Authority: IC 12-17.6-2-11

Affected: IC 12-17.6-3-2

Sec. 6. (a) Notwithstanding any other provision of this article, an individual is not eligible for CHIP if any of the following apply:

1. (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. (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. (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. (4) The individual is an inmate of a public institution as defined in 42 CFR 435.1009.
5. (5) The individual is not a resident of Indiana.
6. (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. (1) and the individual's parent or guardian comply with enrollment requirements, including, but not limited to, paying required premiums; and
2. (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.

(Office of the Secretary of Family and Social Services; 405 IAC 12-2-6; filed May 3, 2000, 2:02 p.m.: 23 IR 2233; readopted filed May 22, 2006, 3:22 p.m.: 29 IR 3424; readopted filed Jun 18, 2012, 11:23 a.m.: 20120718-IR-407120202RFA; readopted filed Apr 9, 2018, 9:12 a.m.: 20180509-IR-405180110RFA; readopted filed Oct 16, 2024, 11:20 a.m.: 20241113-IR- 405230817RFA) NOTE: Transferred from the Office of the Children's Health Insurance Program ( 407 IAC 2-2-6) to the Office of the Secretary of Family and Social Services ( 405 IAC 12-2-6) by P.L.35-2016, SECTION 53, effective March 21, 2016.