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FSSA to Resume Standard Rules for Calculating Patient and Waiver Liability March 1, 2021

The Indiana Family and Social Services Administration (FSSA)

Medicaid Liability Calculation
FSSA to Resume Updating Liability Calculations March 1.

As one of the states electing to receive increased funding for its Medicaid program under the Families First Coronavirus Response Act, Indiana cannot terminate individuals from the Medicaid program until the end of the month in which the Secretary of the Department of Health and Human Services declares that the COVID-19 public health emergency to no longer exists.  This also includes Indiana being unable to reduce benefits for any beneficiary enrolled in Medicaid on or after March 18, 2020, through the end of the month in which the emergency period ends.  As a result of these requirements, the FSSA had not been adjusting patient and waiver liabilities (Medicaid’s version of a copayment) when changes in a recipient’s income would have increased the liability.  Here are some examples of where a liability increase should have occurred but for the Families First Coronavirus Response Act requirements:

  • Increases in income such as the annual Social Security cost of living adjustment.
  • When a waiver recipient who had no liability enters a nursing home. Ordinarily a patient liability should be assessed upon nursing home admission.
  • When an individual has been serving a transfer of assets penalty and the penalty ends.

In November, the Center for Medicare and Medicaid Services issued new regulations to give states more flexibility in how Families First Coronavirus Response Act requirements are met.  Using these flexibilities and in response to concerns about unused income accumulating in recipients accounts that could lead to excess assets, the FSSA will again resume standard rules for calculating patient and waiver liabilities beginning March 1, 2021.  Recipients will begin to see notices updating patient and waiver liabilities beginning the first week of February 2021.

If you receive a liability notice that you believe is incorrect, the Stinson Law Firm can assist you in reviewing the notice and correcting any errors.  Contact us today at 317-622-8181 or www.stinsonlawfirm.com.