in-20261028-IR-405260412ONA: OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES

OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES Public Notice of Change to Alternative Benefits Plan Benefit Alignment In accordance with public notice requirements established at 42 CFR 440.386, the Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) publishes this notice of proposed changes to the Healthy Indiana Plan (HIP) coverage and policies. The public notice period will run from October 28, 2026, to November 27, 2026. FSSA – OMPP is proposing this state plan amendment (SPA) to align all HIP benefits with state plan coverage. Currently, the design of the HIP program offers state plan benefits and an alternative benefit plan (ABP) to those that did not make a POWER account contribution and were not deemed medically frail by the ABP benefit definition. Because the state plans to discontinue permanently POWER accounts with HIP 3.0 in favor of co-payments at place of service and institute a medically frail definition as part of work requirements, this SPA will ensure there is one definition of medically frail for members, providers, and advocates to understand. With this SPA, medically frail status will be a factor of work requirements eligibility for HIP and no longer a separate factor for benefit package. Rather, all individuals will have access to the same HIP benefits. This will streamline the administration of HIP and reduce member confusion concerning medically frail determinations in the Medicaid program. Some members will see a slight increase in dental benefits and will have increased access to certain services, such as nonemergency transportation and physical, speech, and occupational therapy. Consistent with 42 CFR 440.345, HIP enrollees under age 21 will continue to have access to the full range of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services. FSSA – OMPP will assure access to medically necessary EPSDT services, including services within the scope of Section 1905(a) of the Social Security Act that are not otherwise included in the ABP, through Indiana Medicaid's existing coverage, service authorization, and delivery processes. FSSA – OMPP will assure compliance with the provisions of Section 5006(e) of the American Recovery and Reinvestment Act of 2009 by continuing to engage in tribal consultations, in accordance with federal law and the Indiana Medicaid State Plan. Tribal notice has been provided for this SPA. This change will be effective January 1, 2027. A copy of this notice is now on file at the Indiana Government Center South, 402 West Washington Street, Room W451, Indianapolis, Indiana and is open for public inspection. Also, a copy of this notice is now available and may be inspected by contacting the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W374, Indianapolis, Indiana. There will be no public hearing. Written comments will be accepted until 5:00 p.m. on November 27, 2026, and may be directed to FSSA, Office of Medicaid Policy and Planning, Attention: Sarah Tomes, 402 West Washington Street, Room W374, Indianapolis, IN 46204 or by email to spacomment@fssa.in.gov. Correspondence should be identified in the following manner: COMMENT RE: HIP BENEFIT ALIGNMENT. Written comments will be made available for public inspection at the address herein of the OMPP.