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In May 2014, the Centers for Medicare and Medicaid Services approved the Family and Social Services Administration’s request to continue coverage for approximately 360 individuals with End Stage Renal Disease (ESRD) who were at risk of losing access to kidney transplant services as a result of the end of the Spend Down provision.
Individuals eligible for continued coverage under this option must also be:
CMS approved continued coverage for these individuals with an ESRD liability applied, calculated using the same methodology as spend down. As of August 2014, these ESRD liability amounts will begin. Prior to being subject to the liability amount, members eligible under this option will receive notice of their ESRD liability amount by mail. Like spend down, the ESRD liability amount for these individuals will be due to providers after services have been rendered.
Questions can be directed to the ESRD hotline at 800-403-0864 Option 6.
Anyone newly diagnosed with ESRD should consult their transplant or dialysis provider about coverage options, or call the Indiana State Health Insurance Assistance Program (SHIP) at 800-452-4800.