§ 12-15-44.5-4 — Scope of the plan; termination of plan; obligation of state; report to budget committee

Indiana § 12-15-44.5-4

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

Text

Note: This version of section effective until 7-1-2025. See also
following version of this section, effective 7-1-2025.
Sec. 4. (a) The plan:
(1) is not an entitlement program; and
(2) serves as an alternative to health care coverage under Title
XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(b) If either of the following occurs, the office shall terminate the
plan in accordance with section 6(b) of this chapter:
(1) The:
(A) percentages of federal medical assistance available to the
plan for coverage of plan participants described in Section
1902(a)(10)(A)(i)(VIII) of the federal Social Security Act are
less than the percentages provided for in Section 2001(a)(3)(B)
of the federal Patient Protection and Affordable Care Act; and
(B) office, after considering the modification and the reduction
in available funding, does not alter:
(i) the formula established under IC 16-21-10-13.3(b)(1) to
cover the amount of the reduction in federal medical
assistance; or
(ii) if applicable, the fee formula used to fund the
reimbursement for inpatient and outpatient hospital services
under IC 16-21-10-8.5 to cover the amount of the reduction
in federal medical assistance.
For purposes of this subdivision, "coverage of plan participants"
includes reimbursement, payments, contributions, and amounts
referred to in IC 16-21-10-13.3(b)(1)(A), IC 16-21-10-13.3(b)(1)(C), and IC 16-21-10-13.3(b)(1)(D),
including reimbursement, payments, contributions, and amounts
incurred before termination of the plan.
(2) The:
(A) methodology of calculating the incremental fee set forth in
IC 16-21-10-13.3 is modified in any way that results in a
reduction in available funding;
(B) office, after considering the modification and reduction in
available funding, does not alter:
(i) the formula established under IC 16-21-10-13.3(b)(1) to
cover the amount of the reduction in fees; or
(ii) if applicable, the fee formula used to fund the
reimbursement for inpatient and outpatient hospital services
under IC 16-21-10-8.5 to cover the amount of the reduction
in fees; and
(C) office does not use alternative financial support to cover the
amount of the reduction in fees.
(c) If the plan is terminated under subsection (b), the secretary may
implement a plan for coverage of the affected population in a manner
consistent with the healthy Indiana plan (IC 12-15-44.2 (before its
repeal)) in effect on January 1, 2014:
(1) subject to prior approval of the United States Department of
Health and Human Services; and
(2) using funding from the incremental fee set forth in IC 16-21-10-13.3.
(d) The office may not 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.
(e) The office of the secretary shall submit annually to the budget
committee an actuarial analysis of the plan that reflects a determination
that sufficient funding is reasonably estimated to be available to
operate the plan.

Legislative History

As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.29; P.L.216-2025, SEC.11.