IBM V-CAN manual Healthy Indiana Plan HIP

INDIANA ELIGIBILITY MODERNIZATION

Voluntary Community Assistance Network (V-CAN)

Healthy Indiana Plan (HIP)

HIP is a state-sponsored health insurance plan for low-income Hoosiers. Hoosiers who may qualify for HIP include:

•Uninsured, non-disabled adults between the ages of 19-64;

•Parents or caretaker relatives of dependent children from 22% to 200% of federal poverty level (FPL);

•Childless adults (maximum of 34,000 adults may be covered);

•Hoosiers who are ineligible for employer-sponsored health care coverage;

•U.S. citizens, legal immigrants (for at least 5 years), or a qualified non-citizen (refugee or asylee); and

•Hoosiers who are uninsured for at least 6 months.

To apply for HIP, an applicant may complete a paper HIP application, which may be found online at www.HIP.in.gov. Local DFR offices, Hoosier Healthwise Enrollment Centers and participating V-CAN sites also have copies of paper HIP applications. Once completed, a HIP application may be submitted to a local DFR office or to the FSSA Service Center by mail or FAX.

Medicaid Disability (MA-D)

To apply for MA-D, an applicant or Authorized Representative may complete the Indiana Application for Assistance. On the Indiana Application for Assistance, the applicant must answer “yes” to Question

12 “Is this person blind, disabled or incapacitated?” The MA-D application process is listed below:

•Indiana Application for Assistance is completed, signed and submitted;

•FSSA Service Center mails an Interview Appointment notice to the applicant;

•Applicant gathers medical provider information;

•FSSA Service Center conducts interview (by phone, unless in-person is requested); o Worker completes 251B (Social Summary) during interview

o Applicant gives medical provider contact information during interview

•FSSA Service Center mails: 2032 Pending Verifications Notice to applicant (if documents are needed) and 251A to medical provider;

•FSSA Service Center sends records to Medical Review Team (MRT);

•MRT makes disability determination;

•State worker makes Medicaid eligibility determination; and

•FSSA Service Center mails approval/denial notice to applicant.

Medicare Savings Program

The Medicare Savings Program application is used for specific Medicaid categories: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individual (QI).

To apply, applicants may complete the Indiana Application for Assistance online, over the phone, or on paper, or complete the Medicare Savings Program paper application (State Form 49228). MSP applications are processed within 45 days of application date.

V-CAN User Guide 18 vcan@us.ibm.com