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.
- 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.