IC 12-15-41
Chapter 41. Medicaid Buy-In Program for Working Individuals
With Disabilities
IC 12-15-41-1 "Buy-in program" defined
Sec. 1. As used in this chapter, "buy-in program" refers to the
Medicaid buy-in program for working individuals with disabilities
established 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 all
cash, other liquid assets, real property, and personal property owned
by an applicant for or a recipient of Medicaid under this chapter, or
the spouse of an applicant or a recipient, that could be converted to
cash to be used for support or maintenance, except the following:
(1) All resources disregarded by the office under this article for
the 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 under
26 U.S.C. 220 and held by either the applicant or recipient or
the applicant's or recipient's spouse.
(3) Subject to approval by the office, not more than twenty
thousand dollars ($20,000) in independence and self-sufficiency
accounts held by the applicant or recipient for the sole purpose
of purchasing goods or services, including assistive technology
and personal assistance, that:
(A) will increase the employability or independence of the
applicant or recipient; and
(B) are not services to which the recipient is entitled under
Medicaid or any other publicly funded program.
In determining the types of accounts to be approved under this
subdivision, the office shall consider any recommendations
made by the Medicaid work incentives council established by
IC 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 individuals
with disabilities is established to provide, beginning July 1, 2002,
Medicaid to individuals who are disabled and employed, as
authorized under Section 201 of the federal Ticket to Work and
Work 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 under
IC 12-15-2-6, except as follows:
(1) The individual has a severe medically determinable
impairment without regard to the individual's employment
status.
(2) The individual must be at least sixteen (16) years of age but
not more than sixty-four (64) years of age.
(3) The individual must be engaged in a substantial and
reasonable work effort as determined by the office and as
permitted by federal law.
(4) The individual does not have countable resources that
exceed the resource limits for the federal Supplemental Security
Income program (42 U.S.C. 1382).
(5) The individual's annual gross income does not exceed three
hundred fifty percent (350%) of the federal income poverty
level for an individual. In determining an individual's income
under this subdivision, the office may not consider the
following:
(A) The income of the individual's spouse.
(B) Income disregarded under the state Medicaid plan's
financial methodology, including income disregarded under
the federal Supplemental Security Income program (42
U.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 and
who no longer meets the eligibility requirements set forth in section
4 of this chapter due to an improvement in the individual's medical
condition continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) The individual continues to have a severe medically
determinable impairment, as determined by the office and as
allowed by federal law.
(2) The individual is employed and earning a monthly wage that
is not less than the federal minimum hourly wage times forty
(40).
(3) The individual does not have income or countable resources
in excess of the limits established under section 4 of this
chapter.
(4) The individual is at least sixteen (16) years of age and less
than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements under
this 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 program
and who is unable to maintain employment for involuntary reasons,
including temporary leave due to a health problem or involuntary
termination, continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) Within sixty (60) days after the date on which the individual
becomes unemployed, the individual, or an authorized
representative of the individual, submits a written request to the
office that the individual's Medicaid coverage be continued.
(2) The individual maintains a connection to the workforce
during the individual's continued eligibility period by
participating in at least one (1) of the following activities:
(A) Enrollment in a state or federal vocational rehabilitation
program.
(B) Enrollment or registration with the office of workforce
development.
(C) Participation in a transition from school to work
program.
(D) Participation with an approved provider of employment
services.
(E) Provision of documentation from the individual's
employer that the individual is on temporary involuntary
leave.
(3) The individual does not have income or countable resources
in excess of the limits established under section 4 of this
chapter.
(4) The individual is at least sixteen (16) years of age and less
than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements under
this chapter.
(b) The office shall continue Medicaid coverage under the buy-in
program for an individual described in subsection (a) for up to twelve
(12) months from the date of the individual's involuntary loss of
employment.
(c) If an individual is ineligible for continued coverage under the
buy-in program because the individual:
(1) fails to meet the requirements of subsection (a); or
(2) has already met twelve (12) months of continuing eligibility
under this section;
the individual must meet the eligibility requirements of IC 12-15-2-6
to 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-five
dollars ($25) and a maximum monthly premium of two hundred
seventy-five dollars ($275).
(c) Subject to the minimum and maximum amounts described in
subsection (b), the office may annually adjust the scale of premiums
adopted 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, including
the gross annual income of the individual's spouse, if married, is less
than one hundred fifty percent (150%) of the federal income poverty
level for the size of the individual's or couple's family may not be
required to pay a premium to participate in the buy-in program.
(b) An individual whose gross annual income, including the gross
annual income of the individual's spouse, if married, is at least one
hundred fifty percent (150%) but not more than three hundred fifty
percent (350%) of the federal income poverty level for the size of the
individual's or couple's family, must pay a monthly premium in an
amount equal to:
(1) the lesser of:
(A) the amount prescribed by the sliding scale developed by
the office under section 7 of this chapter; or
(B) seven and one-half percent (7 1/2%) of the individual's
or 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 health
insurance 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 the
premium that an individual is required to pay under section 8 of this
chapter.
(b) In addition to the annual review required under subsection (a),
the office shall adjust the premium that an individual is required to
pay under section 8 of this chapter if:
(1) a change in the individual's income or family size is
verified; and
(2) the sliding scale adopted under section 7 of this chapter
applied to the individual's changed circumstances prescribes a
premium 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 the
same administrative procedures regarding premiums for the buy-in
program as are used for the children's health insurance program
established 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 annual
redetermination of disability required under 405 IAC 2-2-3(b) for an
individual participating in the buy-in program on the individual's
medical evidence, including evidence of physical or mental
impairment.
(b) In conducting the annual redetermination described in
subsection (a), the office may not determine that an individual
participating in the buy-in program is no longer an individual with a
disability 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, an
individual participating in the buy-in program:
(1) shall receive the same benefits, including home health care
services; 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 and
continued Medicaid coverage
Sec. 13. (a) The office shall establish criteria to determine the
effectiveness of:
(1) the buy-in program; and
(2) continued Medicaid coverage through Section 1619 of the
federal Social Security Act (42 U.S.C. 1382h).
(b) The criteria required under subsection (a) must include the
following:
(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 federal
Social Security Act (42 U.S.C. 1382h).
(2) State revenues resulting from premiums paid by participants
in the buy-in program.
(3) State costs incurred as a result of implementing the buy-in
program, including administrative costs and costs of providing
services.
(c) In addition to the criteria required under subsection (b), the
office may establish criteria to determine the following:
(1) Comparative costs of Medicaid funded services for
participants in the buy-in program and work incentives created
through Section 1619 of the federal Social Security Act (42
U.S.C. 1382h) before and after employment.
(2) The number of Supplemental Security Income and Social
Security Disability Insurance recipients in Indiana who are no
longer dependent on, or who have reduced dependence on,
public assistance or health care entitlement services, other than
Medicaid or the children's health insurance program, due to
participation in the buy-in program or work incentives created
through Section 1619 of the federal Social Security Act (42
U.S.C. 1382h).
(3) The number of individuals with severe disabilities who are
no longer dependent on, or who have reduced dependence on,
public benefits or services, other than Medicaid or the children's
health insurance program, due to income or support services
received through participation in the buy-in program or work
incentives created through Section 1619 of the federal Social
Security Act (42 U.S.C. 1382h).
(4) The change in the number of buy-in program participants or
participants in work incentives created through Section 1619 of
the federal Social Security Act (42 U.S.C. 1382h) who have
health care needs and related services covered though employer
based benefit programs.
(d) In evaluating the effectiveness of the state's work incentive
initiatives for individuals with disabilities, the office:
(1) shall collaborate with other state agencies on data
collection; and
(2) may consult with an independent contractor to collect data
on the criteria listed under subsection (b).
(e) The office shall provide an annual report of its evaluation
under 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 funds
appropriated 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 to
implement this chapter.
(b) The office may adopt emergency rules under IC 4-22-2-37.1
to 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 before
adopting final rules. As added by P.L.287-2001, SEC.9.
IC 12-15-41
Chapter 41. Medicaid Buy-In Program for Working Individuals
With Disabilities
IC 12-15-41-1 "Buy-in program" defined
Sec. 1. As used in this chapter, "buy-in program" refers to the
Medicaid buy-in program for working individuals with disabilities
established 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 all
cash, other liquid assets, real property, and personal property owned
by an applicant for or a recipient of Medicaid under this chapter, or
the spouse of an applicant or a recipient, that could be converted to
cash to be used for support or maintenance, except the following:
(1) All resources disregarded by the office under this article for
the 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 under
26 U.S.C. 220 and held by either the applicant or recipient or
the applicant's or recipient's spouse.
(3) Subject to approval by the office, not more than twenty
thousand dollars ($20,000) in independence and self-sufficiency
accounts held by the applicant or recipient for the sole purpose
of purchasing goods or services, including assistive technology
and personal assistance, that:
(A) will increase the employability or independence of the
applicant or recipient; and
(B) are not services to which the recipient is entitled under
Medicaid or any other publicly funded program.
In determining the types of accounts to be approved under this
subdivision, the office shall consider any recommendations
made by the Medicaid work incentives council established by
IC 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 individuals
with disabilities is established to provide, beginning July 1, 2002,
Medicaid to individuals who are disabled and employed, as
authorized under Section 201 of the federal Ticket to Work and
Work 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 under
IC 12-15-2-6, except as follows:
(1) The individual has a severe medically determinable
impairment without regard to the individual's employment
status.
(2) The individual must be at least sixteen (16) years of age but
not more than sixty-four (64) years of age.
(3) The individual must be engaged in a substantial and
reasonable work effort as determined by the office and as
permitted by federal law.
(4) The individual does not have countable resources that
exceed the resource limits for the federal Supplemental Security
Income program (42 U.S.C. 1382).
(5) The individual's annual gross income does not exceed three
hundred fifty percent (350%) of the federal income poverty
level for an individual. In determining an individual's income
under this subdivision, the office may not consider the
following:
(A) The income of the individual's spouse.
(B) Income disregarded under the state Medicaid plan's
financial methodology, including income disregarded under
the federal Supplemental Security Income program (42
U.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 and
who no longer meets the eligibility requirements set forth in section
4 of this chapter due to an improvement in the individual's medical
condition continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) The individual continues to have a severe medically
determinable impairment, as determined by the office and as
allowed by federal law.
(2) The individual is employed and earning a monthly wage that
is not less than the federal minimum hourly wage times forty
(40).
(3) The individual does not have income or countable resources
in excess of the limits established under section 4 of this
chapter.
(4) The individual is at least sixteen (16) years of age and less
than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements under
this 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 program
and who is unable to maintain employment for involuntary reasons,
including temporary leave due to a health problem or involuntary
termination, continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) Within sixty (60) days after the date on which the individual
becomes unemployed, the individual, or an authorized
representative of the individual, submits a written request to the
office that the individual's Medicaid coverage be continued.
(2) The individual maintains a connection to the workforce
during the individual's continued eligibility period by
participating in at least one (1) of the following activities:
(A) Enrollment in a state or federal vocational rehabilitation
program.
(B) Enrollment or registration with the office of workforce
development.
(C) Participation in a transition from school to work
program.
(D) Participation with an approved provider of employment
services.
(E) Provision of documentation from the individual's
employer that the individual is on temporary involuntary
leave.
(3) The individual does not have income or countable resources
in excess of the limits established under section 4 of this
chapter.
(4) The individual is at least sixteen (16) years of age and less
than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements under
this chapter.
(b) The office shall continue Medicaid coverage under the buy-in
program for an individual described in subsection (a) for up to twelve
(12) months from the date of the individual's involuntary loss of
employment.
(c) If an individual is ineligible for continued coverage under the
buy-in program because the individual:
(1) fails to meet the requirements of subsection (a); or
(2) has already met twelve (12) months of continuing eligibility
under this section;
the individual must meet the eligibility requirements of IC 12-15-2-6
to 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-five
dollars ($25) and a maximum monthly premium of two hundred
seventy-five dollars ($275).
(c) Subject to the minimum and maximum amounts described in
subsection (b), the office may annually adjust the scale of premiums
adopted 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, including
the gross annual income of the individual's spouse, if married, is less
than one hundred fifty percent (150%) of the federal income poverty
level for the size of the individual's or couple's family may not be
required to pay a premium to participate in the buy-in program.
(b) An individual whose gross annual income, including the gross
annual income of the individual's spouse, if married, is at least one
hundred fifty percent (150%) but not more than three hundred fifty
percent (350%) of the federal income poverty level for the size of the
individual's or couple's family, must pay a monthly premium in an
amount equal to:
(1) the lesser of:
(A) the amount prescribed by the sliding scale developed by
the office under section 7 of this chapter; or
(B) seven and one-half percent (7 1/2%) of the individual's
or 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 health
insurance 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 the
premium that an individual is required to pay under section 8 of this
chapter.
(b) In addition to the annual review required under subsection (a),
the office shall adjust the premium that an individual is required to
pay under section 8 of this chapter if:
(1) a change in the individual's income or family size is
verified; and
(2) the sliding scale adopted under section 7 of this chapter
applied to the individual's changed circumstances prescribes a
premium 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 the
same administrative procedures regarding premiums for the buy-in
program as are used for the children's health insurance program
established 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 annual
redetermination of disability required under 405 IAC 2-2-3(b) for an
individual participating in the buy-in program on the individual's
medical evidence, including evidence of physical or mental
impairment.
(b) In conducting the annual redetermination described in
subsection (a), the office may not determine that an individual
participating in the buy-in program is no longer an individual with a
disability 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, an
individual participating in the buy-in program:
(1) shall receive the same benefits, including home health care
services; 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 and
continued Medicaid coverage
Sec. 13. (a) The office shall establish criteria to determine the
effectiveness of:
(1) the buy-in program; and
(2) continued Medicaid coverage through Section 1619 of the
federal Social Security Act (42 U.S.C. 1382h).
(b) The criteria required under subsection (a) must include the
following:
(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 federal
Social Security Act (42 U.S.C. 1382h).
(2) State revenues resulting from premiums paid by participants
in the buy-in program.
(3) State costs incurred as a result of implementing the buy-in
program, including administrative costs and costs of providing
services.
(c) In addition to the criteria required under subsection (b), the
office may establish criteria to determine the following:
(1) Comparative costs of Medicaid funded services for
participants in the buy-in program and work incentives created
through Section 1619 of the federal Social Security Act (42
U.S.C. 1382h) before and after employment.
(2) The number of Supplemental Security Income and Social
Security Disability Insurance recipients in Indiana who are no
longer dependent on, or who have reduced dependence on,
public assistance or health care entitlement services, other than
Medicaid or the children's health insurance program, due to
participation in the buy-in program or work incentives created
through Section 1619 of the federal Social Security Act (42
U.S.C. 1382h).
(3) The number of individuals with severe disabilities who are
no longer dependent on, or who have reduced dependence on,
public benefits or services, other than Medicaid or the children's
health insurance program, due to income or support services
received through participation in the buy-in program or work
incentives created through Section 1619 of the federal Social
Security Act (42 U.S.C. 1382h).
(4) The change in the number of buy-in program participants or
participants in work incentives created through Section 1619 of
the federal Social Security Act (42 U.S.C. 1382h) who have
health care needs and related services covered though employer
based benefit programs.
(d) In evaluating the effectiveness of the state's work incentive
initiatives for individuals with disabilities, the office:
(1) shall collaborate with other state agencies on data
collection; and
(2) may consult with an independent contractor to collect data
on the criteria listed under subsection (b).
(e) The office shall provide an annual report of its evaluation
under 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 funds
appropriated 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 to
implement this chapter.
(b) The office may adopt emergency rules under IC 4-22-2-37.1
to 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 before
adopting final rules. As added by P.L.287-2001, SEC.9.
IC 12-15-41
Chapter 41. Medicaid Buy-In Program for Working Individuals
With Disabilities
IC 12-15-41-1 "Buy-in program" defined
Sec. 1. As used in this chapter, "buy-in program" refers to the
Medicaid buy-in program for working individuals with disabilities
established 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 all
cash, other liquid assets, real property, and personal property owned
by an applicant for or a recipient of Medicaid under this chapter, or
the spouse of an applicant or a recipient, that could be converted to
cash to be used for support or maintenance, except the following:
(1) All resources disregarded by the office under this article for
the 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 under
26 U.S.C. 220 and held by either the applicant or recipient or
the applicant's or recipient's spouse.
(3) Subject to approval by the office, not more than twenty
thousand dollars ($20,000) in independence and self-sufficiency
accounts held by the applicant or recipient for the sole purpose
of purchasing goods or services, including assistive technology
and personal assistance, that:
(A) will increase the employability or independence of the
applicant or recipient; and
(B) are not services to which the recipient is entitled under
Medicaid or any other publicly funded program.
In determining the types of accounts to be approved under this
subdivision, the office shall consider any recommendations
made by the Medicaid work incentives council established by
IC 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 individuals
with disabilities is established to provide, beginning July 1, 2002,
Medicaid to individuals who are disabled and employed, as
authorized under Section 201 of the federal Ticket to Work and
Work 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 under
IC 12-15-2-6, except as follows:
(1) The individual has a severe medically determinable
impairment without regard to the individual's employment
status.
(2) The individual must be at least sixteen (16) years of age but
not more than sixty-four (64) years of age.
(3) The individual must be engaged in a substantial and
reasonable work effort as determined by the office and as
permitted by federal law.
(4) The individual does not have countable resources that
exceed the resource limits for the federal Supplemental Security
Income program (42 U.S.C. 1382).
(5) The individual's annual gross income does not exceed three
hundred fifty percent (350%) of the federal income poverty
level for an individual. In determining an individual's income
under this subdivision, the office may not consider the
following:
(A) The income of the individual's spouse.
(B) Income disregarded under the state Medicaid plan's
financial methodology, including income disregarded under
the federal Supplemental Security Income program (42
U.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 and
who no longer meets the eligibility requirements set forth in section
4 of this chapter due to an improvement in the individual's medical
condition continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) The individual continues to have a severe medically
determinable impairment, as determined by the office and as
allowed by federal law.
(2) The individual is employed and earning a monthly wage that
is not less than the federal minimum hourly wage times forty
(40).
(3) The individual does not have income or countable resources
in excess of the limits established under section 4 of this
chapter.
(4) The individual is at least sixteen (16) years of age and less
than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements under
this 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 program
and who is unable to maintain employment for involuntary reasons,
including temporary leave due to a health problem or involuntary
termination, continues to be eligible for Medicaid coverage under the
buy-in program if the individual meets the following requirements:
(1) Within sixty (60) days after the date on which the individual
becomes unemployed, the individual, or an authorized
representative of the individual, submits a written request to the
office that the individual's Medicaid coverage be continued.
(2) The individual maintains a connection to the workforce
during the individual's continued eligibility period by
participating in at least one (1) of the following activities:
(A) Enrollment in a state or federal vocational rehabilitation
program.
(B) Enrollment or registration with the office of workforce
development.
(C) Participation in a transition from school to work
program.
(D) Participation with an approved provider of employment
services.
(E) Provision of documentation from the individual's
employer that the individual is on temporary involuntary
leave.
(3) The individual does not have income or countable resources
in excess of the limits established under section 4 of this
chapter.
(4) The individual is at least sixteen (16) years of age and less
than sixty-five (65) years of age.
(5) The individual pays any premiums or other cost sharing
required under this chapter.
(6) The individual meets all other eligibility requirements under
this chapter.
(b) The office shall continue Medicaid coverage under the buy-in
program for an individual described in subsection (a) for up to twelve
(12) months from the date of the individual's involuntary loss of
employment.
(c) If an individual is ineligible for continued coverage under the
buy-in program because the individual:
(1) fails to meet the requirements of subsection (a); or
(2) has already met twelve (12) months of continuing eligibility
under this section;
the individual must meet the eligibility requirements of IC 12-15-2-6
to 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-five
dollars ($25) and a maximum monthly premium of two hundred
seventy-five dollars ($275).
(c) Subject to the minimum and maximum amounts described in
subsection (b), the office may annually adjust the scale of premiums
adopted 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, including
the gross annual income of the individual's spouse, if married, is less
than one hundred fifty percent (150%) of the federal income poverty
level for the size of the individual's or couple's family may not be
required to pay a premium to participate in the buy-in program.
(b) An individual whose gross annual income, including the gross
annual income of the individual's spouse, if married, is at least one
hundred fifty percent (150%) but not more than three hundred fifty
percent (350%) of the federal income poverty level for the size of the
individual's or couple's family, must pay a monthly premium in an
amount equal to:
(1) the lesser of:
(A) the amount prescribed by the sliding scale developed by
the office under section 7 of this chapter; or
(B) seven and one-half percent (7 1/2%) of the individual's
or 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 health
insurance 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 the
premium that an individual is required to pay under section 8 of this
chapter.
(b) In addition to the annual review required under subsection (a),
the office shall adjust the premium that an individual is required to
pay under section 8 of this chapter if:
(1) a change in the individual's income or family size is
verified; and
(2) the sliding scale adopted under section 7 of this chapter
applied to the individual's changed circumstances prescribes a
premium 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 the
same administrative procedures regarding premiums for the buy-in
program as are used for the children's health insurance program
established 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 annual
redetermination of disability required under 405 IAC 2-2-3(b) for an
individual participating in the buy-in program on the individual's
medical evidence, including evidence of physical or mental
impairment.
(b) In conducting the annual redetermination described in
subsection (a), the office may not determine that an individual
participating in the buy-in program is no longer an individual with a
disability 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, an
individual participating in the buy-in program:
(1) shall receive the same benefits, including home health care
services; 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 and
continued Medicaid coverage
Sec. 13. (a) The office shall establish criteria to determine the
effectiveness of:
(1) the buy-in program; and
(2) continued Medicaid coverage through Section 1619 of the
federal Social Security Act (42 U.S.C. 1382h).
(b) The criteria required under subsection (a) must include the
following:
(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 federal
Social Security Act (42 U.S.C. 1382h).
(2) State revenues resulting from premiums paid by participants
in the buy-in program.
(3) State costs incurred as a result of implementing the buy-in
program, including administrative costs and costs of providing
services.
(c) In addition to the criteria required under subsection (b), the
office may establish criteria to determine the following:
(1) Comparative costs of Medicaid funded services for
participants in the buy-in program and work incentives created
through Section 1619 of the federal Social Security Act (42
U.S.C. 1382h) before and after employment.
(2) The number of Supplemental Security Income and Social
Security Disability Insurance recipients in Indiana who are no
longer dependent on, or who have reduced dependence on,
public assistance or health care entitlement services, other than
Medicaid or the children's health insurance program, due to
participation in the buy-in program or work incentives created
through Section 1619 of the federal Social Security Act (42
U.S.C. 1382h).
(3) The number of individuals with severe disabilities who are
no longer dependent on, or who have reduced dependence on,
public benefits or services, other than Medicaid or the children's
health insurance program, due to income or support services
received through participation in the buy-in program or work
incentives created through Section 1619 of the federal Social
Security Act (42 U.S.C. 1382h).
(4) The change in the number of buy-in program participants or
participants in work incentives created through Section 1619 of
the federal Social Security Act (42 U.S.C. 1382h) who have
health care needs and related services covered though employer
based benefit programs.
(d) In evaluating the effectiveness of the state's work incentive
initiatives for individuals with disabilities, the office:
(1) shall collaborate with other state agencies on data
collection; and
(2) may consult with an independent contractor to collect data
on the criteria listed under subsection (b).
(e) The office shall provide an annual report of its evaluation
under 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 funds
appropriated 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 to
implement this chapter.
(b) The office may adopt emergency rules under IC 4-22-2-37.1
to 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 before
adopting final rules. As added by P.L.287-2001, SEC.9.
