405 Ind. Admin. Code 14-5-1

Current through October 31, 2024

Section 405 IAC 14-5-1 - Member enrollment

Authority: IC 12-15-1-10; IC 12-17.6-2-11

Affected: IC 12-15-12; IC 12-17.6-2

Sec. 1.

(a) Individuals enrolled in Medicaid are mandatorily enrolled in an HHW MCO if they are in any of the following categories:

(1) Children.

(2) Pregnant women.

(3) Low income families.

(b) Enrollment in an HHW MCO is mandatory for individuals enrolled in CHIP.

(c) American Indian/Alaska Native enrollees otherwise mandatorily enrolled in managed care under subsection (a) or (b) may choose to receive services through FFS.

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

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

(2) Individuals receiving hospice services.

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

(4) Wards and foster children.

(5) Children receiving adoption assistance.

(6) Undocumented persons.

(7) ICF/IID residents.

(8) Nursing facility residents.

(9) Psychiatric residential treatment facility residents, unless covered by an EPSDT exception.

405 IAC 14-5-1

Office of the Secretary of Family and Social Services; 405 IAC 14-5-1; filed 8/30/2024, 11:42 a.m.: 20240925-IR-405240180FRA