Indiana Medicaid would review timely records before ending coverage

The state office, contracted health plans, and their contractors would have to review submitted information. This applies when a recipient’s Medicaid eligibility is checked again. The information must be relevant and submitted on time. The review must happen before coverage ends.

The state office, contracted health plans, and their contractors would have to send advance notices before ending services. This applies to Medicaid recipients whose services would end. Notices could not cite program rules that the office does not enforce. Notice must come at least 21 days before services end, unless that would cost federal funding; then it must come as early as federal funding allows.

The Healthy Indiana Plan would include coverage that reaches back at least 30 days. This applies to people covered by the Healthy Indiana Plan. The state office determines how and to what extent the plan includes this coverage.

Contracted health plans would send reports, and the state office would post reports and guidance online. Quarterly reports would cover denied claims by Medicaid program and claim type. Monthly reports would cover enrollment changes and help-line use. The office would also post its criteria for deciding who is medically frail and sample Medicaid notices with explanations. Denial reports would cover the previous quarter; the other reports would cover the previous month.