Medicaid Coverage Protections Q & A’s
MEDICAID COVERAGE PROTECTIONS Q & A’s
- Q: Are there work requirements for Indiana Medicaid, including the Healthy Indiana Plan?
A: No, there are no requirements to have work activity, educational activity, or any other similar requirement to qualify for Medicaid, including HIP, in Indiana.
- Q: If a member loses Medicaid and applies on the Federal Marketplace, will they be able to afford the premiums? What kind of coverage will they receive?
- Q: If an individual already knows they are over the income limit for Medicaid, including the Healthy Indiana Plan, can they voluntarily terminate their coverage?
A: Yes, individuals may voluntarily withdraw from Medicaid, including HIP, at any time. To do so, please write down the individual’s full name, date of birth, last four numbers of their Social Security Number and their case number, if known, and either upload it to their Benefits Portal account by clicking here, fax it to 800-403-0864, or mail it to FSSA Document Center, PO Box 1810, Marion, IN 46952.
Individuals may also take their request to the Division of Family Resources office in their county. The locations of these offices are available by clicking here or by calling 800-403-0864.
- Q: How can individuals find out if they are over the income limits for Medicaid, including the Healthy Indiana Plan?
A: Individuals can find a tool with the income limits for most types of Medicaid, by clicking here. Please scroll to the bottom of the page and click on Adults, Pregnant Women, or Children Under 19.
- Q: Indiana has been accepting client statement on applications for most eligibility factors during the public health emergency, will this continue?
A: Yes, during the 12-month return to normal operations period, we will continue to accept self-attestation for most application questions. If we need more information before we can approve your application, we will send you a request for what we need. If we can approve you based on your answers to the application questions, we will approve your application first and then request any documentation we need to confirm your continuing eligibility.
- Q: Indiana has been allowing applicants/members to appoint an Authorized Representative over the phone during the public health emergency. Will this continue?
A: Yes, as long as both the applicant/member and the prospective Authorized Representative are on the call and listen to and agree to all of the requirements that the eligibility worker goes over with them, Authorized Representatives can still be established over the phone via a call with 800-403-0864.
- Q: For members who want to appeal a decision, what will that appeal process be?
A: Detailed instructions on how to appeal a decision are included at the end of every eligibility notice. A copy of the instructions (with placeholders for information that would be case-specific) is available by clicking here.
- Q: Can FSSA please provide instructions for how to upload documents like the instructions released for updating information?
A: Yes, FSSA will provide instructions on how to upload documentation. A video on using the Benefits Portal is available on the FSSA YouTube channel.
- Q: For the first round of notices sent in February warning of upcoming renewals, do these go to everyone or only those who have renewals in April?
A: The warning notices sent in February only went to renewals that occur in April. These individuals will receive their renewal/redetermination request in March. For individuals with renewals in May, the warning notice will be sent in March and the renewal/redetermination request will be sent in April. This process will continue until all PHE renewals are complete.
- Q: How is Indiana returning to normal Medicaid operations?
A: Indiana is following a 12-month plan to return to normal operations.
- Q: Who will retain their Medicaid eligibility after the return to normal operations?
A: Individuals who have remained eligible under normal rules during the public health emergency will be subject to standard requirements starting in April 2023; this could include returning information when income increases or after starting a new job, for example. Individuals who have only remained eligible due to the special rules we have been using since March 2020 will be reevaluated when their annual redetermination comes due. People who remain qualified after they have completed their annual Eligibility Review and Redetermination process will retain coverage.
- Q: When is Indiana resuming redetermination actions?
A: April is when the process begins. If members are not eligible after redetermination or do not provide the information needed, the first day they will no longer have coverage would be May 1. Indiana is taking 12 months to complete this process, and members will be reassessed when their annual redetermination is due.
- Q: Can members complete their redetermination online using the benefits portal?
A: Yes, they can complete their redetermination at fssabenefits.in.gov
- Q: If someone is locked out of their online benefits account, how do they get it reset?
A: If they need assistance, they can call 1-800-403-0864 and press option 6 to reach the benefits portal help desk to assist them. Members can also recover their log-in information, including resetting their password, by following instructions on the log-in screen on the portal.
- Q: If a member contacts FSSA through the benefits portal, mail or by phone to update their address information, will they be sent a Pending Verification Checklist form to confirm that change?
A: This depends on ot her programs they're on and the current circumstances around that case.
- Q: Indiana will complete its return to normal operations in May 2024. What does that mean?
A: May 2024 is when the 12-month return to normal operations is complete and no more members are protected by continuous enrollment rules from the original federal public health emergency.
- Q: Can providers receive information from the state about when their active Medicaid patients will be redetermined?
A: We cannot provide this information to unauthorized representatives; however, we do make an agency portal available. Once authorized, registered agencies may access the portal to check the case status for each of the individuals they support. For more information or to sign up for the agency portal, please click here.
- Q: How will renewals be prioritized?
A: We will be using the annual renewal date for everyone, which is set one year from their initial Medicaid approval or one year from their last annual redetermination.
- Q: If a member is deemed ineligible, is there a grace period before coverage terminates?
A: Disenrollment notices are sent at least 13 days prior to the effective date of coverage termination. If the disenrollment is due to not returning requested information, the missing documents can be provided prior to the effective date of termination and closure may be avoided if the member is still eligible.
For annual redeterminations only, individuals who don’t respond by the due date have up to 90 days to return the missing information and potentially regain coverage without submitting a new application.
- Q: Will the Medicaid Coverage Protection mailings be sent “Return Service Requested” for FSSA to know which individuals are not being contacted?
A: Yes, all mail is sent “Return Service Requested.” Anything that cannot be forwarded is returned to FSSA.
- Q: For people who return verifications for their annual redetermination during the 90-day window after losing coverage, will the coverage be retroactive to when they lost it?
A: This would depend on what kind of coverage the member is receiving. The Healthy Indiana Plan does not have retroactive coverage, so someone on HIP needs to take action to update their information as soon as possible. If they provide the needed information before the effective date of closure, then they can avoid a gap in coverage. For other individuals that are in categories that always offer retroactive coverage , then they can avoid a gap in coverage.
- Q: Is FSSA planning to hire and train new call center staff?
- Q: Will people redetermined at the end of 2023 who lose coverage but are eligible for the marketplace get an extended special enrollment period? Since the state is returning to normal operations over a 12-month period, will some individuals receive a much shorter special enrollment period for the marketplace?
A: In January 2023, CMS announced a Marketplace Special Enrollment Period for qualified individuals and their families who lose Medicaid or CHIP coverage due to the end of the continuous enrollment protections. This SEP, referred to as the “Unwinding SEP,” will allow individuals and families in Marketplaces served by HealthCare.gov to enroll in Marketplace health insurance coverage outside of the annual open enrollment period. Click here for more information.
- Q: If a member's information is transferred to the exchange, is there any proactive outreach letting them know? Do members need to initiate the enrollment process with the exchange?
A: We encourage members to start the process on their own, although they may also receive communication. Click here to find a navigator to help.
- Q: When will the Fast Track process for HIP restart?
A: No earlier than July 2023. We will provide advance notice once our plan is finalized.
- Q: How are you educating the public about Power Accounts, as everyone enrolled during the federal public health emergency hasn't had experience with power accounts?
A: A special notice will go out to individuals when their cost share resumes. It explains what a Power Account is and how the contribution is determined, and connects the member to a managed care entity for questions about the logistics of making the payment.