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[August 3, 2020] FSSA Updates Administrative Code on Medicaid Recipients and Eligibility - IHCA

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[August 3, 2020] FSSA Updates Administrative Code on Medicaid Recipients and Eligibility

Posted Aug 3, 20203 min Read

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On July 22, 2020, the Indiana Family and Social Services Administration (FSSA) published a Proposed Rule, LSA Document #19-602, to amend FSSA’s administrative code regarding Medicaid recipients and eligibility in an effort to align the administrative code with the agency’s current policies and practices.  The Proposed Rule contains three sections applicable to long-term care, as follows:

Authorized Individuals for Eligibility Determinations

The Proposed Rule first amends 405 IAC 2-1-2 (Interview of applicants and members), which as a general rule requires each Medicaid applicant, or the individual authorized to act on the Medicaid applicant’s behalf, to be interviewed by the Division of Family Resources prior to the initial eligibility determination and upon each annual determination of eligibility.  The Proposed Rule clarifies that unless an employee of a nursing facility is legally authorized to act on behalf of a resident, an employee of a nursing facility may not be interviewed on behalf of a resident for the initial or annual determination of Medicaid eligibility.  However, there is an exception that allows an employee of a nursing facility to be interviewed if certified medical documentation shows the resident is medically incapable of being interviewed and there is no one else to act on the resident’s behalf.

This clarification does not prevent an employee of a nursing facility from being duly authorized to serve as a resident’s representative, but the employee may not be interviewed for the initial or annual determination of Medicaid eligibility of the resident if the employee is not the resident’s duly authorized representative, unless the exception applies.  If a former resident is deceased, then a court order would be required to allow a third party to apply for Medicaid on the resident’s behalf.

Posteligibility Treatment of Income

The Proposed Rule also amends 405 IAC 2-1.1-7 (Posteligibility treatment of income) to use the same formula for posteligibility treatment of income for home and community-based waiver services that is currently used for nursing homes.  The separate posteligibility formula for home and community-based waiver services would therefore be repealed.

End Stage Renal Disease Demonstration

Finally, the Proposed Rule aligns FSSA’s administrative code with the agency’s current End Stage Renal Disease (ESRD) demonstration, which has been in place since 2016 and serves approximately 350 individuals who would otherwise be ineligible for Medicaid coverage for ESRD due to income.  Under the new provisions (See 405 IAC 5-39-1 and 405 IAC 5-39-2), if an individual is being served under the ESRD demonstration, they are eligible for admission to nursing facilities, but if the individual is admitted to a nursing facility or other long-term care setting, the individual will be disenrolled from the ESRD demonstration and eligibility will be reassessed upon discharge from the long-term care setting.

If you have any questions, please contact Laura Brown at Lbrown@ihca.org.

About the Author

Laura Brown, Director of Legislative and Legal Affairs