405 IAC 12-2-6 Ineligibility

Sec. 6. (a) Notwithstanding any other provision of this article, an individual is not eligible for CHIP if any of the following apply: (1) The individual is eligible for Medicaid, except for an individual who is subject to a spenddown under 405 IAC 2-3-10. An individual who is eligible for Medicaid with a spenddown may be eligible for CHIP if all other CHIP eligibility requirements are met. (2) The individual is covered under a group health plan or under health insurance coverage as such terms are defined in 42 U.S.C. §300gg-91. (3) The individual is eligible for health benefits coverage under a state health benefits plan on the basis of a family member's employment with a public agency in the state. (4) The individual is an inmate of a public institution as defined in 42 CFR 435.1009. (5) The individual is not a resident of Indiana. (6) The individual is an undocumented alien. (b) If any of the conditions in subsection (a) apply to a member, the member or the member's parent, guardian, or authorized representative must report the change to the local office. (c) An individual who is a patient in an institution for mental diseases at the time of application or redetermination is not eligible for the program. A member who has been determined eligible under the program and becomes a patient in an institution for mental diseases after eligibility determination may remain eligible for covered services under the program until the end of the one (1) year period in section 5 of this rule if the individual: (1) and the individual's parent or guardian comply with enrollment requirements, including, but not limited to, paying required premiums; and (2) does not become ineligible under subsection (a). IMD services are not covered under CHIP. However, the individual remains eligible for services that are covered.