405 Ind. Admin. Code 14-4-1

Current through October 31, 2024

Section 405 IAC 14-4-1 - Member enrollment

Authority: IC 12-15-1-10

Affected: IC 12-15-12

Sec. 1.

(a) Individuals enrolled in Medicaid based on eligibility as one (1) of the following are mandatorily enrolled in an MCO through HCC if they are less than sixty (60) years of age and do not have a nursing facility or psychiatric residential treatment facility level of care:

(1) Blind.

(2) Disabled.

(3) SSI recipients.

(4) MED Works.

(b) Individuals may choose to participate in HCC if they are enrolled in Medicaid based on eligibility as one (1) of the following:

(1) Children receiving adoption assistance.

(2) Foster children.

(3) Former foster children, between eighteen (18) and twenty-six (26) years of age, enrolled as of their eighteenth birthday.

(c) American Indian/Alaska Native members of a federally recognized tribe meeting the HCC mandatory enrollment criteria in subsection (a) may choose to receive services through FFS.

(d) Members meeting any of the following are excluded from HCC managed care enrollment:

(1) Individuals enrolled in an HCBS waiver operated by the office.

(2) Individuals dually eligible for Medicare and Medicaid.

(3) Residents of an ICF/IID.

(4) Individuals enrolled in the family planning eligibility program.

(5) Residential care assistance program enrollees.

(6) Women needing treatment for breast or cervical cancer who are eligible under 1902(a)(10)(A)(ii)(XVIII) of the Social Security Act.

(7) Individuals eligible for emergency services only.

(8) Refugees.

(9) Money Follows the Person grant enrollees.

(10) Individuals receiving psychiatric treatment in a state hospital.

(11) Individuals with long term stays in an institutional setting.

(12) Unless covered by an EPSDT exception, individuals receiving treatment in a psychiatric residential treatment facility.

405 IAC 14-4-1

Office of the Secretary of Family and Social Services; 405 IAC 14-4-1; filed 8/30/2024, 11:42 a.m.: 20240925-IR-405240180FRA