LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6049 NOTE PREPARED: Oct 3, 2020
BILL NUMBER: HB 1141 BILL AMENDED:
SUBJECT: Transportation for Medicaid Presumptive Eligible.
FIRST AUTHOR: Rep. Campbell BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: X GENERAL IMPACT: State
DEDICATED
X FEDERAL
Summary of Legislation: This bill requires coverage for nonemergency medical transportation (NEMT)
of individuals who have been deemed presumptively eligible for Medicaid during the time in which the
individual is deemed presumptively eligible for Medicaid. The bill requires the Office of the Secretary of
Family and Social Services (FSSA) to apply for any Medicaid State Plan Amendment (SPA) or waiver
necessary to provide for the coverage.
Effective Date: Upon passage.
Explanation of State Expenditures: Summary - This bill is expected to increase the number of Medicaid
fee-for-service enrollees eligible for NEMT services by approximately 6%. NEMT services for fee-for-
service enrollees are primarily billed to the state’s contracted broker, Southeastrans, Inc. The increase in
enrollees eligible for NEMT services is expected result in an additional $1.4 M in capitated payments made
to Southeastrans annually. The state’s share of this spending is estimated at approximately $480,000.
Additional Information - Presumptive Eligibility and NEMT: Individuals who are not yet enrolled in
Medicaid may temporarily receive certain covered services under “Presumptive Eligibility” (PE) status if
they provide financial and household information to a qualified health care provider, indicating they are
likely to be Medicaid-eligible. Individuals receiving PE coverage then have a limited amount of time to
submit a formal Medicaid enrollment application for FSSA approval. Current FSSA policy allows children,
pregnant women, and former foster children up to age 26 to receive NEMT services under PE coverage. PE
adults (including those in the PE “family planning” category) are currently ineligible for NEMT benefits.
The bill would expand NEMT benefits to those enrolled under the PE adult and family planning categories.
HB 1141 1
Expansion of NEMT-Eligible Members: A monthly average of 245,000 Medicaid fee-for-service members
were eligible for NEMT services between between April 2019 and March 2020 (the most recent 12-month
period for which FSSA has released such data). During that time period, a monthly average of 13,700
individuals were enrolled under the PE adult and family planning categories. All Medicaid members with
PE status receive care under the state’s fee-for-service system, as opposed to being enrolled in a state-
contracted managed care plan. However, nearly all NEMT services for the fee-for-service population are
billed through the state’s contracted broker, Southeastrans, Inc, which receives capitation payments from the
state at a rate of $8.63 per member per month. The addition of an average 13,700 PE members to the current
NEMT-eligible fee-for-service population would increase capitation payments owed to Southeastrans by
approximately $1.4 M. The state’s share of these payments is estimated at $480,000.
Medicaid is jointly funded between the state and federal governments. The state share of costs for most
Medicaid medical services for FFY 2020 is 34%.
State Plan Amendment or Waiver: The bill requires FSSA, if necessary, to apply to the federal government
for a SPA or waiver authority to implement the NEMT coverage for PE members. Given that some PE
members are already eligible for NEMT services, an SPA or waiver request should not be necessary to
implement this bill. However, FSSA may need to make rule changes, amend provider reference modules, and
likely issue a provider bulletin explaining the changes. These actions, including a potential SPA or waiver
request, fall within FSSA’s routine administrative functions and can likely be accomplished without
additional appropriations.
Explanation of State Revenues: The cost of most Medicaid medical services will be partially reimbursed
at the effective federal match rate (FMAP) of approximately 66% in Indiana for FFY 2021.
Explanation of Local Expenditures:
Explanation of Local Revenues:
State Agencies Affected: Family and Social Services Administration.
Local Agencies Affected:
Information Sources: FSSA, SEA 480 Data Reports: https://www.in.gov/fssa/ompp/5700.htm FSSA,
Medicaid Monthly Enrollment Reports: https://www.in.gov/fssa/ompp/4881.htm, Indiana Transparency
Portal, Public Contract Search: https://contracts.idoa.in.gov/idoacontractsweb/PUBLIC/112380-000.pdf
Fiscal Analyst: Adam White, 317-234-1360.
HB 1141 2


Statutes affected:
1. Introduced House Bill (H): 12-15-30.5-3