§ 12-15-44.5-10 — Benefits for adult group; limit enrollment; limitations on negotiations of plan; changes to plan; written report

Indiana § 12-15-44.5-10

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 44.5: Healthy Indiana Plan 2.0

Text

(a) The secretary has the authority to
provide benefits to individuals eligible under the adult group described
in 42 CFR 435.119 only in accordance with this chapter.
(b) The secretary shall limit enrollment in the plan to the number of
individuals that ensures that financial participation does not exceed the
level of state appropriations or other funding for the plan.
(c) The secretary may negotiate and make changes to the plan,
except that the secretary may not negotiate or change the plan in a way
that would do the following:
(1) Reduce the following:
(A) Contribution amounts below the minimum levels set forth
in section 4.7 of this chapter.
(B) Deductible amounts below the minimum amount
established in section 4.5(c) of this chapter.
(C) The number of hours required to satisfy the work
requirements specified in section 3(c)(1) of this chapter unless
expressly required by federal law.
(2) Remove or reduce the penalties for nonpayment set forth in
section 4.7 of this chapter.
(3) Revise the use of the health care account requirement set forth
in section 4.5 of this chapter.
(4) Include noncommercial benefits or add additional plan
benefits in a manner inconsistent with section 3.5 of this chapter.
(5) Allow services to begin:
(A) without the payment established or required by; or
(B) earlier than the time frames otherwise established by;
section 4.7 of this chapter.
(6) Reduce financial penalties for the inappropriate use of the
emergency room below the minimum levels set forth in section
5.7 of this chapter.
(7) Permit members to change health plans without cause in a
manner inconsistent with section 4.7(g) of this chapter.
(8) Operate the plan in a manner that would obligate the state to
financial participation beyond the level of state appropriations or
funding otherwise authorized for the plan.
(d) The secretary may make changes to the plan under this chapter
if the changes are required by federal law or regulation and the office
provides a written report of the changes to the state budget committee.

Legislative History

As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.35; P.L.126-2025, SEC.13.