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Mission: To develop, finance and
compassionately administer programs to provide
healthcare and other social services to Hoosiers in
need in order to enable them to achieve healthy,
self-sufficient and productive lives.
Vision: To become a high performance,
integrated and interdependent agency,
leveraging its resources across the continuum
of services we provide in order to reliably and
consistently serve our customers while acting
as astute stewards of the state and federal
money provided to us.
FSSA Leadership
FSSA Secretary
• Jennifer Walthall, MD, MPH
Deputy Secretary/Chief of Staff
• Michael Gargano
Divisions Within FSSA
• Division of Aging
• Division of Disability and Rehabilitative Services
• Office of Early Childhood and Out-of-School Learning
• Division of Mental Health and Addiction
• Office of Medicaid Policy and Planning
• Division of Family Resources
DFR Leadership
DFR Director
• Adrienne Shields
Deputy Director Operations
• Victoria Knowles
Director of Training
• Monique Prezzy
Health Coverage Overview
• The Office of Medicaid Policy and Planning (OMPP) administers the Medicaid programs for the State, which include traditional Medicaid (fee for service) and health insurance programs to low income individuals
• DFR determines eligibility for the medical coverage programs in alignment with the policies and procedures established by Centers for Medicare and Medicaid Services (CMS)
Health Coverage General Eligibility
Factors and Requirements
• Age
• Indiana Residency
• Citizenship/Immigration Status
• Social Security Number (SSN)
• Information about other insurance coverages
• Tax Information
• Each health coverage program has specific income
and resource guidelines
Effective May 2017
Effective May 2017
• Indiana's health coverage program for children and pregnant women with low income
• Based on family income, children up to age 19 may be eligible for coverage
• HHW covers medical care such as doctor visits, prescription medicine, mental healthcare, dental care, hospitalizations, surgeries and family planning at little or no cost to the member or the member's family
Hoosier Healthwise (HHW)
Healthy Indiana Plan
• Uninsured adults age 19-64
• Individual may contribute to a Personal Wellness and Responsibility (POWER) Account
• The contribution is approximately 2% of the member’s income
• Minimum contribution is $1 per month
• Maximum contribution is $100 per month
• Applicant must select a Managed Care Entity (MCE)• Anthem
• Managed Health Services
• Mdwise
• CareSource
• Individuals that are not eligible for Medicare
HIP 2.0 Covers:
HIP 2.0: Plan Options
• Initial plan selection for all members
• Benefits: Comprehensive, including vision and dental
• Cost sharing:
• Must pay affordable monthly POWER account contribution: Approximately 2% of member income, ranging from $1 to $100 per month
• No copayment for services*
HIP Plus
• Fall-back option for members with household income less than or equal to100% FPL only
• Benefits: Meets minimum coverage standards, no vision or dental coverage
• Cost sharing:
• Members are not required to pay a monthly POWER account contribution
• Must pay copayment for doctor visits, hospital stays, and prescriptions
HIP Basic
• Individuals who qualify for additional benefits
• Benefits: Comprehensive, with some additional benefits including vision and dental
• Cost sharing:
• HIP Plus OR HIP Basic cost sharing
HIP State Plan
*EXCEPTION: Using Emergency Room for routine medical care
HIP 2.0: Treatment of Unique Populations
Medically Frail
Individuals (Ryan White) with a disability determination, certain conditions impacting their physical or mental health or their ability to perform activities of daily living such as dressing or bathing will receive enhanced benefits
• HIP Basic or HIP Plus cost sharing will apply but access to vision, dental, and non-emergency transportation benefits is ensured regardless of cost sharing option
• Will not be locked out due to non payment of POWER account contribution
Native AmericansBy federal rule, Native Americans are exempt from cost sharing. Can receive HIP benefits without required contributions or emergency room copayments. May opt out of HIP in favor of fee-for-service benefits as of April 1, 2015
Transitional Medical Assistance (TMA)
Individuals who no longer qualify as low-income parents or caretakers due to an increase in pay are eligible for HIP State Plan benefits for a minimum of six months even if income is over 138% FPL
Low-income Parents, Caretakers, and 19-20 year
olds
Individuals eligible for HIP State Plan Plus or HIP State Plan Basic benefits
HIP Plus vs. HIP Basic for Members with
Income Less than or equal to 100% FPLH
IP P
lus • More affordable
• Predictable monthly contributions
• More benefits
• Option to earn reductions to future monthly contributions
• May reduce future contributions by up to 100%
HIP
Bas
ic • May be more expensive
• Unpredictable costs
• Fewer benefits
• Potential to reduce future monthly contributions for HIP Plus enrollment, but these reductions are capped at 50%
Essential Health Benefits
HIP Plus HIP Basic HIP State Plan
Ambulatory(Doctor Visits)
Covered – Includes coverage for Temporomandibular Joint
Disorders (TMJ)
100 visit limit for home health
Covered – No TMJ coverage
100 visit limit for home health
Covered - Includes TMJcoverage & chiropractic
services. Home health limit does not apply
Emergency* Covered Covered Covered
HospitalizationCovered - Includes Bariatric
SurgeryCovered - No Bariatric Surgery
Covered - Includes Bariatric Surgery
Maternity Covered Covered Covered
Mental Health Covered Covered Covered
Laboratory Covered Covered Covered
Pharmacy Covered Covered - Generic Preferred Covered
Rehab & Habilitation
Covered – 75 visits annually of physical, speech and
occupational therapies
100 day limit for skilled nursing facility
Covered – 60 visits annually of physical, speech and
occupational therapies
100 day limit for skilled nursing facility
Covered - Requires prior authorization but not limited
to 60/75 visits annually
Skilled nursing facility limit does not apply
Preventive Covered Covered Covered
Pediatric Early Periodic Screening Diagnosis and Testing (EPSDT) services covered for 19 & 20 year olds
HIP 2.0: Essential Health Benefits
HIP 2.0: Additional Benefits
Other Benefits HIP Plus HIP Basic HIP State Plan
Adult Vision Covered Not Covered Covered
Adult DentalCovered – Limited to 2
cleanings per year and 4 restorative procedures
Not Covered Covered
Transportation Not Covered Not Covered Covered
Medicaid Rehabilitation Option (MRO)
Not Covered Not Covered Covered
Pregnancy-Only
Additional benefits for pregnant women including
transportation and chiropractic services.
Additional benefits for pregnant women including
transportation, vision, dental and chiropractic
services.
Pregnant women receive access to all pregnancy-only benefits on HIP Plus or HIP Basic plan and full
State Plan benefits.
HIP Plus Contributions
Are Not Premiums
• Unlike premiums, members own their contributions
• If members leave the program early with an unused balance, the portion
of the unused balance they are entitled to is returned to them
– Members reporting a change in eligibility and leaving the program (e.g. move
out of state) will retain 100% of their unused portion
– Members leaving for non-payment of the POWER account will retain 75% of
their unused portion
• If members leave the program early but incurred expenses, they may
receive a bill from their health plan for their remaining portion of the
health expenses
• Members remaining in the program may be eligible to receive a rollover of
their remaining contributions
– Rollover is applied to the required contribution for the following year
Medicaid for the Blind, Aged, and Disabled
• MA A
– Covers aged individuals over the age of 64 years old
• MA B
– Covers blind individuals according the SSA definition
• MA D
– Covers disabled individuals based on criteria defined by the State and SSA
• MADW
– Covers disabled individuals who are able to work
• MADI
– Covers individuals that have medically improved and are no longer eligible for MA D
• MASI– Covers SSI recipients
All categories must meet all other eligibility criteria in addition to meeting income and resource guidelines
Home and Community Based Services
Home and Community-Based Services (HCBS)
• HCBS are available for eligible aged and disabled
population
• Applicant can remain at home as opposed to
institutionalization
• Waiver applications are handled through the Division of
Aging and the Division of Disability and Rehabilitative
Services and generally there is a waiting list
• Waiver applicants should submit a Health Coverage
application for an eligibility determination
• Specific guidelines are utilized when determining Health
Coverage eligibility
Applying for Health Coverage
• Now that you have received
information regarding the Health
Coverage Programs…
• How do you apply?
Application Information• Applications for Health Coverage can be completed on-line via the benefit
portal, or applicants can apply at any local office on a self-service kiosk. Staff are available to assist with application processing and questions
• Applications can be printed, completed and submitted at a later date and can be mailed
Mail completed application back to:
FSSA Document Center
P.O. Box 1810
Marion, In 46952
Fax completed application to 1-800-403-0864
• Health Coverage applications take approximately 45 minutes to complete on-line, and can be completed via phone 1-800-403-0864
• When completing applications the following information is recommended:– Names, Date of Birth and Social Security Numbers for everyone applying in the household
– Employer and Income information for household members
– Tax filing status and tax dependent information
– Current health insurance information including policy number for household members
Individuals can apply for assistance by accessing the link below:
https://www.fssabenefits.in.gov/CitizenPortal/application.do
After an account has been created and logged into,
additional information can be accessed by clinking on
this link
Click this link for an optional screening tool to determine potential
eligibility
Estimated time to complete screening:
15 minutes
A full application must be completed before
eligibility can be determined
A recipient can also manage their benefits, report a change and request
proof of benefits. In order to access this information they must sign into
their account. If they do not have an account one can be created. If an
Authorized Representative wishes to obtain information and/or create an
account this is completed on this screen.
https://fssabenefits.in.gov/benefitsportal/app/portalhome#/
Benefits Portal Case Information Page Example
When a topic is selected, the fields
will expand with additional options.
If you select Case Forms…
The Case Forms field expands
Agency Portal
• Agencies working with clients through the interview and application process often need to know the status of their applications. In order to find this information as well as other information, such as upcoming appointments, agencies are encouraged to register on the agency portal. The portal will provide 24 hour access to the registered agency
https://www.fssabenefits.in.gov/AgencyPortal/#/
http://www.in.gov/fssa/files/Agency_Portal_Instructions.pdf
Redeterminations/Renewals
Redeterminations/Auto Renewals
• A Health Coverage redetermination is a required annual
review of Medicaid assistance groups to determine
continuing eligibility
• Timeframes for the review varies dependent upon when
eligibility initially began
• Some eligibility redeterminations are automatically
determined by specific systematic criteria and others
require the return of a mailer which must be signed by
the client or the authorized representative
• If changes are reported verification must be returned
with the signed mailer
PROTECTING HEALTH INFORMATION
What is an Authorized Representative (AR)?
• The individual or organization may assist with
the application and/or renewal of benefits
process and receive copies of notices for
Healthcare coverage
• An applicant or recipient can appoint or
designate an individual or organization to serve
as an authorized representative on their behalf
Authorized Representative Responsibilities
• The individual or organization whom is serving as an AR
must be knowledgeable of an individual’s
circumstances including, but not limited to, knowledge
of income and resources, household composition and
tax relationships
• Assume responsibility for the accuracy of the
information provided and must maintain confidentiality
of all information provided
Authorized Representative Form…
• If printed from the application Benefits Portal the health coverage
form contains a bar code and is unique to a specific case. Copies
of the form should not be made to attach to other cases, and the
bar code should not be altered under any circumstances
• Generic Authorized Representative Forms can be found at the link below:
http://www.in.gov/fssa/dfr/2689.htm
• Both the AR and the individual must sign the form.
…Authorized Representative Form (Continued)
• During form completion the AR and the
applicant will determine their specific
functions
– Apply functions include:• Sign the application on behalf of the applicant and represent the
applicant during an interview
• Provide all required verifications to determine eligibility
• Speak on behalf of the applicant at appeal
– Ongoing Functions include:• Reporting Changes
• Attending redetermination/renewal interview if applicable, or completing
redetermination/renewal mailer
• Receiving notices
Authorization for Disclosure of Personal and Health
Information Form
• Client will need to indicate what personal and health
information they are authorizing DFR personnel to disclose
• What is the purpose of the requested disclosure (i.e.
assistance with obtaining or using FSSA benefits or services)
• Whom is DFR authorized to disclose personal information
(i.e., names of the individuals or organization including their
contact information)
• Right to revoke at any time by providing written notice
• Once disclosed the information may not be protected under
state or federal privacy laws
• Signature and date is required to provide authorization
http://www.in.gov/fssa/dfr/2689.htm
Authorization for Disclosure of Personal
and Health Information Form
This document is utilized to authorize an individual or agency to obtain information
for a specific amount of time which generally expires in 60 calendar days. Receipt of
this form does not translate into the same information that an AR would receive.
DFR CONTACT INFORMATION
Statewide Eligibility Structure
There are 10 regions each with a Regional Manager and Deputy
Regional Manager
Region 1: Lake ([email protected])
Region 2: St. Joseph ([email protected])
Region 3: Allen ([email protected])
Region 4: Grant ([email protected])
Region 5: Marion ([email protected])
Region 6: Vigo ([email protected])
Region 7: Vanderburgh (DFR.Region
Region 8: Clark ([email protected]
Region 9: Tippecanoe ([email protected])
Region 10: Wayne ([email protected])
Each region as mailbox where inquiries can be sent for questions. A response will be received within 3-5 business days
All regions have one local office within their respective counties
that will assist individuals whom wish to apply for
assistance
Exception:Lake, St. Joseph, and Marion Counties have multiple offices which assist individuals by the applicant’s and/or recipient’s zip code
Locating a Local DFR Office:
You can use http://www.in.gov/fssa/dfr to locate your local office:
Information & Resources Tab
Or click here for directions nearest DFR officehttps://secure.in.gov/apps/fssa/providersearch/#/map
Reporting Information
Statewide DFR Telephone/FAX:
1-800-403-0864
• FSSA Document Center
P.O. Box 1630
Marion, IN 46952
State Local Offices Mon-Fri 8am to 4:30pm
Additional Information
Health Coverage has a specific policy manual and income and resource guidelines for the determination of eligibility
Program specific information and policy manuals are available at www.in.gov/fssa
Health Coverage policy manual: http://www.in.gov/fssa/ompp/4904.htm
Questions
How will Ruth be able to afford her
medications?
• Ruth gets $1450/mo in Social Security, no other
income.
• Her $109 Part B premium comes out of SS check.
• Additionally, rent, utilities, insurance, car expenses total $965 per
month.
• Without insurance, her medications are
$432/month.
• What can Ruth do?
Ruth can call HoosierRx!
HoosierRx:
• Is a program that helps low-income seniors pay their premium for Medicare Part D prescription drug coverage, or pay the
prescription drug portion of a Medicare Advantage plan premium.
• Is not a Medicare Part D insurance plan, and cannot assist with deductibles, co-pays, or paying for medication that insurance won’t
cover.
HoosierRx Eligibility
• Must be an Indiana resident, aged 65 or older;
• Must be on Medicare and have a Medicare Part D or Medicare Advantage plan that
works with HoosierRx;
• Cannot be eligible for Medicaid, nor receiving 100% Low-Income Subsidy (Full
“Extra Help”) through Social Security;
• Must meet all other income and eligibility requirements.
Income and Asset Requirements
• Currently, members’ GROSS income must be
no greater than 150% Federal Poverty Level
(FPL).
• In 2017, for one person, gross income limit is
$18,330 annually; for married couple, $24,600
annually.
• There are no asset limitations for HoosierRx
Which Medicare Part D Companies work
with HoosierRx?
Currently, there are seven companies that
have contracts with HoosierRx:
• Cigna-HealthSpring
• EnvisionRx
• First Health
• Indiana University Health Plan
• SilverScript
• UnitedHealthcare/
AARP
• WellCare
How much assistance can HoosierRx
provide?
• HoosierRx can provide premium
assistance up to $70 monthly for eligible
members.
• The premium assistance is paid
directly to the company on
member’s behalf.
• If the premium is over $70/month, the
member will be billed the remaining
premium portion from the company.
How can HoosierRx help Ruth?
• HoosierRx sends Ruth an application to
complete and refers her to SHIP.
• SHIP helps her to find Part D insurance where there is no deductible
and covers her current medications.
• Ruth chooses a plan with a $56/month
premium.
• Her application for HoosierRx is submitted
and approved.
• HoosierRx pays her premium of $56 per
month.
• Her monthly co-pays on her current medication
will be $82.
How do I apply?
• Call 866-267-4679 and
ask for an application.
• Go online and print an
application: http://at.in.gov/HoosierRx
• Mail completed
application to:
HoosierRx
MS07
402 W Washington St. W374
Indianapolis, IN 46204
• Or Fax application and
supporting papers to:
317-234-3709
THANK YOU!
• If you have any questions, please call
866-267-4679.
• Be sure to tell others about this program!