405 Ind. Admin. Code 10-4-9

Current through September 4, 2024

Section 405 IAC 10-4-9 - Eligibility period; renewal

Authority: IC 12-15-44.5-9

Affected: IC 12-15-44.5

Sec. 9.

(a) A member shall be eligible for a twelve (12) month period from the date such individual becomes a member unless the member:

(1) is terminated from the plan in accordance with 405 IAC 10-10-12; or

(2) becomes ineligible under the rules established under section 10 of this rule.

(b) A member shall be subject to an annual renewal process at the end of the eligibility period to determine continued eligibility for participation in the plan. A member may be asked to submit documentation necessary for the division to determine eligibility.

(c) If a member does not provide the requested documentation under subsection (b) before the end of the member's twelve (12) month eligibility period, the member shall be disenrolled from the plan. However, within ninety (90) days of the end of the expired eligibility period, such individual may submit the requested information to the division without having to reapply for the plan. Such individual shall not be eligible to receive services during this ninety (90) day period until documentation is received and payment has been made.

(d) An individual who loses coverage under subsection (c) shall not be permitted to reapply for the plan for a period of at least six (6) months from the date of disenrollment unless the individual is:

(1) medically frail;

(2) a Section 1931 parent and caretaker relative;

(3) eligible for transitional medical assistance; or

(4) eligible for an exception under 405 IAC 10-10-13.

The process set forth in 405 IAC 10-10-6(c) shall apply to a member disenrolled under this subsection.

(e) At the time of a positive eligibility renewal, a member who is enrolled in:

(1) HIP Plus shall remain in HIP Plus unless circumstances have changed that require the member to be transferred to HIP State Plan Plus;

(2) HIP Basic shall remain in HIP Basic unless:

(A) the member's household income has increased above one hundred percent (100%) of the FPL and the member is only eligible for HIP Plus;

(B) the member chooses to transfer to HIP Plus in accordance with subsection (h); or

(C) circumstances have changed such that the member is eligible for HIP State Plan Basic;

(3) HIP State Plan Plus shall remain in HIP State Plan Plus unless circumstances have changed that require the member to be transferred to HIP Plus; or

(4) HIP State Plan Basic shall remain in HIP State Plan Basic unless:

(A) the member's household income has increased above one hundred percent (100%) of the FPL and the member is only eligible for HIP State Plan Plus;

(B) the member chooses to transfer to HIP State Plan Plus in accordance with subsection (h); or

(C) circumstances have changed such that the member is required to be transferred to HIP Plus or HIP Basic.

(f) During renewal, the office shall recalculate a member's monthly POWER account contribution for HIP Plus or HIP State Plan Plus.

(g) A member who must transfer to HIP Plus or HIP State Plan Plus, as applicable, because the member's household income has increased above one hundred percent (100%) of the FPL shall make the required initial contribution to the member's POWER account within sixty (60) days of the renewal effective date. If the member fails to make the initial POWER account contribution within sixty (60) days of the renewal effective date, the member shall be terminated from participation in the plan unless the individual is excepted under 405 IAC 10-10-13.

(h) A member who is in HIP Basic or HIP State Plan Basic and has household income at or below one hundred percent (100%) of the FPL shall have the opportunity at the time of the member's annual renewal to transfer to HIP Plus or HIP State Plan Plus, as applicable, if the member makes the required initial contribution to the member's POWER account within sixty (60) days of the renewal effective date. If the member fails to make the initial POWER account contribution within sixty (60) days of the renewal date, the member shall remain in HIP Basic or HIP State Plan Basic, as applicable.

405 IAC 10-4-9

Filed 5/18/2015, 12:34 p.m.: 20150617-IR-405140339FRA

Filed 1/19/2018, 8:42 a.m.: 20180214-IR-405170484FRA

Errata Filed 2/22/2018, 9:36 a.m: 20180307-IR-405180114ACA

Filed 3/18/2019, 2:27 p.m.: 20190417-IR-405180371FRA