Authority: IC 12-15

Affected: IC 12-15-41

Sec. 1. (a) This rule establishes the eligibility requirements for the two (2) optional Medicaid categories for employees with disabilities identified in 42 U.S.C. 1396a(a)(10)(A)(ii)(XV) and 42 U.S.C. 1396a(a)(10)(A)(ii)(XVI), and in accordance with the provisions of IC 12-15-41.

(b) As used in this rule, "applicant or member" means an individual whose Medicaid eligibility is being determined under one (1) of the Medicaid categories referenced in subsection (a) and in accordance with the requirements of this rule.

(c) A person who is:

1. (1) less than sixteen (16) years of age; or
2. (2) sixty-five (65) years of age or older;

is not eligible for Medicaid for employees with disabilities.

(d) A member must report any change in income, resources, employment status, or marital status within ten (10) days of the date of the change. An additional ten (10) days is allowed to provide any necessary verification.

(e) A disabled individual will be considered for eligibility under this rule if the individual is ineligible for Medicaid under the disability category for any of the following reasons:

1. (1) The individual's income exceeds the applicable standard specified in 405 IAC 2-1.1-5.
2. (2) The individual's resources exceed the limit in 20 CFR 416.1205.
3. (3) The individual's gross earnings exceed the substantial gainful activity amount established by the Social Security Administration in 20 CFR 416.974.

(f) In addition to the requirements in this rule, the requirements in the following apply to applicants and members of Medicaid for employees with disabilities:

1. (1) 405 IAC 2-1-2.
2. (2) 405 IAC 2-1-3.
3. (3) 405 IAC 2-2-4.
4. (4) 405 IAC 2-3-1.1.
5. (5) 405 IAC 2-3-2.
6. (6) 405 IAC 2-3-12.
7. (7) 405 IAC 2-3-14.
8. (8) 405 IAC 2-3-22.
9. (9) 405 IAC 2-4-1.
10. (10) 405 IAC 2-5-1.
11. (11) 405 IAC 2-8-1.
12. (12) 405 IAC 2-8-2.

(Office of the Secretary of Family and Social Services; 405 IAC 2-9-1; filed Jun 10, 2002, 2:21 p.m.: 25 IR 3115; errata filed Aug 22, 2002, 3:14 p.m.: 26 IR 35; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Apr 8, 2014, 12:37 p.m.: 20140507-IR-405130533FRA; readopted filed Nov 13, 2019, 11:54 a.m.: 20191211-IR-405190487RFA; filed Jun 11, 2021, 2:35 p.m.: 20210707-IR-405190602FRA; readopted filed Oct 8, 2025, 3:16 p.m.: 20251105-IR-405240502RFA)