OMPP changes to Indiana Medicaid Eligibility

The Office of Medicaid Policy and Planning (“OMPP”) recently released a bulletin summarizing the changes to Indiana Medicaid eligibility, as required by the Patient Protection and Affordable Care Act (“ACA”).   This memorandum summarizes the key changes and effective dates for Medicaid eligibility.
Starting in October 2013, Indiana Medicaid will begin using the Indiana Application for Health Coverage for all Indiana Medicaid programs, which can be completed through the Internet, by mail, or over the telephone.  However, the Healthy Indiana Plan (“HIP”) will not use this new health coverage application, and instead will continue using the separate, unique HIP application.  Applications for food stamps (“SNAP”) and cash assistance (“TANF”) will also be separate from applications for health coverage.
Effective January 1, 2014, OMPP revised the aid categories for children, the overall aid categories, and the eligibility criteria, all which are summarized here.  Beginning January 1, 2014, Indiana Medicaid is required to use the Modified Adjusted Gross Income (“MAGI”) method to determine income eligibility.  However, Indiana has chosen to begin applying this new methodology to applications received in October, and individuals submitting applications before January 1, 2014, will have their income eligibility calculated using both the current income determination rules and the new MAGI rules.  If the individual is eligible based on the current income determination rules, the individual will be enrolled upon determination.  If the individual is eligible based on the new MAGI rules, the individual will be enrolled effective January 1, 2014.  For individuals that are currently Indiana Medicaid members, the MAGI rules will be applied at the member’s annual redetermination.  This MAGI method will be used to determine income eligibility for the following aid categories: (i) Ages 0 to 1; (ii) Ages 1 to 5; (iii) Ages 6 to 18; (iv) MCHIP; (v) SCHIP; (vi) Former Foster Children, (vii) Parents/Caretakers; (viii) Pregnancy; (ix) HIP; (x) Family Planning Eligibility Program; and (xi) Inpatient Psychiatric Facility.  All other aid categories will continue to use the current, non-MAGI eligibility rules.  The key aspect of MAGI is that it counts all taxable income for determining Medicaid eligibility, and asset or resource tests are no longer considered.
OMPP is also announcing, as recently approved by the Centers for Medicare and Medicaid Services, that effective January 1, 2014, the income eligibility threshold for HIP will be reduced from 200% of the federal poverty limit (“FPL”) to 100% FPL.  Individuals with income above 100% FPL may seek coverage through the Health Insurance Marketplace, and may be eligible for subsidies, such as a tax credit or cost sharing reduction.
Also effective January 1, 2014, Indiana Medicaid will implement a Hospital Presumptive Eligibility (HPE) program that will allow acute-care hospitals to enroll with Indiana Medicaid as Qualified Providers (“QPs”).  QPs are authorized to enroll qualified individuals into presumptively eligible aid categories, such as: (i) Children; (ii) Parents/Caretakers; (iii) Family Planning; (iv) Former Foster Care Children; and (v) Pregnant Women.
Other changes effective January 1, 2014 are that: (1) Hoosier Healthwise Package B (Pregnancy Coverage) will be used only for the Hospital Presumptive Eligibility (HPE) program; and (2) individuals eligible for aid category MA 14: Former Foster Children will no longer be enrolled in Care Select, but rather will be eligible for Hoosier Healthwise Package A.
For questions regarding Medicaid eligibility please contact Kristen Gentry at or Meghan McNab at