Indiana is making major changes to its Medicaid law, including allowing Supplemental Security Income (SSI) recipients to automatically qualify for Medicaid, eliminating the current spend-down program, and making Indiana an income cap state.
Most states either automatically qualify SSI recipients for Medicaid or use the same income, resource, and disability criteria to determine Medicaid eligibility that they use to determine SSI eligibility. Indiana is currently one of eleven "209(b) states," which means it has more restrictive rules for Medicaid eligibility than for SSI eligibility.
Under the new rules, which take effect June 1, 2014, the state will automatically enroll SSI-eligible individuals into Medicaid, eliminating the need for them to file a separate application. The rules also do away with the spend-down program that allowed individuals with earnings over the limit for Medicaid eligibility to "spend down" their income before receiving Medicaid benefits. According to the state, this transition away from a 209(b) state is possible because the Affordable Care Act (ACA) is providing new coverage options for current spend-down participants, so they will not be left without insurance while they transition.
Residents who are not dual eligible will be required to purchase insurance on the ACA exchange if their income exceeds 100 percent of the poverty level. Aged, blind and disabled Hoosiers with incomes below 100 percent of the poverty level will stay on Medicaid with no spend-down or other cost. Dual eligible Indiana residents with incomes between 100 percent and 150 percent of the poverty level will automatically be enrolled in an enhanced Medicare Savings Program without a spend-down or other cost.
The new rules also put a cap on the income an institutionalized or waiver Medicaid applicant can earn and still be eligible for Medicaid. In income cap states, eligibility for Medicaid benefits is barred if a nursing home resident's income exceeds $2,163 a month (for 2014), unless the excess income above this amount is paid into a "(d)(4)(B)" or "Miller" trust.
Indiana ElderLawAnswers member attorney, Keith Huffman, alerted us to these changes. Huffman explains that "The Affordable Care Act allows Hoosiers who are not dual eligible to get coverage on the exchange if they have income above the federal poverty guideline. This allows Indiana to eliminate the spend-down program, which costs about $37 million per year. This may be a key step toward expanding Medicaid in Indiana to be in full compliance with the Affordable Care Act."
For more information about the changes from Huffman’s firm, Dale, Huffman and Babcock, click here.
For information from the state about the new rules, click here.
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