First Regular Session of the 124th General Assembly (2025)
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 2024 Regular Session of the General Assembly.
SENATE ENROLLED ACT No. 2
AN ACT to amend the Indiana Code concerning Medicaid.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 2-5-54-7 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 7. Before October 1 of each year, the office of the
secretary of family and social services shall report the following
aggregate, nonconfidential, and nonpersonally identifying
information to the oversight committee concerning the Medicaid
program for the most recently concluded state fiscal year:
(1) Improper Medicaid payments and expenditures, including
the individual and total dollar amounts for claims that were
determined to be:
(A) fraudulent;
(B) waste; and
(C) abuse.
(2) Federal and state recovered funds, including the dollar
amounts per claim and the total dollar amounts concerning
Medicaid fraud, waste, and abuse.
(3) Aggregate data concerning improper payments and
ineligible Medicaid recipients who received Medicaid services
as a percentage of those investigated or reviewed.
The report must be in an electronic format under IC 5-14-6.
SECTION 2. IC 6-8.1-7-1, AS AMENDED BY P.L.118-2024,
SECTION 21, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
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JULY 1, 2025]: Sec. 1. (a) This subsection does not apply to the
disclosure of information concerning a conviction on a tax evasion
charge. Unless in accordance with a judicial order or as otherwise
provided in this chapter, the department, its employees, former
employees, counsel, agents, or any other person may not divulge the
amount of tax paid by any taxpayer, terms of a settlement agreement
executed between a taxpayer and the department, investigation records,
investigation reports, or any other information disclosed by the reports
filed under the provisions of the law relating to any of the listed taxes,
including required information derived from a federal return, except to
any of the following when it is agreed that the information is to be
confidential and to be used solely for official purposes:
(1) Members and employees of the department.
(2) The governor.
(3) A member of the general assembly or an employee of the
house of representatives or the senate when acting on behalf of a
taxpayer located in the member's legislative district who has
provided sufficient information to the member or employee for
the department to determine that the member or employee is
acting on behalf of the taxpayer.
(4) An employee of the legislative services agency to carry out the
responsibilities of the legislative services agency under
IC 2-5-1.1-7 or another law.
(5) The attorney general or any other legal representative of the
state in any action in respect to the amount of tax due under the
provisions of the law relating to any of the listed taxes.
(6) Any authorized officers of the United States.
(b) The information described in subsection (a) may be revealed
upon the receipt of a certified request of any designated officer of the
state tax department of any other state, district, territory, or possession
of the United States when:
(1) the state, district, territory, or possession permits the exchange
of like information with the taxing officials of the state; and
(2) it is agreed that the information is to be confidential and to be
used solely for tax collection purposes.
(c) The information described in subsection (a) relating to a person
on public welfare or a person who has made application for public
welfare may be revealed to the office of the secretary of family and
social services for purposes of IC 12-15-1-24, the director of the
division of family resources, and to any director of a county office of
the division of family resources located in Indiana, upon receipt of a
written request from either director for the information. The
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information shall be treated as confidential by the office and the
directors. In addition, the information described in subsection (a)
relating to a person who has been designated as an absent parent by the
state Title IV-D agency shall be made available to the state Title IV-D
agency upon request. The information shall be subject to the
information safeguarding provisions of the state and federal Title IV-D
programs.
(d) The name, address, Social Security number, and place of
employment relating to any individual who is delinquent in paying
educational loans owed to a postsecondary educational institution may
be revealed to that institution if it provides proof to the department that
the individual is delinquent in paying for educational loans. This
information shall be provided free of charge to approved postsecondary
educational institutions (as defined by IC 21-7-13-6(a)). The
department shall establish fees that all other institutions must pay to the
department to obtain information under this subsection. However, these
fees may not exceed the department's administrative costs in providing
the information to the institution.
(e) The information described in subsection (a) relating to reports
submitted under IC 6-6-1.1-502 concerning the number of gallons of
gasoline sold by a distributor and IC 6-6-2.5 concerning the number of
gallons of special fuel sold by a supplier and the number of gallons of
special fuel exported by a licensed exporter or imported by a licensed
transporter may be released by the commissioner upon receipt of a
written request for the information.
(f) The information described in subsection (a) may be revealed
upon the receipt of a written request from the administrative head of a
state agency of Indiana when:
(1) the state agency shows an official need for the information;
and
(2) the administrative head of the state agency agrees that any
information released will be kept confidential and will be used
solely for official purposes.
(g) The information described in subsection (a) may be revealed
upon the receipt of a written request from the chief law enforcement
officer of a state or local law enforcement agency in Indiana when it is
agreed that the information is to be confidential and to be used solely
for official purposes.
(h) The name and address of retail merchants, including township,
as specified in IC 6-2.5-8-1(k) may be released solely for tax collection
purposes to township assessors and county assessors.
(i) The department shall notify the appropriate innkeeper's tax
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board, bureau, or commission that a taxpayer is delinquent in remitting
innkeepers' taxes under IC 6-9.
(j) All information relating to the delinquency or evasion of the
vehicle excise tax may be disclosed to the bureau of motor vehicles in
Indiana and may be disclosed to another state, if the information is
disclosed for the purpose of the enforcement and collection of the taxes
imposed by IC 6-6-5.
(k) All information relating to the delinquency or evasion of
commercial vehicle excise taxes payable to the bureau of motor
vehicles in Indiana may be disclosed to the bureau and may be
disclosed to another state, if the information is disclosed for the
purpose of the enforcement and collection of the taxes imposed by
IC 6-6-5.5.
(l) All information relating to the delinquency or evasion of
commercial vehicle excise taxes payable under the International
Registration Plan may be disclosed to another state, if the information
is disclosed for the purpose of the enforcement and collection of the
taxes imposed by IC 6-6-5.5.
(m) All information relating to the delinquency or evasion of the
excise taxes imposed on recreational vehicles and truck campers that
are payable to the bureau of motor vehicles in Indiana may be disclosed
to the bureau and may be disclosed to another state if the information
is disclosed for the purpose of the enforcement and collection of the
taxes imposed by IC 6-6-5.1.
(n) This section does not apply to:
(1) the beer excise tax, including brand and packaged type
(IC 7.1-4-2);
(2) the liquor excise tax (IC 7.1-4-3);
(3) the wine excise tax (IC 7.1-4-4);
(4) the hard cider excise tax (IC 7.1-4-4.5);
(5) the vehicle excise tax (IC 6-6-5);
(6) the commercial vehicle excise tax (IC 6-6-5.5); and
(7) the fees under IC 13-23.
(o) The name and business address of retail merchants within each
county that sell tobacco products may be released to the division of
mental health and addiction and the alcohol and tobacco commission
solely for the purpose of the list prepared under IC 6-2.5-6-14.2.
(p) The name and business address of a person licensed by the
department under IC 6-6 or IC 6-7, or issued a registered retail
merchant's certificate under IC 6-2.5, may be released for the purpose
of reporting the status of the person's license or certificate.
(q) The department may release information concerning total
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incremental tax amounts under:
(1) IC 5-28-26;
(2) IC 36-7-13;
(3) IC 36-7-26;
(4) IC 36-7-27;
(5) IC 36-7-31;
(6) IC 36-7-31.3; or
(7) any other statute providing for the calculation of incremental
state taxes that will be distributed to or retained by a political
subdivision or other entity;
to the fiscal officer of the political subdivision or other entity that
established the district or area from which the incremental taxes were
received if that fiscal officer enters into an agreement with the
department specifying that the political subdivision or other entity will
use the information solely for official purposes.
(r) The department may release the information as required in
IC 6-8.1-3-7.1 concerning:
(1) an innkeeper's tax, a food and beverage tax, or an admissions
tax under IC 6-9;
(2) the supplemental auto rental excise tax under IC 6-6-9.7; and
(3) the covered taxes allocated to a professional sports
development area fund, sports and convention facilities operating
fund, or other fund under IC 36-7-31 and IC 36-7-31.3.
(s) Information concerning state gross retail tax exemption
certificates that relate to a person who is exempt from the state gross
retail tax under IC 6-2.5-4-5 may be disclosed to a power subsidiary (as
defined in IC 6-2.5-1-22.5) or a person selling the services or
commodities listed in IC 6-2.5-4-5 for the purpose of enforcing and
collecting the state gross retail and use taxes under IC 6-2.5.
(t) The department may release a statement of tax withholding or
other tax information statement provided on behalf of a taxpayer to the
department to:
(1) the taxpayer on whose behalf the tax withholding or other tax
information statement was provided to the department;
(2) the taxpayer's spouse, if:
(A) the taxpayer is deceased or incapacitated; and
(B) the taxpayer's spouse is filing a joint income tax return
with the taxpayer; or
(3) an administrator, executor, trustee, or other fiduciary acting on
behalf of the taxpayer if the taxpayer is deceased.
(u) Information related to a listed tax regarding a taxpayer may be
disclosed to an individual without a power of attorney under
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IC 6-8.1-3-8(a)(2) if:
(1) the individual is authorized to file returns and remit payments
for one (1) or more listed taxes on behalf of the taxpayer through
the department's online tax system before September 8, 2020;
(2) the information relates to a listed tax described in subdivision
(1) for which the individual is authorized to file returns and remit
payments;
(3) the taxpayer has been notified by the department of the
individual's ability to access the taxpayer's information for the
listed taxes described in subdivision (1) and the taxpayer has not
objected to the individual's access;
(4) the individual's authorization or right to access the taxpayer's
information for a listed tax described in subdivision (1) has not
been withdrawn by the taxpayer; and
(5) disclosure of the information to the individual is not
prohibited by federal law.
Except as otherwise provided by this article, this subsection does not
authorize the disclosure of any correspondence from the department
that is mailed or otherwise delivered to the taxpayer relating to the
specified listed taxes for which the individual was given authorization
by the taxpayer. The department shall establish a date, which may be
earlier but not later than September 1, 2023, after which a taxpayer's
information concerning returns and remittances for a listed tax may not
be disclosed to an individual without a power of attorney under
IC 6-8.1-3-8(a)(2) by providing notice to the affected taxpayers and
previously authorized individuals, including notification published on
the department's website. After the earlier of the date established by the
department or September 1, 2023, the department may not disclose a
taxpayer's information concerning returns and remittances for a listed
tax to an individual unless the individual has a power of attorney under
IC 6-8.1-3-8(a)(2) or the disclosure is otherwise allowed under this
article.
(v) The department may publish a list of persons, corporations, or
other entities that qualify or have qualified for an exemption for sales
tax under IC 6-2.5-5-16, IC 6-2.5-5-25, or IC 6-2.5-5-26, or otherwise
provide information regarding a person's, corporation's, or entity's
exemption status under IC 6-2.5-5-16, IC 6-2.5-5-25, or IC 6-2.5-5-26.
For purposes of this subsection, information that may be disclosed
includes:
(1) any federal identification number or other identification
number for the entity assigned by the department;
(2) any expiration date of an exemption under IC 6-2.5-5-25;
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(3) whether any sales tax exemption has expired or has been
revoked by the department; and
(4) any other information reasonably necessary for a recipient of
an exemption certificate to determine if an exemption certificate
is valid.
(w) The department may share a taxpayer's name and other personal
identification information with a tax preparer or tax preparation
software provider in cases where the department suspects that a
fraudulent return has been filed on behalf of a taxpayer and the
department suspects that the system of a taxpayer's previous year tax
preparer or tax preparation software provider has been breached.
SECTION 3. IC 12-15-1-14.3 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: 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.
SECTION 4. IC 12-15-1-17.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: 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.
SECTION 5. IC 12-15-1-24 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: 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:
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(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 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.
SECTION 6. IC 12-15-1-25 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 25. (a) Unless prohibited by federal law and on at
least a monthly basis, the office of the secretary shall review the
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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 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.
SECTION 7. IC 12-15-4-1.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2025]: Sec. 1.5. (a) The office of the secretary shall establish the
following:
(1) Performance standards for hospitals to use in making
presumptive eligibility determinations.
(2) An appeals process for a hospital that disputes a
determination that a presumptive eligibility standard was
violated.
The office of the secretary shall limit presumptive eligibility
determination to qualified hospitals.
(b) A hospital shall do the following when making a presumptive
eligibility determination:
(1) Notify the office of the secretary of each presumptive
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eligibility determination not later than five (5) business days
after the date of the determination.
(2) Assist individuals whom the hospital determines are
presumptively eligible with completing and submitting a full
Medicaid application.
(3) Notify the applicant in writing and on all relevant forms
with plain language and large print that if the applicant:
(A) does not file a full Medicaid application with the office
of the secretary before the last day of the following month,
presumptive eligibility will end on that last day; and
(B) files a full Medicaid application with the office of the
secretary before the last day of the following month,
presumptive eligibility will continue until an eligibility
determination is made concerning the application.
(c) The office of the secretary shall use the following
performance standards to establish and ensure accurate
presumptive eligibility determinations by a qualified hospital:
(1) Determine whether each presumptive eligibility
determination received from the hospital complied with the
time requirement set forth in subsection (b)(1).
(2) Determine whether the office of the secretary received
before the expiration of each presumptive eligibility period
the full application from the individual determined by the
hospital to be presumptively eligible.
(3) Determine whether each applicant who was determined by
the hospital to be presumptively eligible was determined to be
eligible for Medicaid after the full application was received.
(d) Each single violation by a hospital of any of the performance
standards under subsection (c) counts as one (1) violation for the
presumptive eligibility determination. Each subsequent violation
of a performance standard is an additional violation for purposes
of this section.
(e) For the first violation of a presumptive eligibility standard
under this section that a hospital receives in a calendar year, the
office of the secretary shall notify the hospital in writing not later
than five (5) days after the determination of a violation is made.
The notice must include the following:
(1) A description of the standard that was not met and an
explanation of why the hospital did not meet the standard.
(2) Notice that a second finding on noncompliance with a
standard will result in a requirement that the hospital's
applicable staff participate in mandatory training on hospital
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presumptive eligibility rules and standards that is performed
by the office of the secretary.
(3) A description of the available appeal procedures that the
hospital may use to dispute the finding of a violation of
presumptive eligibility standards.
(f) If the office of the secretary determines that a hospital has
failed to meet any of the presumptive eligibility standards under
this section in any presumptive eligibility determination by the
hospital for a second time within a twelve (12) month period of a
first violation, the office of the secretary shall notify the hospital in
writing not later than five (5) days after the determination that a
second violation has occurred. The written notice must include the
following:
(1) A description of the standard that was not met and an
explanation of why the hospital did not meet the standard.
(2) Notice that the hospital's applicable staff must participate
in mandatory training on hospital presumptive eligibility
rules and standards that is performed by the office of the
secretary, and information concerning the date, time, and
location of the training by the office.
(3) A description of the available appeal procedures that the
hospital may use to dispute the finding of a violation of
presumptive eligibility standards.
(4) Notice that a third violation by the hospital of a
presumptive eligibility standard within a twelve (12) month
period from the second violation will result in the hospital no
longer being qualified to make presumptive eligibility
determinations.
If a hospital appeals a finding of a violation of presumptive
eligibility standards described in this subsection, the hospital must
provide clear and convincing evidence during the appeals process
that the standard was met by the hospital.
(g) If the office of the secretary determines that a hospital has
failed to meet any of the presumptive eligibility standards under
this section in any presumptive eligibility determination by the
hospital for a third time within a twelve (12) month period of the
second violation by the hospital, the office of the secretary shall
notify the hospital in writing not later than five (5) days from a
determination that a presumptive eligibility standard was violated
by the hospital for the third time. The written notice must include
the following:
(1) A description of the standard that was not met and an
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explanation of why the hospital did not meet the standard.
(2) A description of the available appeal procedures that the
hospital may use to dispute the finding of a violation of
presumptive eligibility standards.
(3) Notice that, effective immediately from receipt of the
notice, the hospital is no longer qualified to make presumptive
eligibility determinations for the Medicaid program.
(h) If a hospital appeals a finding of a violation of presumptive
eligibility standards described in subsection (g), the hospital must
provide clear and convincing evidence during the appeals process
that the standard was met by the hospital.
SECTION 8. IC 12-15-25-2 IS REPEALED [EFFECTIVE JULY 1,
2025]. Sec. 2. This chapter does not preclude a provider from
marketing or advertising the following:
(1) The provider's services to the general public.
(2) Special therapies or services, such as those offered to
ventilator-dependent patients or patients with acquired
immunodeficiency syndrome (AIDS) or Alzheimer's disease.
(3) Children's units.
SECTION 9. IC 12-15-44.5-3, AS AMENDED BY P.L.241-2023,
SECTION 16, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 3. (a) The healthy Indiana plan is established.
(b) The office shall administer the plan.
(c) The following individuals are eligible for the plan:
(1) The adult group described in 42 CFR 435.119 may be eligible
for the plan if the conditions in section 4 of this chapter are
met and if the individual meets at least one (1) of the
following:
(1) Is working at least twenty (20) hours per week on a
monthly average.
(2) Is participating in and complying with the requirements of
a work program for at least twenty (20) hours per week, as
determined by the office.
(3) Is volunteering at least twenty (20) hours per week, as
determined by the office.
(4) Undertakes a combination of the activities described in
subdivision (1), (2), or (3) for a combined total of at least
twenty (20) hours per week, as determined by the office.
(5) Participates in and complies with the requirements of a
workfare program, as determined by the office.
(6) Receives unemployment compensation and complies with
federal and state work requirements under the unemployment
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compensation system.
(7) Participates in a substance use treatment and
rehabilitation program.
(8) Is medically certified as physically or mentally unfit for
employment.
(9) Is pregnant or is a parent or caretaker responsible for the
care of a dependent child less than six (6) years of age.
(10) Is a parent, spouse, or caretaker personally providing the
care for an individual with a serious medical condition or a
disability.
(11) Is an individual who has been released from
incarceration for less than ninety (90) days.
(12) Is an Indiana resident enrolled in and attending an
accredited educational program full time.
(2) Parents and caretaker relatives eligible under 42 CFR 435.110.
(3) Low income individuals who are:
(A) at least nineteen (19) years of age; and
(B) less than twenty-one (21) years of age;
and eligible under 42 CFR 435.222.
(4) Individuals, for purposes of receiving transitional medical
assistance.
An individual must meet the Medicaid residency requirements under
IC 12-15-4-4 and this article to be eligible for the plan.
(d) The following individuals are not eligible for the plan:
(1) An individual who participates in the federal Medicare
program (42 U.S.C. 1395 et seq.).
(2) An individual who is otherwise eligible and enrolled for
medical assistance.
(e) The department of insurance and the office of the secretary shall
provide oversight of the marketing practices of the plan.
(f) The office shall promote the plan and provide information to
potential eligible individuals who live in medically underserved rural
areas of Indiana.
(g) The office shall, to the extent possible, ensure that enrollment in
the plan is distributed throughout Indiana in proportion to the number
of individuals throughout Indiana who are eligible for participation in
the plan.
(h) The office shall establish standards for consumer protection,
including the following:
(1) Quality of care standards.
(2) A uniform process for participant grievances and appeals.
(3) Standardized reporting concerning provider performance,
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consumer experience, and cost.
(i) A health care provider that provides care to an individual who
receives health coverage under the plan shall also participate in the
Medicaid program under this article.
(j) The following do not apply to the plan:
(1) IC 12-15-12.
(2) IC 12-15-13.
(3) IC 12-15-14.
(4) IC 12-15-15.
(5) IC 12-15-21.
(6) IC 12-15-26.
(7) IC 12-15-31.1.
(8) IC 12-15-34.
(9) IC 12-15-35.
(10) IC 16-42-22-10.
SECTION 10. IC 12-15-44.5-4, AS AMENDED BY P.L.30-2016,
SECTION 29, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 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.);
(3) except as provided in section 4.2(a) of this chapter, must
not grant eligibility under the state Medicaid plan for medical
assistance under 42 U.S.C. 1396a; and
(4) must grant eligibility for the plan through an approved
demonstration project under 42 U.S.C. 1315.
(b) If either any 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) hospital assessment committee (IC 16-21-10), after
considering the modification and the reduction in available
funding, does not alter the formula established under
IC 16-21-10-13.3(b)(1) to cover the amount of the reduction
in federal medical assistance.
For purposes of this subdivision, "coverage of plan participants"
includes payments, contributions, and amounts referred to in
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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 payments, contributions,
and amounts incurred during a phase out period 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) hospital assessment fee committee (IC 16-21-10), after
considering the modification and reduction in available
funding, does not alter the formula established under
IC 16-21-10-13.3(b)(1) 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.
(3) The Medicaid waiver approving the plan is revoked,
rescinded, vacated, or otherwise altered in a manner that the
state cannot comply with the requirements of this chapter.
(c) If federal financial participation for recipients covered under
the plan is less than ninety percent (90%), the office may terminate
the plan in accordance with section 6(b) of this chapter.
(c) (d) 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) without funding from the incremental fee set forth in
IC 16-21-10-13.3.
(d) (e) 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) (f) 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.
SECTION 11. IC 12-15-44.5-4.2 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE UPON PASSAGE]: Sec. 4.2. (a) Notwithstanding
section 3 of this chapter, the office of the secretary shall amend the
Medicaid state plan to not include individuals described in 42 CFR
435.119. The office of the secretary shall delay the effective date of
the amendment to not later than upon the completion of
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negotiations with the United States Department of Health and
Human Services for a 3.0 plan waiver and an approved
implementation of the waiver.
(b) The office of the secretary shall continue to operate the plan,
as in effect on January 1, 2025, until the effective date of a 3.0 plan
waiver authorized by the United States Department of Health and
Human Services or the expiration, termination, or vacatur of the
waiver authorizing the plan.
SECTION 12. IC 12-15-44.5-4.7, AS AMENDED BY
P.L.152-2017, SECTION 33, IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2025]: Sec. 4.7. (a) To participate
in the plan, an individual must apply for the plan on a form prescribed
by the office. The office may develop and allow a joint application for
a household.
(b) A pregnant woman is not subject to the cost sharing provisions
of the plan. Subsections (c) through (g) do not apply to a pregnant
woman participating in the plan.
(c) An applicant who is approved to participate in the plan does not
begin benefits under the plan until a payment of at least:
(1) one-twelfth (1/12) of the annual income contribution amount;
or
(2) ten dollars ($10);
is made to the individual's health care account established under
section 4.5 of this chapter for the individual's participation in the plan.
To continue to participate in the plan, an individual must contribute to
the individual's health care account at least two percent (2%) of the
individual's annual household income per year or an amount
determined by the secretary that is based on the individual's annual
household income per year, but not less than one dollar ($1) per month.
The amount determined by the secretary under this subsection must be
approved by the United States Department of Health and Human
Services and must be budget neutral to the state as determined by the
state budget agency.
(d) If an applicant who is approved to participate in the plan fails to
make the initial payment into the individual's health care account, at
least the following must occur:
(1) If the individual has an annual income that is at or below one
hundred percent (100%) of the federal poverty income level, the
individual's benefits are reduced as specified in subsection (e)(1).
(2) If the individual has an annual income of more than one
hundred percent (100%) of the federal poverty income level, the
individual is not enrolled in the plan.
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(e) If an enrolled individual's required monthly payment to the plan
is not made within sixty (60) days after the required payment date, the
following, at a minimum, occur:
(1) For an individual who has an annual income that is at or below
one hundred percent (100%) of the federal income poverty level,
the individual is:
(A) transferred to a plan that has a material reduction in
benefits, including the elimination of benefits for vision and
dental services; and
(B) required to make copayments for the provision of services
that may not be paid from the individual's health care account.
(2) For an individual who has an annual income of more than one
hundred percent (100%) of the federal poverty income level, the
individual shall be terminated from the plan and may not reenroll
in the plan for at least six (6) months.
(f) The state shall contribute to the individual's health care account
the difference between the individual's payment required under this
section and the plan deductible set forth in section 4.5(c) of this
chapter.
(g) A member shall remain enrolled with the same managed care
organization during the member's benefit period. A member may
change managed care organizations as follows:
(1) Without cause:
(A) before making a contribution or before finalizing
enrollment in accordance with subsection (d)(1); or
(B) during the annual plan renewal process.
(2) For cause, as determined by the office.
(h) The office may reimburse medical providers at the
appropriate Medicaid fee schedule rate for certified medical claims
incurred prior to the beginning of benefits under subsection (c)
provided that the claims:
(1) were incurred not more than thirty (30) days prior to the
individual's application; and
(2) are on behalf of an individual who:
(A) is approved to participate in the plan;
(B) is enrolled in the plan subject to the provisions in
subsection (d); and
(C) was eligible for the plan at the time care and services
were furnished.
SECTION 13. IC 12-15-44.5-10, AS AMENDED BY P.L.30-2016,
SECTION 35, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 10. (a) The secretary has the authority to provide
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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.
(b) (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.
(c) (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.
SECTION 14. IC 16-19-3-19, AS AMENDED BY P.L.128-2015,
SECTION 237, IS AMENDED TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2025]: Sec. 19. (a) The state department shall
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study the vital statistics and endeavor to make intelligent and profitable
use of the collected records of death and sickness among the people.
(b) As required under 52 U.S.C. 21083, after January 1, 2006, the
department shall provide information to the following:
(1) The election division to coordinate the computerized list of
voters maintained under IC 3-7-26.3 with the department records
concerning individuals identified as deceased under IC 3-7-45.
(2) The office of the secretary of family and social services to
determine whether a Medicaid recipient is identified as
deceased for purposes of IC 12-15-1-24(c).
SECTION 15. IC 22-4-19-6, AS AMENDED BY P.L.122-2019,
SECTION 32, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2025]: Sec. 6. (a) Each employing unit shall keep true and
accurate records containing information the department considers
necessary. These records are:
(1) open to inspection; and
(2) subject to being copied;
by an authorized representative of the department at any reasonable
time and as often as may be necessary. The department, the review
board, or an administrative law judge may require from any employing
unit any verified or unverified report, with respect to persons employed
by it, which is considered necessary for the effective administration of
this article.
(b) Except as provided in this section, information obtained or
obtained from any person in the administration of this article and the
records of the department relating to the unemployment tax or the
payment of benefits is confidential and may not be published or be
open to public inspection in any manner revealing the individual's or
the employing unit's identity, except in obedience to an order of a court
or as provided in this section.
(c) A claimant or an employer at a hearing before an administrative
law judge or the review board shall be supplied with information from
the records referred to in this section to the extent necessary for the
proper presentation of the subject matter of the appearance.
(d) The department may release the following information:
(1) Summary statistical data may be released to the public.
(2) Employer specific information known as Quarterly Census of
Employment and Wages data and data resulting from
enhancements made through the business establishment list
improvement project may be released to the Indiana economic
development corporation only for the following purposes:
(A) The purpose of conducting a survey.
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(B) The purpose of aiding the officers or employees of the
Indiana economic development corporation in providing
economic development assistance through program
development, research, or other methods.
(C) Other purposes consistent with the goals of the Indiana
economic development corporation and not inconsistent with
those of the department, including the purposes of IC 5-28-6-7.
(3) Employer specific information known as Quarterly Census of
Employment and Wages data and data resulting from
enhancements made through the business establishment list
improvement project may be released to:
(A) the budget agency and the legislative services agency only
for aiding the employees of the budget agency or the
legislative services agency in forecasting tax revenues; and
(B) the Indiana department of labor for the purpose of
conducting a survey and reporting to the United States
Department of Labor or the federal Bureau of Labor Statistics.
(4) Wages data to the office of the secretary of family and
social services for the purposes specified in IC 12-15-1-24(d).
(e) The department may make information available under
subsection (d) only:
(1) if:
(A) under subsection (d)(1), data provided in summary form
cannot be used to identify information relating to a specific
employer or specific employee; or
(B) under subsection (d)(2) and (d)(3), there is an agreement
that the employer specific information released will be treated
as confidential and will be released only in summary form that
cannot be used to identify information relating to a specific
employer or a specific employee; and
(2) after the cost of making the information available to the
person requesting the information is paid under IC 5-14-3.
(f) The department may disclose confidential information:
(1) to an individual or employer as provided in 20 CFR 603.5(c),
upon request and proper identification of the individual or
employer;
(2) through informed consent of a party as provided in 20 CFR
603.5(d);
(3) to a public official as provided in 20 CFR 603.5(e);
(4) to an agent or contractor of a public official as provided in 20
CFR 603.5(f); or
(5) to the Bureau of Labor Statistics as provided in 20 CFR
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603.5(g);
after the cost of making the information available to the party
requesting the information is paid under IC 5-14-3.
(g) In addition to the confidentiality provisions of subsection (b), the
fact that a claim has been made under IC 22-4-15-1(c)(8) and any
information furnished by the claimant or an agent to the department to
verify a claim of domestic or family violence are confidential.
Information concerning the claimant's current address or physical
location shall not be disclosed to the employer or any other person.
Disclosure is subject to the following additional restrictions:
(1) The claimant must be notified before any release of
information.
(2) Any disclosure is subject to redaction of unnecessary
identifying information, including the claimant's address.
(h) An employee:
(1) of the department who recklessly violates subsection (a), (c),
(d), (e), (f), or (g); or
(2) of any governmental entity listed in subsection (f) who
recklessly violates subsection (f);
commits a Class B misdemeanor.
(i) An employee of the Indiana economic development corporation,
the budget agency, or the legislative services agency who violates
subsection (d), (e), or (f) commits a Class B misdemeanor.
(j) An employer or agent of an employer that becomes aware that a
claim has been made under IC 22-4-15-1(c)(8) shall maintain that
information as confidential.
(k) The department may charge a reasonable processing fee not to
exceed two dollars ($2) for each record that provides information about
an individual's last known employer released in compliance with a
court order under subsection (b).
SECTION 16. An emergency is declared for this act.
SEA 2 — Concur President of the Senate
President Pro Tempore
Speaker of the House of Representatives
Governor of the State of Indiana
Date: Time:
SEA 2 — Concur