Part IV: Schedule Renewal Appointment for Medicaid (11 months post enrollment) – Updated 2023 Please enable JavaScript in your browser to complete this form.Consumer Name: *Navigator: *County of Residence:Type:MedicaidMixAge RangeChild (0-12)Adolescent (13-18)Adult (19-64)Senior (65+)Date: *Survey Complete: *YesNoAnswer and VoicemailAnswerNo Answer and No VoicemailNo Answer and Left VoicemailPhone in Service:YesNoAttempts:1st2nd3rdDuration of Call:[Voice Mail Message] Hi _________. My name is _____________ and I’m a Health Navigator with ASPIN. I/One of my co-workers helped you/your family apply for health insurance on _________. Since your annual redetermination for Medicaid is coming soon, I wanted to reach out to verify that you have all the necessary information and to help you renew your coverage for the next 12 months. You may have also heard that Indiana Medicaid has returned to normal operations as of March 31st, 2023. I’d be more than happy to explain what this means and assist you with the next steps in renewing your health coverage. If you can please return my call, my number is _______. Thank you and have a great day. *Always send a text message afterwards summarizing voicemail script.Hi. Is _____ available? Good morning/afternoon, __________. My name is _________and I’m a __________with ASPIN. I/One of my co-workers assisted you/your family apply for health insurance on _________. Since your annual redetermination for Medicaid is coming soon, I wanted to reach out to verify that you have all the necessary information and to help you renew your coverage for the next 12 months. You may have also heard that Indiana Medicaid has now returned to normal operations after the ‘continuous enrollment condition’ ended on March 31st, 2023. I. Schedule Renewal Appointment for Medicaid1. 1. Have you received an annual redetermination letter in the mail from the FSSA?YesNo (skip question #2)2. I can schedule an appointment to help you review your redetermination letter and determine the next steps? (Always offer to assist consumer immediately instead of scheduling an appointment unless Navigator or consumer is unavailable. Always ask for the due date listed on the letter to send required documentation and schedule appointment as soon as possible.)Scheduled – (skip question 3) Be sure to bring any re-determination documents you have received to your appointment.Not Scheduled – (skip question 3)3. Since you have not received a letter yet, I can help you create an account on the FSSA benefits portal to verify all your information is up to date and that no letters were missed. Do you have time to do this now or we can schedule an appointment?YesNo4. Have you had any changes to your household such as losing Medicaid coverage or employer insurance, family size, income, job, and/or address?YesNo – (skip question 5 & 6)5. What are those changes? (Click all that apply)Losing health insuranceFamily SizeIncome/JobAddressOther6. How do you plan to sign up?ASPIN NavigatorLocal assister/NavigatorSelfOtherUnsureII. Health Improvement7. Do you feel that having health insurance coverage has had a positive influence on your health?YesNo If no, why not?8. On a scale of 1-10 (10 being greatest) has having health insurance improved your health?NA012345678910End of call. Thank you! We will follow up with you in the next few months for more reminders and information so you can get the most out of your health insurance. If you ever have any questions or need further assistance, you can call my direct number or our ASPIN Call Center at 877-313-7215. Comments:PhoneSubmit