Authority: IC 12-15-2.3-12; IC 12-15-21

Affected: IC 12-15-2; IC 12-15-2.3

Sec. 1. The following definitions apply throughout this rule:

1. (1) "Applicant" means an individual who has been determined presumptively eligible for Medicaid and has submitted an application.
2. (2) "Application" means an Indiana application for health coverage.

3. (3) "Presumptive eligibility period" means the period that begins on the day on which a qualified provider makes a presumptive eligibility determination and ends on the earlier of the following:

   1. (A) In the case of an applicant, the day that a decision is made on the application.
   2. (B) In the case of a presumptively eligible individual, the last day of the month following the month in which a qualified provider determined the individual to be presumptively eligible.
   3. (C) In the case of an individual eligible under 405 IAC 10-4-1(a), the periods, as applicable, in accordance with 405 IAC 10-4-11(c) through 405 IAC 10-4-11(e).
4. (4) "Presumptively eligible individual" refers to a person who has been determined presumptively eligible by a qualified provider but has not yet attained full Medicaid eligibility.

5. (5) "Qualified provider" means a community mental health center, federally qualified health center, rural health clinic, or local county health department that meets all of the following criteria:

   1. (A) Participates as a Medicaid or waiver provider, except for local county health departments.
   2. (B) Notifies the office of its intention to make presumptive eligibility determinations under this rule.
   3. (C) Agrees to make presumptive eligibility determinations in accordance with applicable laws and policies.
   4. (D) Agrees to assist an applicant or individual in completing and submitting an application during the presumptive eligibility period.
   5. (E) Is not disqualified in accordance with section 3 of this rule.

6. (6) "Sufficiently complete" means an application that includes, at a minimum, an applicant's:

   1. (A) name;
   2. (B) date of birth;
   3. (C) Social Security number;
   4. (D) marital status;
   5. (E) citizenship status;
   6. (F) pregnancy status;
   7. (G) presumptive eligibility member identification number;
   8. (H) income;
   9. (I) home address;
   10. (J) mailing address;
   11. (K) phone number;
   12. (L) number of members in family; and
   13. (M) signature.

(Office of the Secretary of Family and Social Services; 405 IAC 2-3.4-1; filed Jun 11, 2021, 2:35 p.m.: 20210707-IR-405190602FRA; readopted filed Oct 8, 2025, 3:16 p.m.: 20251105-IR-405240502RFA)