Ind. Code ch. 12-15-1

Ind. Code ch. 12-15-1
in effect

Ind. Code § 12-15-1-1 Administration of Medicaid program

Sec. 1. The office of the secretary shall administer the Medicaid program under 42 U.S.C. 1396 et seq. [Pre-1992 Revision Citation: 12-1-7-16(a) part.] As added by P.L.2-1992, SEC.9. Amended by P.L.109-2014, SEC.18.

Ind. Code § 12-15-1-2 Agents of the division of family resources

Sec. 2. A county office shall serve as an agent of the division of family resources. [Pre-1992 Revision Citation: 12-1-7-16(a) part.] As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.106; P.L.5-1993, SEC.119; P.L.145-2006, SEC.82.

Ind. Code § 12-15-1-3 Supervision of county offices

Sec. 3. The division of family resources shall supervise the county offices regarding services provided under this chapter. [Pre-1992 Revision Citation: 12-1-7-16(a) part.] As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.107; P.L.5-1993, SEC.120; P.L.145-2006, SEC.83.

Ind. Code § 12-15-1-4 Written protocols; contracts implementing state program

Sec. 4. (a) The office and the division of family resources shall formulate written protocols that specify the following: (1) That the county offices are responsible for all eligibility determinations made under the state Medicaid program. (2) That the office is responsible for payment of a claim made under the state Medicaid plan. (b) The office may enter into any contract to implement the state program. [Pre-1992 Revision Citation: 12-6-6-5.] As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.108; P.L.5-1993, SEC.121; P.L.145-2006, SEC.84.

Ind. Code § 12-15-1-5 Agreement with Commissioner of the United States Social Security Administration; eligibility determinations for aged, blind, and disabled; authorization to request transition change for determinations

Sec. 5. (a) The office may enter into an agreement with the Commissioner of the United States Social Security Administration under which the Commissioner shall accept applications and make determinations of eligibility for Medicaid for individuals who are aged, individuals who are blind, and individuals with a disability in accordance with the standards and criteria established by the state plan for Medicaid. (b) The office may request the United States Department of Health and Human Services to approve Indiana's transition, beginning January 1, 2014, as a state that determines eligibility for individuals who are aged, blind, or disabled under Medicaid based on Section 1634 of the federal Social Security Act. [Pre-1992 Revision Citation: 12-1-7-19.1(a) part.] As added by P.L.2-1992, SEC.9. Amended by P.L.99-2007, SEC.93; P.L.160-2011, SEC.5.

Ind. Code § 12-15-1-6 Agreement with Secretary of United States Department of Health and Human Services; division of administrative costs

Sec. 6. The office may pay to the Secretary of the United States Department of Health and Human Services one-half (1/2) of the administrative cost of carrying out the agreement. However, with respect to an individual eligible for benefits under the federal Supplemental Security Income program the costs must only include those costs which are additional to the cost in carrying out the Supplemental Security Income program. [Pre-1992 Revision Citation: 12-1-7-19.1(a) part.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-1-7 Agreement with Secretary of United States Department of Health and Human Services; eligibility determinations after January 1, 1974

Sec. 7. The agreement under section 5 of this chapter must cover eligibility determinations after January 1, 1974. [Pre-1992 Revision Citation: 12-1-7-19.1(a) part.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-1-8 Receipt of assistance in adult category before January 1, 1974; automatic coverage

Sec. 8. An individual who receives assistance in one (1) of the adult categories before January 1, 1974, is not required to make a new application and is automatically covered by the plan while the individual remains eligible. [Pre-1992 Revision Citation: 12-1-7-19.1(a) part.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-1-9 Application to county offices

Sec. 9. (a) If the state does not enter into a contract with the Secretary of the United States Department of Health and Human Services to administer the Medicaid program, a recipient must make an application for Medicaid to the county office of the county or district in which the recipient resides. (b) The application must be in the manner required by the office. (c) However, an applicant who: (1) was receiving assistance before January 1, 1974; and (2) has been certified as eligible for Medicaid; is not required to make an application while the recipient continues to remain eligible under state laws. [Pre-1992 Revision Citation: 12-1-7-19.1(b).] As added by P.L.2-1992, SEC.9. Amended by P.L.4-1993, SEC.109; P.L.5-1993, SEC.122.

Ind. Code § 12-15-1-10 Administrative actions and directions; adoption of procedures and rules

Sec. 10. The secretary may: (1) take actions; (2) give directions; and (3) adopt procedures and rules under IC 4-22-2; necessary to carry out the Medicaid program and the federal Social Security Act to provide Medicaid and ensure uniform equitable treatment of applicants for and recipients of Medicaid. [Pre-1992 Revision Citation: 12-1-7-16(b).] As added by P.L.2-1992, SEC.9. Amended by P.L.35-2016, SEC.33.

Ind. Code § 12-15-1-11 Money received from recipient or collected from estate; payment into Medicaid account; apportionment

Sec. 11. (a) Money received from a Medicaid recipient or collected from the recipient's estate shall be: (1) forwarded to the office; and (2) paid into the Medicaid account of the state general fund. (b) Money under subsection (a) must be distributed in proportion to the amounts in which the assistance payments represented money contributed by the federal government and the state. [Pre-1992 Revision Citation: 12-1-7-27.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-1-12 Attorney general; appearance and representation of state in proceedings affecting property or resources upon which state may have claim

Sec. 12. The attorney general may enter the appearance of the state in a proceeding affecting property or resources upon which the state may have a claim for Medicaid to do the following: (1) Prosecute and defend in the proceeding. (2) Institute probate proceedings as a creditor to deceased persons. (3) Enter into a stipulation, a compromise, a settlement, an agreement, or an arrangement with respect to appropriate claims, either in the course of or in the absence of and apart from any action or proceeding. [Pre-1992 Revision Citation: 12-1-7-26.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-1-13 Annual effectiveness evaluation

Sec. 13. The office shall conduct an annual evaluation of the effectiveness of providing Medicaid under IC 12-15-2-12 and IC 12-15-2-14. [Pre-1992 Revision Citation: 12-1-7-58 part.] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-1-14 Effectiveness evaluation; annual report to legislative council

Sec. 14. The office shall annually submit a report to the legislative council that covers all aspects of the office's evaluation, including the following: (1) The number and demographic characteristics of the individuals receiving Medicaid during the preceding fiscal year. (2) The number of births during the preceding fiscal year. (3) The number of infant deaths during the preceding fiscal year. (4) The improvement in the number of low birth weight babies for the preceding fiscal year. (5) The total cost of providing Medicaid during the preceding fiscal year. (6) The total cost savings during the preceding fiscal year that are realized in other state funded programs because of providing Medicaid. The report must be in an electronic format under IC 5-14-6. [Pre-1992 Revision Citation: 12-1-7-58 part.] As added by P.L.2-1992, SEC.9. Amended by P.L.28-2004, SEC.103.

Ind. Code § 12-15-1-14.3 Annual report to the budget committee

Sec. 14.3. The office of the secretary shall annually prepare and present a report to the budget committee concerning the enforcement of the Medicaid five (5) year look back period required under this article. As added by P.L.126-2025, SEC.3.

Ind. Code § 12-15-1-14.5 Report concerning services provided to recipients who have medically complex conditions; recommendations

Sec. 14.5. (a) The office of the secretary shall prepare a report on the provision of Medicaid services, including Medicaid home and community based waiver services, to recipients who have medically complex conditions. The report must include the following, categorized by whether the recipient was less than, or at least, eighteen (18) years of age: (1) The number of recipients, by county, who received Medicaid services through: (A) the state plan; (B) a Medicaid waiver; or (C) services under both clauses (A) and (B). (2) A list of the specific services provided to the recipients, by county, and the number of recipients who received each service. (3) The median length of time recipients have received Medicaid, by county, through the following: (A) The state plan. (B) A Medicaid waiver. (C) Services under both clauses (A) and (B). (b) Not later than September 1, 2025, and each September 1 thereafter, the office of the secretary shall submit the report described in subsection (a) to the following: (1) The Medicaid advisory commission, established by IC 12-15-33-2. (2) The Medicaid oversight committee, in an electronic format under IC 5-14-6. (3) The budget committee. (4) The legislative council, in an electronic format under IC 5-14-6. (5) The division of disability and rehabilitative services advisory council established under IC 12-9-4. (c) The division of disability and rehabilitative services advisory council established under IC 12-9-4 shall provide the following recommendations to the division of disability, aging, and rehabilitative services to ensure the delivery of appropriate high quality services to recipients, including an evaluation of models of care for complex care assistants used in other states: (1) The potential benefits and risks to recipients and family caregivers. (2) Training and certification requirements. (3) Implementation challenges and strategies to address the challenges. (4) Any potential fiscal impact of implementing a complex care assistant program in Indiana. As added by P.L.243-2025, SEC.10. Amended by P.L.23-2026, SEC.80; P.L.122-2026, SEC.56.

Ind. Code § 12-15-1-15 Assignment, enforcement, and collection of rights of payment; contracts for administration of program; rules

Sec. 15. (a) The office shall administer the program of assignment, enforcement, and collection of rights of payments for medical care that is provided for under 42 U.S.C. 1396k. (b) The office may enter into contracts to administer the program described in subsection (a). (c) The secretary shall adopt rules under IC 4-22-2 to implement this section. [Pre-1992 Revision Citation: 12-1-2-18.] As added by P.L.2-1992, SEC.9. Amended by P.L.210-2015, SEC.43; P.L.35-2016, SEC.34.

Ind. Code § 12-15-1-16 School corporations; enrollment in Medicaid program; sharing reimbursable costs; school based covered services

Sec. 16. (a) Each: (1) school corporation; or (2) school corporation's employed, licensed, or qualified provider; must enroll in a program to use federal funds under the Medicaid program (IC 12-15-1 et seq.) with the intent to share the costs of services that are reimbursable under the Medicaid program and that are provided to eligible children by the school corporation. However, a school corporation or a school corporation's employed, licensed, or qualified provider is not required to file any claims or participate in the program developed under this section. (b) The secretary and the department of education may develop policies and adopt rules to administer the program developed under this section. (c) The federal reimbursement for services provided under this section must be distributed to the school corporation. The state shall retain the nonfederal share of the reimbursement for Medicaid services provided under this section. (d) The office of Medicaid policy and planning, with the approval of the budget agency and after consultation with the department of education, shall establish procedures for the timely distribution of federal reimbursement due to the school corporations. The distribution procedures may provide for offsetting reductions to distributions of state tuition support or other state funds to school corporations in the amount of the nonfederal reimbursements required to be retained by the state under subsection (c). (e) The office may apply to the United States Department of Health and Human Services for a state plan amendment to allow school corporations to seek Medicaid reimbursement for medically necessary, school based Medicaid covered services that are provided under federal or state mandates. If the state plan amendment is approved and implemented, services may be provided by a qualified provider in a school setting to Medicaid enrolled students. Subject to subsection (f), the services may be pursuant to any of the following: (1) An individualized education program (as defined in IC 20-18-2-9). (2) A plan developed under Section 504 of the federal Rehabilitation Act, 29 U.S.C. 794. (3) A behavioral intervention plan (as defined in IC 20-20.5-13-1). (4) A service plan developed under 511 IAC 7-34. (5) An individualized health care plan. The office may, in consultation with the department of education, develop any necessary state plan amendment under this subsection. The office may apply for any state plan amendment necessary to implement this subsection. (f) Services under subsection (e) may not include the following: (1) An abortion. (2) Counseling for abortion procedures. (3) Referrals for abortion services. (4) Abortifacients. (5) Contraceptives. (g) If the state plan amendment described in subsection (e) is approved and implemented, the medically necessary, school based Medicaid covered services described in subsection (e): (1) may only be performed by a qualified provider; (2) must be within the qualified provider's scope of practice; and (3) must be provided in accordance with this article and administrative rules concerning the Medicaid program. As added by P.L.80-1994, SEC.1. Amended by P.L.224-2003, SEC.64; P.L.35-2016, SEC.35; P.L.108-2019, SEC.193; P.L.196-2021, SEC.1; P.L.35-2022, SEC.3; P.L.74-2026, SEC.13.

Ind. Code § 12-15-1-17 Reimbursement from parent for health services provided to child

Sec. 17. (a) The office shall, under procedures established by the department of state revenue, file an application for the offset of state tax refunds due to a parent who: (1) is required by a court or an administrative order to provide coverage of the costs of health services to a child who is eligible for medical assistance; (2) has received payment from a third party for the costs of the services to the child; and (3) has not used the payments to reimburse, as appropriate, either the: (A) other parent or guardian of the child; or (B) provider of the health services; to the extent necessary to reimburse the office, or, where the other parent has paid the provider or the office, the other parent, for the costs of the services provided to the child under the Medicaid program. (b) The office may institute garnishment proceedings against the wages, salary, or other employment income of the parent described in subsection (a) to the extent necessary to reimburse the office for the costs of health services provided to a child who has received the services under the Medicaid program. (c) Claims for current or past due child support take priority over any claims authorized by this section. As added by P.L.46-1995, SEC.30.

Ind. Code § 12-15-1-17.5 Advertising under the Medicaid program; prohibitions; rules

Sec. 17.5. The following may not advertise or otherwise market the Medicaid program: (1) A state agency. (2) A person that has contracted with the office of the secretary under the Medicaid program except to indicate their participation in the program. The secretary may adopt rules concerning permissible advertising or marketing indicating participation in the Medicaid program by a person that has contracted with the office of the secretary. As added by P.L.126-2025, SEC.4.

Ind. Code § 12-15-1-18 Use of funds to encourage application and enrollment of minors

Sec. 18. The office shall use all funds that are appropriated to the office under 42 U.S.C. 1397ee to conduct activities allowed under 42 U.S.C. 1397bb(c)(1) in order to encourage children who are: (1) less than nineteen (19) years of age; (2) eligible for Medicaid; and (3) not enrolled in the Medicaid program; to apply for and enroll in the Medicaid program. As added by P.L.58-1998, SEC.5.

Ind. Code § 12-15-1-18.5 Payer affordability penalty fund

Sec. 18.5. (a) The payer affordability penalty fund is established for the purpose of receiving fines collected under IC 16-21-6-3, IC 27-1-4.5-7, IC 16-21-6-13, IC 16-21-19, IC 27-1-46.5, and IC 27-2-25.5 to be used for: (1) the state's share of the Medicaid program; and (2) a study of hospitals that are impacted by changes made in the disproportionate share hospital methodology payments set forth in Section 203 of the federal Consolidated Appropriations Act of 2021. The office of the secretary shall perform the study and provide the results of the study described in subdivision (2) to the budget committee. (b) The fund shall be administered by the office of the secretary. (c) The expenses of administering the fund shall be paid from money in the fund. (d) The treasurer of state shall invest the money in the fund not currently needed to meet the obligations of the fund in the same manner as other public money may be invested. Interest that accrues from these investments shall be deposited in the fund. (e) Money in the fund at the end of a state fiscal year does not revert to the state general fund. (f) Money in the fund is continually appropriated. As added by P.L.203-2023, SEC.5. Amended by P.L.216-2025, SEC.2; P.L.239-2025, SEC.1; P.L.23-2026, SEC.81.

Ind. Code § 12-15-1-19 Contracts with community entities

Sec. 19. The office may, in administering managed care programs, contract with community entities, including private entities, for the following: (1) Outreach for and enrollment in the managed care programs. (2) Provision of services. (3) Consumer education and public health education. As added by P.L.273-1999, SEC.170.

Ind. Code § 12-15-1-20 Implementation of policy of funds following an individual transferring to community based care

Sec. 20. (a) The office shall implement a policy that allows the amount of Medicaid funds necessary to provide services to follow an individual who is transferring from institutional care to Medicaid home and community based care. (b) The amount may not exceed the amount that would have been spent on the individual if the individual had stayed in institutional care. As added by P.L.47-2009, SEC.2.

Ind. Code § 12-15-1-20.2 Computer system for disproportionate share hospital payment program; HCI; UPL

Sec. 20.2. The office shall develop, maintain, and use a computer system to store documents concerning the disproportionate share hospital payment program, the hospital care for the indigent program, and the hospital care for the indigent upper payment level program. The system must include the following documents related to the programs: (1) Federal and state laws. (2) Federal and state rules and regulations. (3) Policies and guidance statements. (4) Medicaid waivers. (5) Medicaid state plan amendments. (6) Funding allotments to health care facilities. (7) Funding formulas and any other explanatory information detailing how an individual allotment is calculated. As added by P.L.140-2009, SEC.1.

Ind. Code § 12-15-1-20.4 Suspension of Medicaid; notice of release; eligibility and services

Sec. 20.4. (a) If a Medicaid recipient is: (1) adjudicated to be a delinquent child and placed in: (A) a community based correctional facility for children; (B) a juvenile detention facility; or (C) a secure facility, not including a facility licensed as a child caring institution under IC 31-27; or (2) incarcerated in a prison or jail; and ineligible to participate in the Medicaid program during the placement described in subdivision (1) or (2) because of federal Medicaid law, the division of family resources, upon notice that a child has been adjudicated to be a delinquent child and placed in a facility described in subdivision (1) or upon notice that a person is incarcerated in a prison or jail and placed in a facility described in subdivision (2), shall suspend the person's participation in the Medicaid program. (b) If the division of family resources receives: (1) a dispositional decree under IC 31-37-19-28; or (2) a modified disposition order under IC 31-37-22-9; regarding a person described in subsection (a)(2) and the department of correction gives the division of family resources at least forty (40) days notice that the person will be released from a facility described in subsection (a)(2), the division of family resources shall take action necessary to ensure that the person is eligible to participate in the Medicaid program upon the person's release, if the person is eligible to participate. (c) A facility described in subsection (a)(1) shall, not less than forty-five (45) days before the release date of a person placed in the facility as described in subsection (a)(1), provide notice of the person's release date to the division of family resources. The division of family resources shall take action necessary to ensure that the person is eligible to: (1) participate in the Medicaid program upon the person's release, if the person is eligible to participate; and (2) receive services mandated under 42 U.S.C. 1396a for thirty (30) days before the person's release date and for thirty (30) days after the person's release date. As added by P.L.114-2009, SEC.1. Amended by P.L.1-2010, SEC.57; P.L.185-2015, SEC.9; P.L.152-2017, SEC.3; P.L.57-2021, SEC.1; P.L.26-2025, SEC.2; P.L.23-2026, SEC.82.

Ind. Code § 12-15-1-21 Single electronic Medicaid eligibility verification system

Sec. 21. Beginning January 1, 2012, the office and a contractor of the office shall operate a single electronic eligibility verification system that would allow the determination of whether an individual is participating in the state Medicaid program. As added by P.L.27-2011, SEC.1.

Ind. Code § 12-15-1-21.2 Plan to qualify services for exceptional learners; recovery of state share of cost of services

Sec. 21.2. (a) The budget agency shall develop a plan and seek federal approval to qualify services that are provided to assist exceptional learners in accessing or coordinating services, or both, under the state Medicaid plan. (b) The budget agency and the office of the secretary shall establish a method to collect the state share of the costs of services that are: (1) reimbursable under the Medicaid program; and (2) provided to Medicaid eligible children receiving services in private psychiatric residential treatment facilities; from the county of residence of the child receiving services. As added by P.L.220-2011, SEC.263.

Ind. Code § 12-15-1-21.7 Life insurance policy treatment

Sec. 21.7. (a) To the extent allowed by federal law, the office may use federal or state funds under the Medicaid program to pay premiums and other expenses related to a life insurance policy that is in force and owned by an applicant or a recipient who: (1) is: (A) at least fifty-five (55) years of age; or (B) permanently institutionalized; and (2) has: (A) made an irrevocable election to name the state as a beneficiary of the life insurance policy for an amount equal to: (i) Medicaid benefits provided to the recipient under IC 12-15-5 or IC 12-14-17; plus (ii) premiums or expenses paid by the office to the insurer that issued the life insurance policy; or (B) collaterally assigned the life insurance policy to the state under a written agreement submitted to and recorded by the insurer that issued the life insurance policy. (b) Any life insurance policy that is in force and under which the state is named as an irrevocable beneficiary or that has been collaterally assigned to the state may not be sold, assigned, or the ownership transferred to any person or entity. This restriction exists as long as the life insurance policy names the state as an irrevocable beneficiary or as long as the life insurance policy is collaterally assigned to the state. (c) Life insurance policy proceeds that exceed the amount of Medicaid benefits provided to a recipient shall be paid to a beneficiary named by the applicant or recipient. As added by P.L.196-2011, SEC.1.

Ind. Code § 12-15-1-22 Visit to Medicaid provider offices, entities, or facilities; rules

Sec. 22. (a) The office shall visit a Medicaid provider's office, entity, or facility if: (1) the provider is categorized as high risk to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450; and (2) the provider's Medicaid claims have increased by at least fifty percent (50%) over a six (6) month period. (b) The office shall adopt rules under IC 4-22-2 or issue a Medicaid provider bulletin setting forth procedures and standards for the visit required under this section. As added by P.L.197-2013, SEC.9.

Ind. Code § 12-15-1-23 Periodic review of Medicaid reimbursement rates

Sec. 23. (a) Not later than November 1, 2023, the office shall: (1) develop a schedule for the periodic review of Medicaid reimbursement rates for each category of service that does not have a rate review frequency in state or federal code; and (2) provide the schedule developed under subdivision (1) to the budget committee. The office may determine the frequency of review of each service category's Medicaid reimbursement rates according to the schedule. However, each service category's Medicaid reimbursement rates must be reviewed at least once every four (4) years. (b) The review of the first set of Medicaid reimbursement rates to be reviewed according to the schedule developed under subsection (a)(1) must be completed not later than November 1, 2024. (c) The office shall provide the findings of each review of each service category's Medicaid reimbursement rates to the budget committee as reviews are completed according to the schedule. As added by P.L.201-2023, SEC.135.

Ind. Code § 12-15-1-24 Prohibition on self-attestation without verification; data matching agreements; review of data from other agencies concerning Medicaid recipients

Note: This version of section effective until 1-1-2027. See also following version of this section, effective 1-1-2027. Sec. 24. (a) Except as required under federal law, the office of the secretary may not accept self-attestation of any of the following in the administration of the Medicaid program without verification before enrollment: (1) Income. (2) Residency. (3) Age. (4) Household composition. (5) Caretaker or relative status. (6) Receipt of other coverage. (b) The office of the secretary shall enter into a data matching agreement with: (1) the state lottery commission; and (2) the Indiana gaming commission; to, on at least a monthly basis, identify individuals receiving Medicaid assistance with lottery and gambling winnings of at least three thousand dollars ($3,000). Upon verification of any winnings resulting in the individual no longer being eligible for Medicaid, the office of the secretary shall terminate the individual's enrollment. (c) On at least a monthly basis, the office of the secretary shall review vital statistics information provided by the Indiana department of health under IC 16-19-3-19 to determine removal of deceased individuals from Medicaid enrollment. (d) On at least a quarterly basis, the office of the secretary shall receive and review information from the department of state revenue and the department of workforce development concerning Medicaid recipients that indicates a change in circumstances that may affect eligibility, including changes to employment or wages. (e) On at least an annual basis, the office of the secretary shall receive and review information from the department of state revenue concerning Medicaid recipients, including: (1) adjusted gross income; and (2) family composition; that indicates a change in circumstances that may affect Medicaid eligibility. (f) On at least a monthly basis, the office of the secretary shall review information concerning Medicaid recipients who also receive SNAP benefits to determine whether there has been any change in circumstances that may affect Medicaid eligibility, including a change in residency as may be identified through electronic benefit transfer program transactions. (g) On at least a monthly basis, the office of the secretary shall receive and review information from the department of correction concerning Medicaid recipients that may indicate a change in circumstances that may affect Medicaid eligibility. (h) Upon receiving information concerning a Medicaid recipient that indicates a change in circumstances that may affect Medicaid eligibility, the office of the secretary shall promptly conduct an eligibility redetermination for the recipient. As added by P.L.126-2025, SEC.5. Amended by P.L.23-2026, SEC.83.

Ind. Code § 12-15-1-24 Prohibition on self-attestation; data matching agreements; review of data from other agencies; redeterminations

Note: This version of section effective 1-1-2027. See also preceding version of this section, effective until 1-1-2027. Sec. 24. (a) Except as required under federal law, the office of the secretary may not accept self-attestation of any of the following in the administration of the Medicaid program without verification before enrollment: (1) Income. (2) Residency. (3) Age. (4) Household composition. (5) Caretaker or relative status. (6) Receipt of other coverage. (b) The office of the secretary shall enter into a data matching agreement with: (1) the state lottery commission; and (2) the Indiana gaming commission; to, on at least a monthly basis, identify individuals receiving Medicaid assistance with lottery and gambling winnings of at least three thousand dollars ($3,000). Upon verification of any winnings resulting in the individual no longer being eligible for Medicaid, the office of the secretary shall terminate the individual's enrollment. (c) On at least a monthly basis, the office of the secretary shall review vital statistics information provided by the Indiana department of health under IC 16-19-3-19 to determine removal of deceased individuals from Medicaid enrollment. (d) On at least a quarterly basis, the office of the secretary shall receive and review information from the department of state revenue and the department of workforce development concerning Medicaid recipients that indicates a change in circumstances that may affect eligibility, including changes to employment or wages. (e) On at least an annual basis, the office of the secretary shall receive and review information from the department of state revenue concerning Medicaid recipients, including: (1) adjusted gross income; and (2) family composition; that indicates a change in circumstances that may affect Medicaid eligibility. (f) On at least a monthly basis, the office of the secretary shall review information concerning Medicaid recipients who also receive SNAP benefits to determine whether there has been any change in circumstances that may affect Medicaid eligibility, including a change in residency as may be identified through electronic benefit transfer program transactions. (g) On at least a monthly basis, the office of the secretary shall receive and review information from the department of correction concerning Medicaid recipients that may indicate a change in circumstances that may affect Medicaid eligibility. (h) Upon receiving information concerning a Medicaid recipient that indicates a change in circumstances that may affect Medicaid eligibility, the office of the secretary shall promptly conduct an eligibility redetermination for the recipient. (i) Unless prohibited by federal law, the office of the secretary shall conduct a Medicaid eligibility redetermination for a recipient as follows: (1) At least one (1) time every six (6) months for a nonelderly adult Medicaid recipient whose eligibility is determined based upon a modified adjusted gross income standard under 42 CFR 435.603, including adults eligible under 42 U.S.C. 1396u-1. (2) At least one (1) time every twelve (12) months for any other Medicaid recipient. As added by P.L.126-2025, SEC.5. Amended by P.L.23-2026, SEC.83; P.L.63-2026, SEC.8.

Ind. Code § 12-15-1-25 Review of information to assess eligibility authority to contract with third party; transmission of information to federal government

Sec. 25. (a) Unless prohibited by federal law and on at least a monthly basis, the office of the secretary shall review the following to assess continuous eligibility of Medicaid recipients: (1) The following information maintained by the United States Social Security Administration: (A) Earned income information. (B) Death register information. (C) Incarceration records. (D) Supplemental security income information. (E) Beneficiary records. (F) Earnings information. (G) Pension information. (2) The following information maintained by the United States Department of Health and Human Services: (A) Income and employment information maintained in the national directory of new hires data base. (B) Child support enforcement data. (3) Change of address or mail forwarding address information maintained by the United States Postal Service. (4) Payment and earnings information maintained by the United States Department of Housing and Urban Development. (5) National fleeing felon information maintained by the United States Federal Bureau of Investigation. (6) Tax filing information maintained by the United States Department of the Treasury. (b) The office of the secretary may contract with an independent third party for additional data base searches that may contain information that indicates a change in circumstances that may affect Medicaid applicant or recipient eligibility. (c) At least one (1) time per month, the office of the secretary shall transmit information as prescribed by the United States Department of Health and Human Services to prevent Medicaid enrollment in more than one (1) state. As added by P.L.126-2025, SEC.6. Amended by P.L.63-2026, SEC.9.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026