MedicaidAdministrativeMedium impact
BT2021107: Quarterly cost sharing cap to include M.E.D. Works premiums in January 2022
Indiana Medicaid (IHCP)·IN·Provider Bulletin
Effective date
Jan 26, 2022
We identified it
Jun 19, 2026
Summary
Starting January 26, 2022, M.E.D. Works (Medicaid for Employees with Disabilities) monthly premiums will be included in the quarterly cost-sharing calculations along with copayments. This means M.E.D. Works members may reach their 5% quarterly income cost-sharing cap sooner, after which no copayments or premiums are required for the remainder of that quarter.
Action Required
By January 26, 2022: Billing team must update procedures to track M.E.D. Works member premium payments toward their quarterly cost-sharing cap. Monitor when members reach 5% of quarterly income threshold and stop collecting copayments for remainder of that quarter. Update billing system to account for combined premium and copayment tracking for M.E.D. Works members.