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INDIANA ELIGIBILITY MODERNIZATION
Voluntary Community Assistance Network (V-CAN)
V-CAN User Guide 18 vcan@us.ibm.com
Healthy Indiana Plan (HIP)
HIP is a state-sponsored health insurance plan for low-income Hoosiers. Hoosiers who may qu
include:
alify for HIP
64;
f federal poverty level
PL);
adults may be covered);
ge;
zen (refugee or asylee);
months.
ay be found online at
• Uninsured, non-disabled adults between the ages of 19-
• Parents or caretaker relatives of dependent children from 22% to 200% o
(F
• Childless adults (maximum of 34,000
• Hoosiers who are ineligible for employer-sponsored health care covera
• U.S. citizens, legal immigrants (for at least 5 years), or a qualified non-citi
and
• Hoosiers who are uninsured for at least 6
To apply for HIP, an applicant may complete a paper HIP application, which m
www.HIP.in.gov
. Local DFR offices, Hoosier Healthwise Enrollment Centers and p
also have copies of paper HIP applications. Once completed, a HIP applica
articipating V-CAN sites
tion may be submitted to a
mplete the Indiana Application
licant must answer “yes” to Question
ocess is listed below:
gned and submitted;
intment notice to the applicant;
;
• conducts interview (by phone, unless in-person is requested);
w
(if documents are
ical Review Team (MRT);
• MRT makes disability determination;
• State worker makes Medicaid eligibility determination; and
• FSSA Service Center mails approval/denial notice to applicant.
Medicare Savings Program
The Medicare Savings Program application is used for specific Medicaid categories: Qualified Medicare
Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and Qualified Individual (QI).
To apply, applicants may complete the Indiana Application for Assistance online, over the phone, or
on paper, or complete the Medicare Savings Program paper application (State Form 49228). MSP
applications are processed within 45 days of application date.
local DFR office or to the FSSA Service Center by mail or FAX.
Medicaid Disability (MA-D)
To apply for MA-D, an applicant or Authorized Representative may co
for Assistance. On the Indiana Application for Assistance, the app
12 “Is this person blind, disabled or incapacitated?” The MA-D application pr
• Indiana Application for Assistance is completed, si
• FSSA Service Center mails an Interview Appo
• Applicant gathers medical provider information
FSSA Service Center
Worker coo mpletes 251B (Social Summary) during interview
o Applicant gives medical provider contact information during intervie
• FSSA Service Center mails: 2032 Pending Verifications Notice to applicant
needed) and 251A to medical provider;
• FSSA Service Center sends records to Med