Citations Affected: IC 12-7-2; IC 12-15; IC 12-16; IC 34-30-2.
January 14, 2009, read first time and referred to Committee on Health and Provider
Services.
account of a plan participant under certain circumstances. Specifies
that the minimum amount paid by certain plan participants into the
participant's health care account is $60. Adds additional purposes for
expenditures from the state hospital care for the indigent fund.
Requires the office to: (1) apply to the federal government to change
the
state's status regarding Medicaid and individuals who participate in
SSI; (2) terminate the state's Medicaid spend down program; and (3)
increase Medicaid eligibility for individuals with a disability. Repeals
a provision allowing for additional payments to specified hospitals.
Repeals a provision allowing individuals to obtain health care coverage
that is the same as the plan if the plan has reached maximum
enrollment using standard underwriting practices. Repeals the hospital
care for the indigent program beginning January 1, 2010. Makes
technical changes.
A BILL FOR AN ACT to amend the Indiana Code concerning
Medicaid.
SECTION 53, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2009]: Sec. 104.5. "Holocaust victim's settlement payment"
has the meaning set forth in IC 12-14-18-1.7 for purposes of the
following:
(1) IC 12-10-6.
(2) IC 12-14-2.
(3) IC 12-14-18.
(4) IC 12-14-19.
(5) IC 12-15-2.
(6) IC 12-15-3.
(7) IC 12-16-3.5 (repealed effective January 1, 2010).
(8) IC 12-20-5.5.
amount must include an annual payment by the individual of at
least sixty dollars ($60). The payment may be made in monthly
installments of at least five dollars ($5).
(d) If an individual's required payment determined under
subsection (c) is not made within sixty (60) days after the required
payment date, the individual may be terminated from participation
in the Medicaid program. The individual must receive written
notice before the individual is terminated from the Medicaid
program.
(e) After termination from the Medicaid program under
subsection (d), the individual may not reapply for Medicaid under
this section for twelve (12) months.
year under section 1.5(b) STEP FIVE (B) of this chapter; and
(2) the payments for a state fiscal year to each hospital are an
amount that is as equal as possible to the amount each hospital
would have received under section 1.5(b) STEP FIVE (B) of this
chapter for that state fiscal year.
(d) If the office determines that payments made under section 1.5(b)
STEP FIVE (C) of this chapter will not be approved for federal
financial participation, the office may make alternative payments to
payments under section 1.5(b) STEP FIVE (C) of this chapter if:
(1) the payments for a state fiscal year are made only to a hospital
that would have been eligible for a payment for that state fiscal
year under section 1.5(b) STEP FIVE (C) of this chapter; and
(2) the payments for a state fiscal year to each hospital are an
amount that is as equal as possible to the amount each hospital
would have received under section 1.5(b) STEP FIVE (C) of this
chapter for that state fiscal year.
(e) If the office determines, based on information received from the
federal Centers for Medicare and Medicaid Services, that payments
made under subsection (b), (c), or (d) will not be approved for federal
financial participation, The office shall use the funds that would have
served as the nonfederal share of these payments under section 1.4 of
this chapter for a state fiscal year to serve as the nonfederal share of
a payment program for hospitals to be established by the office. The
payment program must distribute payments to hospitals for a state
fiscal year based upon a methodology determined by the office to be
equitable under the circumstances.
occurred in the county.
(b) For each state fiscal year ending after June 30, 2003, and before
July 1, 2007, a hospital licensed under IC 16-21-2 that submits to the
division during the state fiscal year a payable claim under IC 12-16-7.5
(repealed effective January 1, 2010) is entitled to a payment under
subsection (c).
(c) Except as provided in section 9.8 of this chapter and Subject to
section 9.6 of this chapter, for a state fiscal year, the office shall pay to
a hospital referred to in subsection (b) an amount equal to the amount,
based on information obtained from the division and the calculations
and allocations made under IC 12-16-7.5-4.5 (repealed effective
January 1, 2010), that the office determines for the hospital under
STEP SIX of the following STEPS:
STEP ONE: Identify:
(A) each hospital that submitted to the division one (1) or
more payable claims under IC 12-16-7.5 (repealed effective
January 1, 2010) during the state fiscal year; and
(B) the county to which each payable claim is attributed.
STEP TWO: For each county identified in STEP ONE, identify:
(A) each hospital that submitted to the division one (1) or
more payable claims under IC 12-16-7.5 (repealed effective
January 1, 2010) attributed to the county during the state
fiscal year; and
(B) the total amount of all hospital payable claims submitted
to the division under IC 12-16-7.5 (repealed effective
January 1, 2010) attributed to the county during the state
fiscal year.
STEP THREE: For each county identified in STEP ONE, identify
the amount of county funds transferred to the Medicaid indigent
care trust fund under IC 12-16-7.5-4.5 (repealed effective
January 1, 2010).
STEP FOUR: For each hospital identified in STEP ONE, with
respect to each county identified in STEP ONE, calculate the
hospital's percentage share of the county's funds transferred to the
Medicaid indigent care trust fund under IC 12-16-7.5-4.5
(repealed effective January 1, 2010). Each hospital's percentage
share is based on the total amount of the hospital's payable claims
submitted to the division under IC 12-16-7.5 (repealed effective
January 1, 2010) attributed to the county during the state fiscal
year, calculated as a percentage of the total amount of all hospital
payable claims submitted to the division under IC 12-16-7.5
(repealed effective January 1, 2010) attributed to the county
during the state fiscal year.
STEP FIVE: Subject to subsection (j), for each hospital identified
in STEP ONE, with respect to each county identified in STEP
ONE, multiply the hospital's percentage share calculated under
STEP FOUR by the amount of the county's funds transferred to
the Medicaid indigent care trust fund under IC 12-16-7.5-4.5
(repealed effective January 1, 2010).
STEP SIX: Determine the sum of all amounts calculated under
STEP FIVE for each hospital identified in STEP ONE with
respect to each county identified in STEP ONE.
(d) For state fiscal years beginning after June 30, 2007, a hospital
that received a payment determined under STEP SIX of subsection (c)
for the state fiscal year ending June 30, 2007, shall be paid in an
amount equal to the amount determined for the hospital under STEP
SIX of subsection (c) for the state fiscal year ending June 30, 2007.
(e) A hospital's payment under subsection (c) or (d) is in the form
of a Medicaid supplemental payment. The amount of a hospital's
Medicaid supplemental payment is subject to the availability of funding
for the non-federal share of the payment under subsection (f). The
office shall make the payments under subsection (c) and (d) before
December 15 that next succeeds the end of the state fiscal year.
(f) The non-federal share of a payment to a hospital under
subsection (c) or (d) is funded from the funds transferred to the
Medicaid indigent care trust fund under IC 12-16-7.5-4.5 (repealed
effective January 1, 2010).
(g) The amount of a county's transferred funds available to be used
to fund the non-federal share of a payment to a hospital under
subsection (c) is an amount that bears the same proportion to the total
amount of funds of the county transferred to the Medicaid indigent care
trust fund under IC 12-16-7.5-4.5 (repealed effective January 1,
2010) that the total amount of the hospital's payable claims under
IC 12-16-7.5 (repealed effective January 1, 2010) attributed to the
county submitted to the division during the state fiscal year bears to the
total amount of all hospital payable claims under IC 12-16-7.5
(repealed effective January 1, 2010) attributed to the county
submitted to the division during the state fiscal year.
(h) Any county's funds identified in subsection (g) that remain after
the non-federal share of a hospital's payment has been funded are
available to serve as the non-federal share of a payment to a hospital
under section 9.5 of this chapter.
(i) For purposes of this section, "payable claim" has the meaning set
forth in IC 12-16-7.5-2.5(b)(1) (repealed effective January 1, 2010).
the hospital to the division during the state fiscal year;
is entitled to a payment under subsection (c).
(c) Subject to section 9.6 of this chapter, for a state fiscal year, the
office shall pay to a hospital referred to in subsection (b) an amount
equal to the amount, based on information obtained from the division
and the calculations and allocations made under IC 12-16-7.5-4.5
(repealed effective January 1, 2010), that the office determines for
the hospital under STEP EIGHT of the following STEPS:
STEP ONE: Identify each county whose transfer of funds to the
Medicaid indigent care trust fund under IC 12-16-7.5-4.5
(repealed effective January 1, 2010) for the state fiscal year was
less than the total amount of all hospital payable claims attributed
to the county and submitted to the division during the state fiscal
year.
STEP TWO: For each county identified in STEP ONE, calculate
the difference between the amount of funds of the county
transferred to the Medicaid indigent care trust fund under
IC 12-16-7.5-4.5 (repealed effective January 1, 2010) and the
total amount of all hospital payable claims attributed to the county
and submitted to the division during the state fiscal year.
STEP THREE: Calculate the sum of the amounts calculated for
the counties under STEP TWO.
STEP FOUR: Identify each hospital whose payment under section
9(c) of this chapter was less than the total amount of the hospital's
payable claims under IC 12-16-7.5 submitted by the hospital to
the division during the state fiscal year.
STEP FIVE: Calculate for each hospital identified in STEP FOUR
the difference between the hospital's payment under section 9(c)
of this chapter and the total amount of the hospital's payable
claims under IC 12-16-7.5 (repealed effective January 1, 2010)
submitted by the hospital to the division during the state fiscal
year.
STEP SIX: Calculate the sum of the amounts calculated for each
of the hospitals under STEP FIVE.
STEP SEVEN: For each hospital identified in STEP FOUR,
calculate the hospital's percentage share of the amount calculated
under STEP SIX. Each hospital's percentage share is based on the
amount calculated for the hospital under STEP FIVE calculated
as a percentage of the sum calculated under STEP SIX.
STEP EIGHT: For each hospital identified in STEP FOUR,
multiply the hospital's percentage share calculated under STEP
SEVEN by the sum calculated under STEP THREE. The amount
calculated under this STEP for a hospital may not exceed the
amount by which the hospital's total payable claims under
IC 12-16-7.5 (repealed effective January 1, 2010) submitted
during the state fiscal year exceeded the amount of the hospital's
payment under section 9(c) of this chapter.
(d) For state fiscal years beginning after June 30, 2007, a hospital
that received a payment determined under STEP EIGHT of subsection
(c) for the state fiscal year ending June 30, 2007, shall be paid an
amount equal to the amount determined for the hospital under STEP
EIGHT of subsection (c) for the state fiscal year ending June 30, 2007.
(e) A hospital's payment under subsection (c) or (d) is in the form
of a Medicaid supplemental payment. The amount of the hospital's
add-on payment is subject to the availability of funding for the
nonfederal share of the payment under subsection (f). The office shall
make the payments under subsection (c) or (d) before December 15
that next succeeds the end of the state fiscal year.
(f) The nonfederal share of a payment to a hospital under subsection
(c) or (d) is derived from funds transferred to the Medicaid indigent
care trust fund under IC 12-16-7.5-4.5 (repealed effective January 1,
2010) and not expended under section 9 of this chapter.
(g) Except as provided in subsection (h), the office may not make a
payment under this section until the payments due under section 9 of
this chapter for the state fiscal year have been made.
(h) If a hospital appeals a decision by the office regarding the
hospital's payment under section 9 of this chapter, the office may make
payments under this section before all payments due under section 9 of
this chapter are made if:
(1) a delay in one (1) or more payments under section 9 of this
chapter resulted from the appeal; and
(2) the office determines that making payments under this section
while the appeal is pending will not unreasonably affect the
interests of hospitals eligible for a payment under this section.
(i) Any funds transferred to the Medicaid indigent care trust fund
under IC 12-16-7.5-4.5 (repealed effective January 1, 2010)
remaining after payments are made under this section shall be used as
provided in IC 12-15-20-2(8).
(j) For purposes of subsection (c):
(1) "payable claim" has the meaning set forth in
IC 12-16-7.5-2.5(b) (repealed effective January 1, 2010);
(2) the amount of a payable claim is an amount equal to the
amount the hospital would have received under the state's
fee-for-service Medicaid reimbursement principles for the
hospital care for which the payable claim is submitted under
IC 12-16-7.5 (repealed effective January 1, 2010) if the
individual receiving the hospital care had been a Medicaid
enrollee; and
(3) a payable hospital claim under IC 12-16-7.5 (repealed
effective January 1, 2010) includes a payable claim under
IC 12-16-7.5 (repealed effective January 1, 2010) for the
hospital's care submitted by an individual or entity other than the
hospital, to the extent permitted under the hospital care for the
indigent program.
collected under this section may be used to fund the following:
(A) Medicaid coverage for the disabled under IC 12-15-2-6.
(B) The Indiana check-up plan under IC 12-15-44.2.
(c) If federal financial participation to match the assessment in
this chapter becomes unavailable under federal law, the authority
to impose the assessment terminates on the date that the federal
statutory, regulatory, or interpretive change takes effect.
IC 12-15-2-13 and infants and children described in
IC 12-15-2-14.
(4) Municipal disproportionate share payments to providers under
IC 12-15-19-8.
(5) Payments to hospitals under IC 12-15-15-9.
(6) Payments to hospitals under IC 12-15-15-9.5.
(7) Payments, funding, and transfers as otherwise provided in
clauses (8)(D), (8)(F), and (8)(G).
(8) Of the intergovernmental transfers deposited into the
Medicaid indigent care trust fund, the following apply:
(A) The entirety of the intergovernmental transfers deposited
into the Medicaid indigent care trust fund for state fiscal years
ending on or before June 30, 2000, shall be used to fund the
state's share of the disproportionate share payments to
providers under IC 12-15-19-2.1.
(B) Of the intergovernmental transfers deposited into the
Medicaid indigent care trust fund for the state fiscal year
ending June 30, 2001, an amount equal to one hundred percent
(100%) of the total intergovernmental transfers deposited into
the Medicaid indigent care trust fund for the state fiscal year
beginning July 1, 1998, and ending June 30, 1999, shall be
used to fund the state's share of disproportionate share
payments to providers under IC 12-15-19-2.1. The remainder
of the intergovernmental transfers, if any, for the state fiscal
year shall be used to fund the state's share of additional
Medicaid payments to hospitals licensed under IC 16-21
pursuant to a methodology adopted by the office.
(C) Of the intergovernmental transfers deposited into the
Medicaid indigent care trust fund, for state fiscal years
beginning July 1, 2001, and July 1, 2002, an amount equal to:
(i) one hundred percent (100%) of the total
intergovernmental transfers deposited into the Medicaid
indigent care trust fund for the state fiscal year beginning
July 1, 1998; minus
(ii) an amount equal to the amount deposited into the
Medicaid indigent care trust fund under IC 12-15-15-9(d)
for the state fiscal years beginning July 1, 2001, and July 1,
2002;
shall be used to fund the state's share of disproportionate share
payments to providers under IC 12-15-19-2.1. The remainder
of the intergovernmental transfers, if any, must be used to fund
the state's share of additional Medicaid payments to hospitals
licensed under IC 16-21 pursuant to a methodology adopted by
the office.
(D) The intergovernmental transfers, which shall include
amounts transferred under IC 12-16-7.5-4.5 (repealed
effective January 1, 2010), deposited into the Medicaid
indigent care trust fund and the certifications of public
expenditures deemed to be made to the Medicaid indigent care
trust fund, for the state fiscal years ending after June 30, 2005,
but before July 1, 2007, shall be used, in descending order of
priority, as follows:
(i) As provided in clause (B) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) (repealed effective January 1,
2010) and clause (B) of STEP THREE of
IC 12-16-7.5-4.5(b)(2) (repealed effective January 1,
2010), to fund the amount to be transferred to the office.
(ii) As provided in clause (C) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) (repealed effective January 1,
2010) and clause (C) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), (repealed effective January 1,
2010), to fund the non-federal share of the payments made
under IC 12-15-15-9 and IC 12-15-15-9.5.
(iii) To fund the non-federal share of the payments made
under IC 12-15-15-1.1, IC 12-15-15-1.3, and IC 12-15-19-8.
(iv) As provided under clause (A) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) (repealed effective January 1,
2010) and clause (A) of STEP THREE of
IC 12-16-7.5-4.5(b)(2) (repealed effective January 1,
2010), for the payment to be made under clause (A) of STEP
FIVE of IC 12-15-15-1.5(b). IC 12-15-15-1.4.
(v) As provided under STEP FOUR of
IC 12-16-7.5-4.5(b)(1) (repealed effective January 1,
2010) and STEP FOUR of IC 12-16-7.5-4.5(b)(2) (repealed
effective January 1, 2010), to fund the payments to be
made under clause (B) of STEP FIVE of IC 12-15-15-1.5(b).
IC 12-15-15-1.4.
(vi) To fund, in an order of priority determined by the office
to best use the available non-federal share, the programs
listed in clause (H).
(E) For state fiscal years ending after June 30, 2007, the total
amount of intergovernmental transfers used to fund the
non-federal share of payments to hospitals under
IC 12-15-15-9 and IC 12-15-15-9.5 shall not exceed the
amount provided in clause (G)(ii).
(F) As provided in clause (D), for the following:
(i) Each state fiscal year ending after June 30, 2003, but
before July 1, 2005, an amount equal to the amount
calculated under STEP THREE of the following formula
shall be transferred to the office:
STEP ONE: Calculate the product of thirty-five million dollars
($35,000,000) multiplied by the federal medical assistance
percentage for federal fiscal year 2003.
STEP TWO: Calculate the sum of the amounts, if any,
reasonably estimated by the office to be transferred or
otherwise made available to the office for the state fiscal year,
and the amounts, if any, actually transferred or otherwise made
available to the office for the state fiscal year, under
arrangements whereby the office and a hospital licensed under
IC 16-21-2 agree that an amount transferred or otherwise made
available to the office by the hospital or on behalf of the
hospital shall be included in the calculation under this STEP.
STEP THREE: Calculate the amount by which the product
calculated under STEP ONE exceeds the sum calculated under
STEP TWO.
(ii) The state fiscal years ending after June 30, 2005, but
before July 1, 2007, an amount equal to thirty million dollars
($30,000,000) shall be transferred to the office.
(G) Subject to IC 12-15-20.7-2(b), for each state fiscal year
ending after June 30, 2007, the total amount in the Medicaid
indigent care trust fund, including the amount of
intergovernmental transfers of funds transferred, and the
amounts of certifications of expenditures eligible for federal
financial participation deemed to be transferred, to the
Medicaid indigent care trust fund, shall be used to fund the
following:
(i) Thirty million dollars ($30,000,000) transferred to the
office for the Medicaid budget.
(ii) An amount not to exceed the non-federal share of
payments to hospitals under IC 12-15-15-9 and
IC 12-15-15-9.5.
(iii) An amount not to exceed the non-federal share of
payments to hospitals made under IC 12-15-15-1.1 and
IC 12-15-15-1.3.
(iv) An amount not to exceed the non-federal share of
disproportionate share payments to hospitals under
IC 12-15-19-8.
(v) An amount not to exceed the non-federal share of
payments to hospitals under clause (A) of STEP FIVE of
IC 12-15-15-1.5(c). IC 12-15-15-1.4.
(vi) An amount not to exceed the non-federal share of
Medicaid safety-net payments.
(vii) An amount not to exceed the non-federal share of
payments to hospitals made under clauses (C) or (D) of
STEP FIVE of IC 12-15-15-1.5(c).
(viii) An amount not to exceed the non-federal share of
payments to hospitals made under clause (F) of STEP FIVE
of IC 12-15-15-1.5(c).
(ix) (vii) An amount not to exceed the non-federal share of
disproportionate share payments to hospitals under
IC 12-15-19-2.1.
(x) (viii) If additional funds are available after making
payments under items (i) through (ix), (vii), to fund other
Medicaid supplemental payments for hospitals approved by
the office and included in the Medicaid state plan.
(H) For purposes of clause (D)(vi), the office shall fund the
following:
(i) An amount equal to the non-federal share of the
payments to the hospital that is eligible under this item, for
payments made under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b) IC 12-15-15-1.4 under an agreement
with the office, Medicaid safety-net payments and any
payment made under IC 12-15-19-2.1. The amount of the
payments to the hospital under this item shall be equal to
one hundred percent (100%) of the hospital's
hospital-specific limit for state fiscal year 2005, when the
payments are combined with payments made under
IC 12-15-15-9, IC 12-15-15-9.5, and clause (B) of STEP
FIVE of IC 12-15-15-1.5(b) IC 12-15-15-1.4 for a state
fiscal year. A hospital is eligible under this item if the
hospital was eligible for Medicaid disproportionate share
hospital payments for the state fiscal year ending June 30,
1998, the hospital received a Medicaid disproportionate
share payment under IC 12-15-19-2.1 for state fiscal years
2001, 2002, 2003, and 2004, and the hospital merged two
(2) hospitals under a single Medicaid provider number,
effective January 1, 2004.
(ii) An amount equal to the non-federal share of payments to
hospitals that are eligible under this item, for payments
made under clause (C) of STEP FIVE of IC 12-15-15-1.5(b)
IC 12-15-15-1.4 under an agreement with the office,
Medicaid safety-net payments, and any payment made under
IC 12-15-19-2.1. The amount of payments to each hospital
under this item shall be equal to one hundred percent
(100%) of the hospital's hospital-specific limit for state
fiscal year 2004, when the payments are combined with
payments made to the hospital under IC 12-15-15-9,
IC 12-15-15-9.5, and clause (B) of STEP FIVE of
IC 12-15-15-1.5(b) IC 12-15-15-1.4 for a state fiscal year.
A hospital is eligible under this item if the hospital did not
receive a payment under item (i), the hospital has less than
sixty thousand (60,000) Medicaid inpatient days annually,
the hospital either was eligible for Medicaid
disproportionate share hospital payments for the state fiscal
year ending June 30, 1998, or the hospital met the office's
Medicaid disproportionate share payment criteria based on
state fiscal year 1998 data and received a Medicaid
disproportionate share payment for the state fiscal year
ending June 30, 2001, and the hospital received a Medicaid
disproportionate share payment under IC 12-15-19-2.1 for
state fiscal years 2001, 2002, 2003, and 2004.
(iii) Subject to IC 12-15-19-6, an amount not less than the
non-federal share of Medicaid safety-net payments in
accordance with the Medicaid state plan.
(iv) An amount not less than the non-federal share of
payments made under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b) IC 12-15-15-1.4 under an agreement
with the office to a hospital having sixty thousand (60,000)
Medicaid inpatient days annually.
(v) An amount not less than the non-federal share of
Medicaid disproportionate share payments for hospitals
eligible under this item, and made under IC 12-15-19-6 and
the approved Medicaid state plan. A hospital is eligible for
a payment under this item if the hospital is eligible for
payments under IC 12-15-19-2.1.
(vi) If additional funds remain after the payments made
under (i) through (v), payments approved by the office and
under the Medicaid state plan, to fund the non-federal share
of other Medicaid supplemental payments for hospitals.
SECTION 21, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2009]: Sec. 2. (a) For each state fiscal year ending before July
1, 2005, and subject to section 3 of this chapter, the office shall make
the payments identified in this section in the following order:
(1) First, payments under IC 12-15-15-9 and IC 12-15-15-9.5.
(2) Second, payments under clauses (A) and (B) of STEP FIVE of
IC 12-15-15-1.5(b). IC 12-15-15-1.4.
(3) Third, Medicaid inpatient payments for safety-net hospitals
and Medicaid outpatient payments for safety-net hospitals.
(4) Fourth, payments under IC 12-15-15-1.1 and 12-15-15-1.3.
(5) Fifth, payments under IC 12-15-19-8 for municipal
disproportionate share hospitals.
(6) Sixth, payments under IC 12-15-19-2.1 for disproportionate
share hospitals.
(7) Seventh, payments under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b).
(b) For each state fiscal year ending after June 30, 2007, the office
shall make the payments for the programs identified in
IC 12-15-20-2(8)(G) in the order of priority that best utilizes available
non-federal share, Medicaid supplemental payments, and Medicaid
disproportionate share payments, and may change the order or priority
at any time as necessary for the proper administration of one (1) or
more of the payment programs listed in IC 12-15-20-2(8)(G).
SECTION 98, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2009]: Sec. 9. (a) Except as provided in subsection (b), an
individual is eligible for participation in the plan if the individual meets
the following requirements:
(1) The individual is at least eighteen (18) years of age and less
than sixty-five (65) years of age.
(2) The individual is a United States citizen and has been a
resident of Indiana for at least twelve (12) months.
(3) The individual has an annual household income of not more
than two hundred percent (200%) of the federal income poverty
level.
(4) The individual is not eligible for health insurance coverage
through the individual's employer.
(5) The individual has not had health insurance coverage for at
least six (6) months.
(b) An individual who:
(1) meets the requirements of subsection (a) but is not
enrolled because the plan has reached maximum enrollment;
or
(2) meets all of the requirements in subsection (a) except for
subsection (a)(3);
is eligible to participate in the plan. However, the state does not
provide funding for health insurance coverage provided under the
plan to an individual who is described in this subsection.
(b) (c) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare
program (42 U.S.C. 1395 et seq.).
(2) A pregnant woman for purposes of pregnancy related services.
(3) An individual who is eligible for the Medicaid program as a
disabled person.
(c) (d) The eligibility requirements specified in subsection (a) are
subject to approval for federal financial participation by the United
States Department of Health and Human Services.
does not begin until an initial payment is made for the individual's
participation in the plan. A required payment to the plan for the
individual's participation may not exceed one-twelfth (1/12) of the
annual payment required under subsection (b).
(b) To participate in the plan, an individual shall do the following:
(1) Apply for the plan on a form prescribed by the office. The
office may develop and allow a joint application for a household.
(2) If the individual is approved by the office under section 9(a)
of this chapter to participate in the plan, contribute to the
individual's health care account the lesser of the following:
(A) One thousand one hundred dollars ($1,100) per year, less
any amounts paid by the individual under the:
(i) Medicaid program under IC 12-15;
(ii) children's health insurance program under IC 12-17.6;
and
(iii) Medicare program (42 U.S.C. 1395 et seq.);
as determined by the office.
(B) Not more than the following applicable percentage of the
individual's annual household income per year, less any
amounts paid by the individual under the Medicaid program
under IC 12-15, the children's health insurance program under
IC 12-17.6, and the Medicare program (42 U.S.C. 1395 et
seq.) as determined by the office:
(i) Two percent (2%) of the individual's annual household
income per year if the individual has an annual household
income of not more than one hundred percent (100%) of the
federal income poverty level.
(ii) Three percent (3%) of the individual's annual household
income per year if the individual has an annual household
income of more than one hundred percent (100%) and not
more than one hundred twenty-five percent (125%) of the
federal income poverty level.
(iii) Four percent (4%) of the individual's annual household
income per year if the individual has an annual household
income of more than one hundred twenty-five percent
(125%) and not more than one hundred fifty percent (150%)
of the federal income poverty level.
(iv) Five percent (5%) of the individual's annual household
income per year if the individual has an annual household
income of more than one hundred fifty percent (150%) and
not more than two hundred percent (200%) of the federal
income poverty level.
must incorporate cultural competency standards established by the
office. The standards must include standards for non-English speaking,
minority, and disabled populations.
subdivision (1):
(A) calculate the total amount of payable claims submitted
during the state fiscal year for:
(i) each hospital;
(ii) each physician; and
(iii) each transportation provider; and
(B) determine the amount of each payable claim for each
hospital, physician, and transportation provider listed in clause
(A).
(b) For the state fiscal years beginning after June 30, 2005, but
before July 1, 2007, and before November 1 following the end of a
state fiscal year, the division shall allocate the funds transferred from
a county's hospital care for the indigent fund to the state hospital care
for the indigent fund under IC 12-16-14 during or for the following
state fiscal years:
(1) For the state fiscal year ending June 30, 2006, as required
under the following STEPS:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims submitted
to the division during the state fiscal year from all counties
under subsection (a), determine the amount that is the lesser
of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division to make payments under section 5 of this chapter.
STEP THREE: Transfer an amount equal to the sum of:
(A) the non-federal share of the payments made under
clause (A) of STEP FIVE of IC 12-15-15-1.5(b);
(B) the amount transferred under IC 12-15-20-2(8)(F); and
(C) the non-federal share of the payments made under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the payments
identified in this STEP.
STEP FOUR: Transfer an amount equal to sixty-one million
dollars ($61,000,000) less the sum of:
(A) the amount determined in STEP TWO; and
IC 34-30-2-45.2; IC 34-30-2-45.5; IC 34-30-2-45.7; IC 34-30-2-45.9.