Introduced Version
SENATE BILL No. 207
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 12-14-30-6.5; IC 12-15; IC 12-17.6-3-3.
Synopsis: FSSA matters. Limits work requirements for Supplemental
Nutrition Assistance Program (SNAP) recipients to the minimum
required by federal law. Changes the requirements for submitting
eligibility information for an individual who is: (1) less than 19 years
of age; and (2) a recipient of either the Medicaid program or the
children's health insurance program (CHIP) (programs). (Current law
concerning the submission of eligibility information in the programs
applies to individuals less than three years of age.) Prohibits the office
of the secretary of family and social services (office) from requiring a
participant of the healthy Indiana plan (plan) to cost share or otherwise
make copayments in order to participate in the plan. Prohibits the office
from requiring an individual to work or be a student in order to
participate in the plan.
Effective: July 1, 2023.
Breaux
January 10, 2023, read first time and referred to Committee on Family and Children
Services.
2023 IN 207—LS 7036/DI 104 Introduced
First Regular Session of the 123rd General Assembly (2023)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2022 Regular Session of the General Assembly.
SENATE BILL No. 207
A BILL FOR AN ACT to amend the Indiana Code concerning
human services.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 12-14-30-6.5 IS ADDED TO THE INDIANA
2 CODE AS A NEW SECTION TO READ AS FOLLOWS
3 [EFFECTIVE JULY 1, 2023]: Sec. 6.5. The division may not require
4 a SNAP recipient to meet any work requirements that are stricter
5 than what is required by federal law for the SNAP program.
6 SECTION 2. IC 12-15-2-15.8, AS ADDED BY P.L.218-2007,
7 SECTION 10, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
8 JULY 1, 2023]: Sec. 15.8. After an individual who is less than three (3)
9 nineteen (19) years of age is determined to be eligible for Medicaid
10 under section 14 of this chapter, the individual is not required to submit
11 eligibility information more frequently than once in a twelve (12)
12 month period until the child becomes three (3) nineteen (19) years of
13 age.
14 SECTION 3. IC 12-15-44.5-3.5, AS AMENDED BY
15 P.L.180-2022(ss), SECTION 16, IS AMENDED TO READ AS
16 FOLLOWS [EFFECTIVE JULY 1, 2023]: Sec. 3.5. (a) The plan must
17 include the following in a manner and to the extent determined by the
2023 IN 207—LS 7036/DI 104 2
1 office:
2 (1) Mental health care services.
3 (2) Inpatient hospital services.
4 (3) Prescription drug coverage, including coverage of a long
5 acting, nonaddictive medication assistance treatment drug if the
6 drug is being prescribed for the treatment of substance abuse.
7 (4) Emergency room services.
8 (5) Physician office services.
9 (6) Diagnostic services.
10 (7) Outpatient services, including therapy services.
11 (8) Comprehensive disease management.
12 (9) Home health services, including case management.
13 (10) Urgent care center services.
14 (11) Preventative care services.
15 (12) Family planning services:
16 (A) including contraceptives and sexually transmitted disease
17 testing, as described in federal Medicaid law (42 U.S.C. 1396
18 et seq.); and
19 (B) not including abortion or abortifacients.
20 (13) Hospice services.
21 (14) Substance abuse services.
22 (15) Donated breast milk that meets requirements developed by
23 the office of Medicaid policy and planning.
24 (16) A service determined by the secretary to be required by
25 federal law as a benchmark service under the federal Patient
26 Protection and Affordable Care Act.
27 (b) The plan may not permit treatment limitations or financial
28 requirements on the coverage of mental health care services or
29 substance abuse services if similar limitations or requirements are not
30 imposed on the coverage of services for other medical or surgical
31 conditions.
32 (c) The plan may provide vision services and dental services. only
33 to individuals who regularly make the required monthly contributions
34 for the plan as set forth in section 4.7(c) of this chapter.
35 (d) The benefit package offered in the plan:
36 (1) must be benchmarked to a commercial health plan described
37 in 45 CFR 155.100(a)(1) or 45 CFR 155.100(a)(4); and
38 (2) may not include a benefit that is not present in at least one (1)
39 of these commercial benchmark options.
40 (e) The office shall provide to an individual who participates in the
41 plan a list of health care services that qualify as preventative care
42 services for the age, gender, and preexisting conditions of the
2023 IN 207—LS 7036/DI 104 3
1 individual. The office shall consult with the federal Centers for Disease
2 Control and Prevention for a list of recommended preventative care
3 services.
4 (f) The plan shall, at no cost to the individual, provide payment of
5 preventative care services described in 42 U.S.C. 300gg-13 for an
6 individual who participates in the plan.
7 (g) The plan shall, at no cost to the individual, provide payments of
8 not more than five hundred dollars ($500) per year for preventative
9 care services not described in subsection (f). Any additional
10 preventative care services covered under the plan and received by the
11 individual during the year are subject to the deductible. and payment
12 requirements of the plan.
13 (h) The office shall apply to the United States Department of Health
14 and Human Services for any amendment to the waiver necessary to
15 implement the providing of the services or supplies described in
16 subsection (a)(15). This subsection expires July 1, 2024.
17 SECTION 4. IC 12-15-44.5-4.5, AS ADDED BY P.L.30-2016,
18 SECTION 30, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
19 JULY 1, 2023]: Sec. 4.5. (a) An individual who participates in the plan
20 must have a health care account to which payments may be made for
21 the individual's participation in the plan.
22 (b) An individual's health care account must be used to pay the
23 individual's deductible for health care services under the plan.
24 (c) An individual's deductible must be at least two thousand five
25 hundred dollars ($2,500) per year.
26 (d) An individual may make payments to the individual's health care
27 account as follows:
28 (1) An employer withholding or causing to be withheld from an
29 employee's wages or salary, after taxes are deducted from the
30 wages or salary, the individual's contribution under this chapter
31 and distributed equally throughout the calendar year.
32 (2) Submission of the individual's contribution under this chapter
33 to the office to deposit in the individual's health care account in
34 a manner prescribed by the office.
35 (3) Another method determined by the office.
36 (e) An individual may not be required to contribute to the
37 individual's health care account.
38 SECTION 5. IC 12-15-44.5-4.7, AS AMENDED BY P.L.152-2017,
39 SECTION 33, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
40 JULY 1, 2023]: Sec. 4.7. (a) To participate in the plan, an individual
41 must apply for the plan on a form prescribed by the office. The office
42 may develop and allow a joint application for a household.
2023 IN 207—LS 7036/DI 104 4
1 (b) The office may not require an applicant or participant of the
2 plan to make copayments or other cost sharing requirements to the
3 participant's health care account in order to participate in or
4 remain a member of the plan.
5 (b) A pregnant woman is not subject to the cost sharing provisions
6 of the plan. Subsections (c) through (g) do not apply to a pregnant
7 woman participating in the plan.
8 (c) An applicant who is approved to participate in the plan does not
9 begin benefits under the plan until a payment of at least:
10 (1) one-twelfth (1/12) of the annual income contribution amount;
11 or
12 (2) ten dollars ($10);
13 is made to the individual's health care account established under
14 section 4.5 of this chapter for the individual's participation in the plan.
15 To continue to participate in the plan, an individual must contribute to
16 the individual's health care account at least two percent (2%) of the
17 individual's annual household income per year or an amount
18 determined by the secretary that is based on the individual's annual
19 household income per year, but not less than one dollar ($1) per month.
20 The amount determined by the secretary under this subsection must be
21 approved by the United States Department of Health and Human
22 Services and must be budget neutral to the state as determined by the
23 state budget agency.
24 (d) If an applicant who is approved to participate in the plan fails to
25 make the initial payment into the individual's health care account, at
26 least the following must occur:
27 (1) If the individual has an annual income that is at or below one
28 hundred percent (100%) of the federal poverty income level, the
29 individual's benefits are reduced as specified in subsection (e)(1).
30 (2) If the individual has an annual income of more than one
31 hundred percent (100%) of the federal poverty income level, the
32 individual is not enrolled in the plan.
33 (e) If an enrolled individual's required monthly payment to the plan
34 is not made within sixty (60) days after the required payment date, the
35 following, at a minimum, occur:
36 (1) For an individual who has an annual income that is at or below
37 one hundred percent (100%) of the federal income poverty level,
38 the individual is:
39 (A) transferred to a plan that has a material reduction in
40 benefits, including the elimination of benefits for vision and
41 dental services; and
42 (B) required to make copayments for the provision of services
2023 IN 207—LS 7036/DI 104 5
1 that may not be paid from the individual's health care account.
2 (2) For an individual who has an annual income of more than one
3 hundred percent (100%) of the federal poverty income level, the
4 individual shall be terminated from the plan and may not reenroll
5 in the plan for at least six (6) months.
6 (f) The state shall contribute to the individual's health care account
7 the difference between the individual's payment required under this
8 section and the plan deductible set forth in section 4.5(c) of this
9 chapter.
10 (g) (c) A member shall remain enrolled with the same managed care
11 organization during the member's benefit period. A member may
12 change managed care organizations as follows:
13 (1) Without cause:
14 (A) before making a contribution or before finalizing
15 enrollment; in accordance with subsection (d)(1); or
16 (B) during the annual plan renewal process.
17 (2) For cause, as determined by the office.
18 SECTION 6. IC 12-15-44.5-4.9, AS AMENDED BY P.L.114-2018,
19 SECTION 6, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
20 JULY 1, 2023]: Sec. 4.9. (a) An individual who is approved to
21 participate in the plan is eligible for a twelve (12) month plan period if
22 the individual continues to meet the plan requirements specified in this
23 chapter.
24 (b) If an individual chooses to renew participation in the plan, the
25 individual is subject to an annual renewal process at the end of the
26 benefit period to determine continued eligibility for participating in the
27 plan. If the individual does not complete the renewal process, the
28 individual may not reenroll in the plan for at least six (6) months.
29 (c) This subsection applies to participants who consistently made
30 the required payments in the individual's health care account. If the
31 individual receives the qualified preventative services recommended
32 to the individual during the year, the individual is eligible to have the
33 individual's unused share of the individual's health care account at the
34 end of the plan period, determined by the office, matched by the state
35 and carried over to the subsequent plan period. to reduce the
36 individual's required payments. If the individual did not, during the
37 plan period, receive all qualified preventative services recommended
38 to the individual, only the nonstate contribution to the health care
39 account may be used to reduce the individual's payments for the
40 subsequent plan period.
41 (d) For individuals participating in the plan who, in the past, did not
42 make consistent payments into the individual's health care account
2023 IN 207—LS 7036/DI 104 6
1 while participating in the plan, but:
2 (1) had a balance remaining in the individual's health care
3 account; and
4 (2) received all of the required preventative care services;
5 the office may elect to offer a discount on the individual's required
6 payments to the individual's health care account for the subsequent
7 benefit year. The amount of the discount under this subsection must be
8 related to the percentage of the health care account balance at the end
9 of the plan year but not to exceed a fifty percent (50%) discount of the
10 required contribution.
11 (e) (d) If an individual is no longer eligible for the plan or does not
12 renew participation in the plan at the end of the plan period, or is
13 terminated from the plan for nonpayment of a required payment, the
14 office shall, not more than one hundred twenty (120) days after the last
15 date of the plan benefit period, refund to the individual the amount
16 determined under STEP FOUR of subsection (f) (e) of any funds
17 remaining in the individual's health care account. as follows:
18 (1) An individual who is no longer eligible for the plan or does
19 not renew participation in the plan at the end of the plan period
20 shall receive the amount determined under STEP FOUR of
21 subsection (f).
22 (2) An individual who is terminated from the plan due to
23 nonpayment of a required payment shall receive the amount
24 determined under STEP SIX of subsection (f).
25 The office may charge a penalty for any voluntary withdrawals from the
26 health care account by the individual before the end of the plan benefit
27 year. The individual may receive the amount determined under STEP
28 SIX FIVE of subsection (f). (e).
29 (f) (e) The office shall determine the amount payable to an
30 individual described in subsection (e) (d) as follows:
31 STEP ONE: Determine the total amount paid into the individual's
32 health care account under this chapter.
33 STEP TWO: Determine the total amount paid into the individual's
34 health care account from all sources.
35 STEP THREE: Divide STEP ONE by STEP TWO.
36 STEP FOUR: Multiply the ratio determined in STEP THREE by
37 the total amount remaining in the individual's health care account.
38 STEP FIVE: Subtract any nonpayments of a required payment.
39 STEP SIX: FIVE: Multiply the amount determined under STEP
40 FIVE FOUR by at least seventy-five hundredths (0.75).
41 SECTION 7. IC 12-15-44.5-5.5, AS ADDED BY P.L.30-2016,
42 SECTION 33, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
2023 IN 207—LS 7036/DI 104 7
1 JULY 1, 2023]: Sec. 5.5. The office shall refer any member of the plan
2 who:
3 (1) is employed for less than twenty (20) hours per week; and
4 (2) is not a full-time student;
5 to a workforce training and job search program. The office may not
6 require an individual to be employed or be a full-time student in
7 order to participate in or remain a member of the plan.
8 SECTION 8. IC 12-15-44.5-10, AS AMENDED BY P.L.30-2016,
9 SECTION 35, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
10 JULY 1, 2023]: Sec. 10. (a) The secretary has the authority to provide
11 benefits to individuals eligible under the adult group described in 42
12 CFR 435.119 only in accordance with this chapter.
13 (b) The secretary may negotiate and make changes to the plan,
14 except that the secretary may not negotiate or change the plan in a way
15 that would do the following:
16 (1) Reduce the following:
17 (A) Contribution amounts below the minimum levels set forth
18 in section 4.7 of this chapter.
19 (B) deductible amounts below the minimum amount
20 established in section 4.5(c) of this chapter.
21 (2) Remove or reduce the penalties for nonpayment set forth in
22 section 4.7 of this chapter.
23 (3) (2) Revise the use of the health care account requirement set
24 forth in section 4.5 of this chapter.
25 (4) (3) Include noncommercial benefits or add additional plan
26 benefits in a manner inconsistent with section 3.5 of this chapter.
27 (5) (4) Allow services to begin
28 (A) without the payment established or required by; or
29 (B) earlier than the time frames frame otherwise established
30 by
31 section 4.7 of this chapter.
32 (6) (5) Reduce financial penalties for the inappropriate use of the
33 emergency room below the minimum levels set forth in section
34 5.7 of this chapter.
35 (7) (6) Permit members to change health plans without cause in
36 a manner inconsistent with section 4.7(g) 4.7(c) of this chapter.
37 (8) (7) Operate the plan in a manner that would obligate the state
38 to financial participation beyond the level of state appropriations
39 or funding otherwise authorized for the plan.
40 (c) The secretary may make changes to the plan under this chapter
41 if the changes are required by federal law or regulation.
42 SECTION 9. IC 12-17.6-3-3, AS AMENDED BY P.L.218-2007,
2023 IN 207—LS 7036/DI 104 8
1 SECTION 42, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
2 JULY 1, 2023]: Sec. 3. (a) Subject to subsections (b) and (c), a child
3 who is eligible for the program shall receive services from the program
4 until the earlier of the following:
5 (1) The child becomes financially ineligible.
6 (2) The child becomes nineteen (19) years of age.
7 (b) Subsection (a) applies only if the child and the child's family
8 comply with enrollment requirements.
9 (c) After a child who is less than three (3) nineteen (19) years of
10 age is determined to be eligible for the program, the child is not
11 required to submit eligibility information more frequently than once in
12 a twelve (12) month period until the child becomes three (3) nineteen
13 (19) years of age.
14 SECTION 10. [EFFECTIVE JULY 1, 2023] (a) Before September
15 1, 2023, the office of the secretary of family and social services shall
16 apply for any state plan amendment or Medicaid waiver necessary
17 to change the age set forth in IC 12-15-2-15.8, as amended by this
18 act, concerning continuous eligibility for the Medicaid program
19 from a Medicaid recipient who is less than three (3) years of age to
20 a Medicaid recipient who is less than nineteen (19) years of age.
21 (b) Before September 1, 2023, the office of Medicaid policy and
22 planning shall apply for any federal approval necessary to change
23 the age set forth in IC 12-17.6-3-3, as amended by this act,
24 concerning continuous eligibility for the children's health
25 insurance program from a recipient who is less than three (3) years
26 of age to a recipient who is less than nineteen (19) years of age.
27 (c) The office of the secretary of family and social services shall
28 apply for any amendment to the healthy Indiana plan Medicaid
29 waiver necessary to do the following:
30 (1) Eliminate copayment requirements for healthy Indiana
31 plan participants.
32 (2) Eliminate working requirements for healthy Indiana plan
33 participants.
34 (d) This SECTION expires December 31, 2023.
2023 IN 207—LS 7036/DI 104