Benefits for adult group; limiting enrollment; limitations on negotiating and changing plan; verification of compliance; medically frail; limitations
Ind. Code § 12-15-44.5-10
in effectNote: This version of section effective 1-1-2027. See also preceding version of this section, effective until 1-1-2027.
Sec. 10. (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.
(e) The secretary shall verify an individual's compliance with the requirements of section 3(c) of this chapter on an ongoing, and at least quarterly, basis. The secretary may not accept any of the following methods as being sufficient to verify compliance:
(1) A plan participant's self-attestation of compliance.
(2) Designations, approvals, or determinations of compliance by a managed care organization.
(f) The secretary may accept a medically frail status set forth in section 3(c)(8) of this chapter only if the individual has been medically certified as medically frail (as defined in 42 CFR 440.315(f)) by any of the following:
(1) A physician.
(2) A physician's assistant.
(3) An advanced practice registered nurse.
(4) A nurse.
(5) A designated representative of a physician's office, on behalf of an individual described in subdivisions (1) through (4).
(6) A psychologist.
(7) A social worker.
(g) The secretary may not do any of the following:
(1) Expand the definition of medically frail for purposes of this chapter beyond the definition set forth in 42 CFR 440.315(f).
(2) Request the implementation of any additional exemptions other than the exemptions set forth in section 3 of this chapter.
As added by P.L.213-2015, SEC.136. Amended by P.L.30-2016, SEC.35; P.L.126-2025, SEC.13; P.L.63-2026, SEC.30.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026