405 IAC 10-12-7 Noncompliance

Sec. 7. (a) Subject to subsection (b), coverage shall be suspended effective the first day of the new benefit period for HIP members who fail to meet required community engagement hours for eight (8) out of the twelve (12) months in the previous Gateway to Work eligibility period. (b) A member shall not be suspended in January of the following benefit period if the member: (1) has an exemption in place during the month of December; or (2) appeals the suspension prior to its effective date pursuant to section 10 of this rule, and the appeal is still pending. (c) A member shall remain in a suspended state for one (1) benefit period or until one (1) of the following occurs: (1) The member completes one (1) month of required community engagement hours with a qualifying activity. (2) The member becomes eligible for Medicaid under a group not subject to the community engagement requirements of this rule. (3) The member obtains an exempt status. (d) A member may remain enrolled in HIP if suspended for noncompliance with Gateway to Work. However, the member shall not receive any benefits while suspended. (e) A member who is suspended shall have the member's annual renewal date changed to December 31. (f) If a member does not come into compliance during the member's suspension period, the member shall be disenrolled from the plan at the member's annual eligibility determination. The member may reapply to regain HIP coverage.