Indiana § 12-15-2-26 - Eligibility for Medicare beneficiaries

§ 12-15-2-26. Eligibility for Medicare beneficiaries

Sec. 26. (a) This section applies beginning the later of the following:

(1) The date that the office is informed that the United States Department of Health and Human Services has approved Indiana's conversion to 1634 status within the Medicaid program.

(2) January 1, 2014.

(b) As used in this section, "qualified Medicare beneficiary" means an individual defined in 42 U.S.C. 1396d(p)(1).

(c) As used in this section, "qualifying individual" refers to an individual described in 42 U.S.C. 1396a(a)(10)(E)(iv).

(d) As used in this section, "specified low-income Medicare beneficiary" refers to an individual described in 42 U.S.C. 1396a(a)(10)(E)(iii).

(e) The following individuals are eligible for the specified coverage under this section:

(1) A qualified Medicare beneficiary whose:

(A) income does not exceed one hundred fifty percent (150%) of the federal income poverty level; and

(B) resources do not exceed the resource limits established by the office;

is eligible for Medicare Part A and Medicare Part B premiums, coinsurance, and deductibles.

(2) A specified low-income Medicare beneficiary whose:

(A) income does not exceed one hundred seventy percent (170%) of the federal income poverty level; and

(B) resources do not exceed the resource limits set by the office;

is eligible for coverage of Medicare Part B premiums.

(3) A qualifying individual whose:

(A) income does not exceed one hundred eighty-five percent (185%) of the federal income poverty level; and

(B) resources do not exceed the resource limits set by the office;

is eligible for coverage of Medicare Part B premiums.

(f) The office may adopt rules under IC 4-22-2 to implement this section.

As added by P.L.278-2013, SEC.8.

IC 12-15-2.2Chapter 2.2. RepealedRepealed by P.L.1-2001, SEC.51.

IC 12-15-2.3Chapter 2.3. Presumptive Eligibility for Women With Breast or Cervical Cancer

12-15-2.3-1Applicability of chapter 12-15-2.3-2"Qualified entity" 12-15-2.3-3Qualified entities to establish eligibility 12-15-2.3-4Identity of qualified entities 12-15-2.3-5Qualified entities provided with application forms and information 12-15-2.3-6Period during which services provided 12-15-2.3-7Woman's eligibility determined by qualified entity 12-15-2.3-8Actions taken after establishment of eligibility 12-15-2.3-9Completion of application 12-15-2.3-10Expired 12-15-2.3-11Reimbursement for care during presumptive eligibility 12-15-2.3-12Rules 12-15-2.3-13Annual appropriation to provide services

IC 12-15-2.3-1Applicability of chapter Sec. 1. This chapter applies to a woman who is eligible for Medicaid under IC 12-15-2-13.5.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-2"Qualified entity" Sec. 2. As used in this chapter, "qualified entity" means an entity that:

(1) is eligible to receive payments and provide items and services under this article;

(2) provides outpatient hospital services, rural health clinic services, and any other ambulatory services offered by a rural health clinic, or clinic services furnished by or under the direction of a licensed physician; and

(3) meets all other requirements set forth in 42 U.S.C. 1396r-1b(b)(2).

As added by P.L.152-2001, SEC.3. Amended by P.L.7-2015, SEC.34.

IC 12-15-2.3-3Qualified entities to establish eligibility Sec. 3. A qualified entity may establish the presumptive eligibility of a woman described in section 1 of this chapter.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-4Identity of qualified entities Sec. 4. The office shall consider the following to be qualified entities:

(1) A disproportionate share provider under IC 12-15-16-1(a) or IC 12-15-16-1(b).

(2) A federally qualified health clinic.

(3) A rural health clinic.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-5Qualified entities provided with application forms and information Sec. 5. The office shall provide each qualified entity with the following:

(1) Application forms for Medicaid.

(2) Information on how to assist a woman described in section 1 of this chapter in completing and filing the application forms.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-6Period during which services provided Sec. 6. The office shall provide Medicaid services to a woman described in section 1 of this chapter during a period that:

(1) begins on the date on which a qualified entity determines on the basis of preliminary information that the woman is eligible for Medicaid under IC 12-15-2-13.5; and

(2) ends on the earlier of the following:

(A) The date on which a determination is made by a representative of the county office with respect to the eligibility of the woman under IC 12-15-2-13.5.

(B) The last day of the month following the month in which the qualified entity makes the determination described in subdivision (1).

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-7Woman's eligibility determined by qualified entity Sec. 7. A woman described in section 1 of this chapter may only have a presumptive eligibility determination made by an entity described in section 2 of this chapter.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-8Actions taken after establishment of eligibility Sec. 8. A qualified entity that determines that a woman described in section 1 of this chapter is presumptively eligible for Medicaid shall do the following:

(1) Notify the office of the determination within five (5) working days after the date on which the determination is made.

(2) Inform the woman at the time a determination is made that an application for Medicaid is required to be made at the county office in the county where the woman resides or an enrollment center (as provided in IC 12-15-4-1) not later than the last day of the month following the month during which the determination is made.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-9Completion of application Sec. 9. If a woman described in section 1 of this chapter is determined to be presumptively eligible for Medicaid under this chapter, the woman must complete an application for Medicaid as provided in IC 12-15-4 not later than the last day of the month following the month during which the determination is made.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-10ExpiredAs added by P.L.152-2001, SEC.3. Expired 12-31-2013 by P.L.278-2013, SEC.9.

IC 12-15-2.3-11Reimbursement for care during presumptive eligibility Sec. 11. If a woman described in section 1 of this chapter is:

(1) determined to be presumptively eligible for Medicaid under this chapter; and

(2) subsequently determined not to be eligible for Medicaid;

a qualified entity under section 4(1) or 4(2) of this chapter that determined that the woman was presumptively eligible for Medicaid shall reimburse the office for all funds expended by the office in paying for care for the woman during the woman's period of presumptive eligibility.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-12Rules Sec. 12. The office shall adopt rules under IC 4-22-2 to implement this chapter, including rules that may impose additional requirements for qualified entities that are consistent with federal regulations.

As added by P.L.152-2001, SEC.3.

IC 12-15-2.3-13Annual appropriation to provide services Sec. 13. There is annually appropriated to the office of the secretary of family and social services from the state general fund an amount sufficient to provide services to those individuals eligible for Medicaid under IC 12-15-2-13.5 and this chapter.

As added by P.L.16-2009, SEC.18.

IC 12-15-2.5Chapter 2.5. Eligibility of Refugees, Lawful Permanent Residents, and Illegal Aliens for Medicaid Assistance

12-15-2.5-1Refugees 12-15-2.5-1Eligibility if classified as a citizen 12-15-2.5-2Lawful permanent residents; exceptions 12-15-2.5-3Illegal aliens 12-15-2.5-3Ineligibility for assistance 12-15-2.5-3.5Verification of citizenship or immigration status; referral to federal government 12-15-2.5-4Child born in United States 12-15-2.5-4.5Assistance to child or pregnant woman who is not lawful permanent resident 12-15-2.5-5Violation of federal law

IC 12-15-2.5-1Refugees Note: This version of section effective until 10-1-2026. See also following version of this section, effective 10-1-2026.

Sec. 1. A person who is classified as a refugee (as defined in 8 U.S.C. 1101) is eligible for all services under this article as if the person were classified as a citizen of the United States.

As added by P.L.46-1995, SEC.38.

IC 12-15-2.5-1Eligibility if classified as a citizen Note: This version of section effective 10-1-2026. See also preceding version of this section, effective until 10-1-2026.

Sec. 1. (a) This section does not apply to any alien for whom federal financial participation is unavailable under 42 U.S.C. 1396b(v)(5) or any alien who has not satisfied the requirements of 8 U.S.C. 1613.

(b) A person who:

(1) is lawfully admitted for permanent residence (as defined in 8 U.S.C. 1101(a)(20);

(2) has been granted the status of Cuban or Haitian entrant under Section 501(e) of the Refugee Education Assistance Act of 1980; or

(3) lawfully resides in the United States in accordance with a Compact of Free Association under 8 U.S.C. 1612(b)(2)(G);

is eligible for all services under this article as if the person were classified as a citizen of the United States.

As added by P.L.46-1995, SEC.38. Amended by P.L.63-2026, SEC.12.

IC 12-15-2.5-2Lawful permanent residents; exceptions Sec. 2. (a) Except as provided in subsection (b), a person who is a lawful permanent resident is eligible for Medicaid assistance under this article for a period of one (1) year.

(b) This subsection applies to the eligibility of an individual or the individual's dependent for Medicaid assistance and Medicaid waiver services. An individual who:

(1) is a legal Indiana resident;

(2) is an active member of the armed forces of the United States (as defined in IC 5-9-4-3) or the national guard;

(3) is assigned to a duty station outside Indiana or deployed; and

(4) except for meeting the state residency requirements, is otherwise eligible for Medicaid assistance or Medicaid waiver services under this article;

or the individual's dependent is eligible for Medicaid assistance or Medicaid waiver services under this article for one (1) year following the individual's discharge from service in the armed forces of the United States or the national guard or postdeployment in the armed forces of the United States or the national guard.

(c) The office shall allow an individual described in subsection (b) or a dependent of the individual to be placed on a Medicaid waiver waiting list if the individual or the individual's dependent does not reside in Indiana due to the individual's military assignment outside Indiana. When residency has been reestablished, the office shall resume:

(1) Medicaid assistance; and

(2) Medicaid waiver services, subject to the availability of a waiver slot under federal regulations;

for the individual or the individual's dependent if the individual or the individual's dependent is otherwise eligible under this section.

As added by P.L.46-1995, SEC.38. Amended by P.L.161-2007, SEC.36; P.L.116-2016, SEC.3.

IC 12-15-2.5-3Illegal aliens Note: This version of section effective until 10-1-2026. See also following version of this section, effective 10-1-2026.

Sec. 3. A person who is in the United States without permission of the United States Citizenship and Immigration Services is not entitled to receive assistance under this article.

As added by P.L.46-1995, SEC.38. Amended by P.L.1-2007, SEC.121.

IC 12-15-2.5-3Ineligibility for assistance Note: This version of section effective 10-1-2026. See also preceding version of this section, effective until 10-1-2026.

Sec. 3. A person who is in the United States and who does not meet the requirements of 42 U.S.C. 1396b(v)(5) is not entitled to receive assistance under this article.

As added by P.L.46-1995, SEC.38. Amended by P.L.1-2007, SEC.121; P.L.63-2026, SEC.13.

IC 12-15-2.5-3.5Verification of citizenship or immigration status; referral to federal government Sec. 3.5. (a) This section is effective October 1, 2026.

(b) The office of the secretary shall do the following:

(1) Verify citizenship or satisfactory immigration status for each applicant, recipient, or identified household member of an applicant or recipient.

(2) Either:

(A) after a reasonable opportunity period to verify citizenship or satisfactory immigration status where the status could not be verified; or

(B) upon receipt of verification that indicates that the applicant, recipient, or household member is not a United States citizen or lacks satisfactory immigration status and has entered the United States without inspection or admission, or has remained beyond the expiration of an authorized period of stay;

promptly refer the applicant, recipient, or household member of an applicant or recipient to the United States Department of Homeland Security or any other appropriate federal authority for further investigation and enforcement.

As added by P.L.63-2026, SEC.14.

IC 12-15-2.5-4Child born in United States Sec. 4. A child who:

(1) is born in the United States to a person described in section 2 or 3 of this chapter; and

(2) otherwise meets the requirements for assistance under this article;

is eligible to receive Medicaid under this article.

As added by P.L.46-1995, SEC.38.

IC 12-15-2.5-4.5Assistance to child or pregnant woman who is not lawful permanent resident Sec. 4.5. (a) This section applies to the following individuals who are lawfully residing in the United States as set forth in 42 U.S.C. 1396b(v)(4):

(1) A pregnant individual during:

(A) the pregnancy; and

(B) the maximum amount of time allowable under federal law that does not exceed the twelve (12) month period beginning on the last day of the pregnancy.

(2) An individual who is less than twenty-one (21) years of age.

(b) An individual described in subsection (a) who:

(1) meets any other requirement under federal law; and

(2) is otherwise eligible for Medicaid under this article;

is entitled to receive assistance under this article without a waiting period as allowed under 42 U.S.C. 1396b(v).

(c) The office of the secretary shall apply for any Medicaid state plan amendment or waiver necessary to implement this section.

As added by P.L.213-2023, SEC.2.

IC 12-15-2.5-5Violation of federal law Sec. 5. Any provision of this chapter that violates a federal law or federal regulation is void.

As added by P.L.46-1995, SEC.38.

IC 12-15-3Chapter 3. Ineligibility; Financial Limitations

12-15-3-0.5Applicability of chapter 12-15-3-1Expired 12-15-3-1.5Eligibility of aged, blind, disabled; spouse assets 12-15-3-2Expired 12-15-3-3Expired 12-15-3-4Repealed 12-15-3-5Limitation on total cash value of money, stocks, bonds, and life insurance owned by applicants or recipients not described in IC 12-15-3-1 12-15-3-6Purchase of qualified long term care insurance policy; computation under this chapter 12-15-3-7Effect of certain applicants' assignment of life insurance benefits to state on applicants' Medicaid eligibility 12-15-3-8529 Education savings plan