Indiana Medicaid Guidelines

Most Indiana Medicaid applications are reviewed within 45 days. Disability-based applications may take up to 90 days for approval. However, coverage may be retroactive for three months preceding enrollment if requirements are met during that time. Applicants must meet income, age, resource and disability guidelines to qualify for different Medicaid programs. Additionally, members must adhere to Medicaid regulations regarding treatment and household changes to continue to receive benefits.

General Eligibility

• Medicaid is available to adults with eligible dependents, children, pregnant women, and aged or disabled individuals. Only U.S. citizens or lawful immigrants are eligible for Medicaid. Lawful immigrants may receive full benefits after five years of residency or emergency Medicaid before the five-year period ends. Emergency Medicaid is available to qualifying unlawful immigrants as well.

Income

• Children up to age 1 and pregnant women qualify if the family income does not exceed 200 percent of the federal poverty level. The income limit for children ages 1 through 5 is 133 percent of the federal poverty level, and for ages 6 through 19, 100 percent of the federal poverty level. As of 2010, adult caretakers of eligible children qualify if their income is at or below $288 monthly. Adults age 65 and older or disabled individuals qualify if their income does not exceed the monthly Supplemental Security Income rate of $674 for singles or $1,011 for couples.

Assets

• In addition to financial criteria, Medicaid eligibility may be based on your assets or resources. Asset guidelines may be as low as $1,000 for able-bodied caretaker adults or unlimited for certain pregnant women and children. Countable assets may include bank accounts, stocks and bonds or insurance policies with cash value. Excluded assets include your home, trusts, household goods and one vehicle.

Dual Insurance

• Most Medicaid programs may be used with other insurance plans. If you currently have health insurance, it will be considered your primary carrier and charged for medical expenses before Medicaid is used. Medicare members with incomes between 100 to 135 percent of the federal poverty level may be eligible for Medicaid coverage to help pay for Medicare premiums, co-pays and deductibles.

Member Responsibilities

• Medicaid members must report eligibility changes to their social worker or the Indiana Division of Family Resources to continue to receive benefits. Changes may include household size, income, relocation or new health conditions. Additionally, most Medicaid plans require members to choose a primary physician and members are responsible for finding out if a particular doctor accepts Medicaid payments. If they do not accept Medicaid, the member may be liable for medical bills.