If you receive a Medicaid renewal form (also called a redetermination form) from FSSA in the
mail, it is important that you read the form carefully and return any information that is
being requested by the due date listed on the form.
- Notes & Corrections — The form will list the information that FSSA
already knows about you, including what you have told them in the past. If FSSA does
not have all of the people, income, resources (assets) or other items for your
household listed or it is not correct, make notes and corrections on the
redetermination form.
- Proof of Income — For all income sources for your family, provide the
latest thirty (30) days of proof of income. This could be paystubs or an employer’s
signed statement of your gross income (what you make before any taxes or
deductions). FSSA will re-evaluate your eligibility based on the most current
information you provide.
- Income Source Statement — If an income source listed has stopped but
you do not have a way to prove it, you can write a statement telling FSSA the
details. Be sure to include as much information as possible, including the income
source name, amounts, and dates for the last month you received it. Sign and date
this statement before turning it in to FSSA and include a phone number where you
can be reached if they have any questions.
- Resources — If your redetermination form asks about resources
(assets), provide bank statements or other proof of the value of the asset from
within the last thirty (30) days. If your form does not ask about resources, you
do not need to provide any information about them. Resource (asset) information
is only needed for determining eligibility for Medicaid for the Aged, Blind,
Disabled, and Medicare Savings Programs.
- New Option: Submit Your Form Online — You can now submit
information for your redetermination online using the FSSA Benefits Portal at fssabenefits.in.gov. You will
need to create an account if you have not already done so. After you complete and
sign your redetermination form, you can upload the form and supporting
verification documents (like paystubs or bank statements). At a minimum, you will
need to submit your income from the last thirty (30) days along with the form to
complete your redetermination. Your form will tell you if you also need to submit
information on your resources (assets such as bank accounts). If FSSA needs more
information from you after you submit information online, they will send you a
separate request.
For complete instructions on how to respond to the form electronically in your
Benefits Portal account,
watch this how-to video on YouTube
.
- Or, Mail Your Form — If you are submitting a paper form, make sure
the person it is addressed to (or their Authorized Representative on file with
FSSA) signs it.
If FSSA does not receive this information, your health coverage will change after the
redetermination due date on the form they send you. If you miss the due date, you can
still turn in the form and information up to 90 days late and they will review you for
restarting eligibility without completing a new application. If you do turn in
information but are determined to be ineligible, you can reapply at any time.
If you are no longer eligible, you will get a final notice about two (2) weeks before
your coverage is scheduled to change. You can appeal FSSA’s decisions, and your appeal
rights will be found at the end of the final notice.
If you have any questions, please call the FSSA Call Center at 1-800-403-0864 between 8:00 a.m. and 4:30 p.m., Monday through Friday.