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Family and Social Services Administration

FSSA Home > Information for ESRD Medicaid Patients and Caregivers Information for ESRD Medicaid Patients and Caregivers

In May 2014, the Centers for Medicare and Medicaid Services approved the Family and Social Services Administration’s request  to continue coverage for approximately 360 individuals with End Stage Renal Disease (ESRD) who were at risk of losing access to kidney transplant services as a result of the end of the Spend Down provision.

Individuals eligible for continued coverage under this option must also be:

  • Eligible for Medicare
  • Have income between 150 percent of the federal poverty level (FPL) ($17,505 annually or $1,459 monthly for an individual and $23,595 annually or $1,967 monthly for a couple) and 300 percent FPL ($35,010 annually or $2,919 monthly for an individual and $47,190 annually or $3,933 monthly for a couple)
  • Not be institutionalized
  • Be resource eligible based on standards in effect as of May 31, 2014
    • $1500 for an individual and $2250 for a married couple
  • Not be eligible for full benefits under another Medicaid coverage option

CMS approved continued coverage for these individuals with an ESRD liability applied, calculated using the same methodology as spend down. As of August 2014, these ESRD liability amounts will begin. Prior to being subject to the liability amount, members eligible under this option will receive notice of their ESRD liability amount by mail. Like spend down, the ESRD liability amount for these individuals will be due to providers after services have been rendered.

Questions can be directed to the ESRD hotline at 800-403-0864 Option 6.

Anyone newly diagnosed with ESRD should consult their transplant or dialysis provider about coverage options, or call the Indiana State Health Insurance Assistance Program (SHIP) at 800-452-4800.