(e) The office may apply a resource standard in determining the
eligibility 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 breast
or cervical cancer
Sec. 13.5. (a) A woman:
(1) who is not eligible for Medicaid under any other section of
this 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 breast
and cervical cancer screening program or by another
provider under the federal Breast and Cervical Cancer
Mortality Prevention Act of 1990 (42 U.S.C. 300k); and
(B) determined to need treatment for breast or cervical
cancer;
(4) who is not otherwise covered under credible coverage (as
defined 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 size
family;
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 or
cervical 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 level
established 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's
family income does not exceed one hundred fifty percent (150%) of
the federal income poverty level for the same size family.
(c) The office may apply a resource standard in determining the
eligibility 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 of
age is determined to be eligible for Medicaid under section 14 of this
chapter, the individual is not required to submit eligibility
information more frequently than once in a twelve (12) month period
until 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 child
services under IC 31-35-6-1 (or IC 31-6-5-5 before its
repeal); or
(C) a child placed under the supervision or in the custody of
the 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 an
applicant for or a recipient of Medicaid:
(1) establishes one (1) irrevocable trust that has a value of not
more than ten thousand dollars ($10,000), exclusive of interest,
and is established for the sole purpose of providing money for
the burial of the applicant or recipient;
(2) enters into an irrevocable prepaid funeral agreement having
a value of not more than ten thousand dollars ($10,000); or
(3) owns a life insurance policy with a face value of not more
than ten thousand dollars ($10,000) and with respect to which
provision 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 insurance
policy may not be considered as a resource in determining the
applicant's or recipient's eligibility for Medicaid.
(b) Subject to subsection (d), if an applicant for or a recipient of
Medicaid establishes an irrevocable trust or escrow under
IC 30-2-13, the entire value of the trust or escrow may not be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(c) If an applicant for or a recipient of Medicaid owns resources
described in subsection (a) and the total value of those resources is
more than ten thousand dollars ($10,000), the value of those
resources that is more than ten thousand dollars ($10,000) may be
considered as a resource in determining the applicant's or recipient's
eligibility for Medicaid.
(d) In order for a trust, an escrow, a life insurance policy, or a
prepaid funeral agreement to be exempt as a resource in determining
an applicant's or a recipient's eligibility for Medicaid under this
section, the applicant or recipient must designate the office or the
applicant's or recipient's estate to receive any remaining amounts
after delivery of all services and merchandise under the contract as
reimbursement for Medicaid assistance provided to the applicant or
recipient after fifty-five (55) years of age. The office may receive
funds under this subsection only to the extent permitted by 42 U.S.C.
1396p. The computation of remaining amounts shall be made as of
the date of delivery of services and merchandise under the contract
and 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 retail
price of all services, merchandise, and cash advance items set forth
in 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 individual
receives a state or federal higher education award that is paid directly
to an approved postsecondary educational institution for the
individual's benefit:
(1) the individual is not required to report that award as income
or as a resource of the individual when applying for Medicaid;
and
(2) the award may not be considered as income or a resource of
the individual in determining initial or continuing eligibility for
Medicaid. 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 of
county office; alteration or cancellation of assistance; recovery of
excess assistance
Sec. 19. (a) If, while receiving Medicaid, a recipient becomes the
owner of any:
(1) property;
(2) income; or
(3) resources;
in excess of the amount owned when the recipient's eligibility was
determined, the recipient shall immediately notify the county office
of 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 or
alteration of the amount of Medicaid in accordance with the
circumstances.
(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 the
recipient or the estate of the recipient.
(d) However, an eligible individual is not required to notify the
division or county office of a Holocaust victim's settlement payment
received by the individual. A county office may not cancel or alter
the amount of Medicaid received by the individual after the
individual's receipt of the payment. Assistance paid after the
individual's receipt of the payment is not recoverable by the office
from 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 defined
in IC 12-7-2-149.1(2)).
(b) A person convicted of an offense under IC 35-43-5-7.1 is
ineligible 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, a
person who is ineligible for assistance under IC 12-14-2 because of
noncompliance 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 vehicle
may not be considered
Sec. 22. When the office applies a resource standard to determine
an applicant's or a recipient's eligibility for Medicaid under this
chapter, 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) motor
vehicle 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 if
transfer 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 conducts
a look back (as described in 42 U.S.C. 1396p(c)) to determine, for
purposes of eligibility, whether an individual improperly transferred
assets, the office shall not consider in total one thousand two
hundred dollars ($1,200) per year of contributions made by the
individual to a:
(1) family member; or
(2) nonprofit organization;
as an improper transfer.
(c) The office may disregard a contribution by an individual if the
individual can demonstrate that the transfer follows a pattern that
existed for at least three (3) years before applying for Medicaid or
was not for the purpose of fraud.
(d) Any rule adopted by the office of the secretary concerning a
transfer of property may not apply to a transfer of property that
occurred 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 noninstitutionalized
individual; 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 allowed
in 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 of
the noninstitutionalized individual for the disposal of assets for less
than fair market value.
(c) In implementing the federal Deficit Reduction Act of 2005, the
office shall comply with the following:
(1) A rule adopted may not apply to the transfer of property or
another transaction that occurred before the passage of the rule.
(2) The office may not require an individual to return all assets
in order to reduce a penalty period for the transfer of assets. The
office shall allow a penalty period to be proportionally reduced
for 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 an
individual 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 in
subsection (a), the office shall, beginning in calendar year 2006, use
the greater of the following community spouse resource allowances:
(1) Nineteen thousand twenty dollars ($19,020), subject to an
adjustment 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 administrative
hearing if the community spouse's income is less than the
minimum monthly needs allowance established under 42 U.S.C.
1396r-5(d)(3) and an increased amount is necessary to increase
the community spouse's income to the minimum monthly needs
allowance.
(c) An institutionalized spouse shall not be ineligible for the
program because of resources if:
(1) the institutionalized spouse:
(A) establishes that the individual has a right to receive
support from the community spouse; and
(B) assigns to the office the right to receive support from the
community 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 the
amount of resources necessary to provide income to the community
spouse 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 retain
an income allowance for the purpose of supporting a community
spouse if:
(1) the community spouse's income is less than the minimum
monthly needs allowance established under 42 U.S.C.
1396r-5(d)(3); and
(2) an increased amount is necessary to increase the community
spouse's income to the minimum monthly needs allowance.
(c) If either spouse establishes that a higher allowance is needed
due to exceptional circumstances resulting in significant financial
duress, the minimum monthly needs allowance may be increased
after an administrative hearing or by a court order.
(d) The office shall adopt rules under IC 4-22-2 setting forth the
manner in which the office will determine the existence of
exceptional circumstances resulting in significant financial duress
under subsection (c). As added by P.L.246-2005, SEC.103.
