Eligible and Excluded Populations Sample Clauses

Eligible and Excluded Populations. The State has sole authority for determining whether individuals or families meet any of the eligibility criteria of the Hoosier Healthwise program. The FSSA Division of Family Resources (DFR) makes eligibility determinations. Except for Native American members, enrollment in managed care is mandatory for Medicaid individuals in the children, pregnant women, and low-income family’s aid categories. It is also mandatory for children eligible for CHIP and presumptively eligible pregnant women. The specific eligibility aid category determines the benefit package. The following Medicaid enrollees are excluded from participation in Hoosier Healthwise managed care:  Persons in nursing homes and other institutions, such as ICF/MR and PRTF facilities;  Undocumented persons;  Persons receiving waiver or hospice services;  Wards and xxxxxx children; and  Children receiving adoption assistance.

Eligible and Excluded Populations. The State has sole authority for determining whether individuals or families meet any of the eligibility criteria of the HIP program. The FSSA Division of Family Resources (DFR) makes eligibility determinations. The Healthy Indiana Plan (HIP) is a Medicaid expansion for individuals 19-64 years of age with annual household income of not more than 138% of the federal poverty level (FPL), as calculated based on the Modified Adjusted Gross Income (MAGI) guidelines with 5% income disregard. All individuals eligible for HIP, with the exception of Native Americans, must enroll in managed care. Additional eligibility criteria are set forth in IC 12-15-44.2 and 405 IAC 10-4, as may be amended. The following individuals are not eligible for HIP:  An individual who participates in the federal Medicare program; and  An individual who qualifies for Medicaid under another aid category, with the exception of (i) the adult group under 42 CFR 435.119; (ii) pregnant women who choose to remain in HIP during the pregnancy; (iii) parents & caretaker relatives eligible under 42 CFR 435.110; (iv) low income individuals who are at least nineteen (19) years of age and less than twenty-one (21) years of age and eligible under 42 CFR 435.222; or (v) transitional medical assistance.