When individuals are incarcerated and are receiving a MO HealthNet (MHN) based program, a suspension must be completed when it is reported that the individual is in custody for a period longer than thirty (30) days.
Section 1001 of the Support Act (42 USC § 1396a) outlines the framework for the act of suspension for individuals who are in a certain class of individuals who are receiving Medicaid benefits:
- Juvenile under the age of 21, or
- Former Foster Youth up to age 26.
Under the RSMo §217.930 and RSMo §221.125 MO HealthNet benefits shall be suspended, rather than cancelled or terminated, for offenders entering into a correctional facility, jail, or penal facility if the Family Support Division (FSD) is notified. Upon release from incarceration, the suspension shall end and the individual’s eligibility shall be redetermined for Medicaid eligibility. The Department of Corrections (DOC) will notify FSD within twenty (20) days of receiving information that the individual is receiving MO HealthNet. As well, DOC will notify FSD within 45 days prior to release of the individual. City, county, and private jails will report to FSD within ten (10) days.
Eligibility Unit (EU) – is comprised of certain identified persons who would be considered in determining eligibility for the purpose of a benefit case.
Offender – is an inmate or resident of a public institution according to the definition of “inmate of a public institution” in 42 CFR section 435.1010
- This definition includes but is not limited to an inmate serving time for a criminal offense, who is being confined in a local or state prison, jail, correction, detention facility or other penal facility, regardless of adjudication status
Incarcerated – is a confined individual who meets the definition of an offender as defined for the purposes of this rule
Suspended Participant – The participant who is incarcerated and whose MHN benefits are suspended.
Redetermination – process where FSD staff reviews eligibility factors prior to or upon release of a suspended participant.
Restoring Benefits – process where FSD completes redetermination to continue eligibility and activate MHN benefits upon release from prison/jail.
Single Member Household – an eligibility unit with only one person who is also the head of household.
Multiple Member Household – an eligibility unit with at least two people with one eligible member and one head of household.
Head of Household (HOH) – an eligibility unit member who is responsible for managing the benefit case.
For the purposes of MAGI:
Remaining Adult – the responsible adult who is still in the home when there is an incarcerated head of household.
Incarcerated Participant – someone who is actively receiving MO HealthNet and becomes incarcerated.
Incarcerated Individual – eligibility unit member who is incarcerated and not receiving MAGI.
When it is reported to FSD that an eligibility unit member is incarcerated, staff must review the case for the incarcerated individual’s role in the case and whether or not they are receiving benefits.
- If the incarcerated individual is not actively receiving MO HealthNet and is not the head of household, the incarcerated individual will remain in the eligibility unit until release or until a reported change in circumstance that would affect his/her role in the eligibility unit.
- If the incarcerated individual is not actively receiving MO HealthNet and is the head of household of a multiple member household, the eligibility unit will remain the same until FSD is notified of a change in circumstance for the eligibility unit.
- If the incarcerated individual is actively receiving MO HealthNet, suspend coverage. The incarcerated participant will remain in the eligibility unit until release or until a reported change in circumstance that would affect his/her role in the eligibility unit.
Note: If policy interpretation is required to complete the act of suspending, please follow appropriate supervisory channels to complete a request for policy interpretation for case specific questions.
Suspending MO HealthNet
When FSD is notified of a participant’s incarceration, MO HealthNet will be suspended for that individual. For the purposes of eligibility, the incarcerated participant and/or incarcerated individual will remain in the eligibility unit they were a part of prior to the suspension. This composition will also be applicable to all member of the eligibility unit for continued participation in a MO HealthNet benefit program. If the expected release date is thirty (30) days or less from the reported date, FSD will not take action to suspend MO HealthNet benefits.
Example: The correctional facility reports on 9/9/2019 that John was incarcerated effective 8/28/2019 and his expected release date is 9/30/2019. FSD reviews the task on 9/9/2019 and determines that the release date is in 21 days; therefore, FSD will NOT take action as the release date is less than 30 days from the reported date.
Example: The correctional facility reports on 9/9/2019 that Bob was incarcerated effective 8/28/2019 and his expected release date is 10/9/2019. FSD reviews the task on 9/9/2019 and determines that the release date is in 30 days; therefore, FSD will take action as the release date is 30 days from the reported date
If the incarcerated participant is the head of household and a single member household, he or she will receive all FSD notices while suspended. However, if the incarcerated participant is the head of household and is part of a multiple member household with a remaining adult in the home, all FSD notices will be sent to the last known home/mailing address.
If the incarcerated participant is the head of household and part of a multiple member household with NO remaining adult in the home, FSD will send a suspension notice to the incarcerated individual and establish where to send FSD notices regarding other active eligibility unit members.
Note: The last known address may be the address of the correctional facility.
Example: FSD receives a report that John is incarcerated and he is actively receiving MO HealthNet for Families Adult. John is NOT the head of household; therefore, all FSD notices will be sent to the last known address and suspend John’s MHN benefits.
Example: FSD receives a report that Mary (age 17) is incarcerated and she is actively receiving MO HealthNet for Kids. Mary is the head of household and part of a single member household; therefore, Mary’s home address and mailing address will be updated to the institution’s address and FSD will suspend Mary’s MHN benefits.
Example: FSD receives a report that Bob is incarcerated and he is actively receiving MO HealthNet for Families Adult. Bob is the head of household but his daughter’s mother, Kimberly, is still in the home. Therefore, Kimberly is a responsible adult for Bob’s daughter and can receive FSD notice regarding annual renewals and changes to eligibility.
Example: FSD receives a report that Steve is incarcerated and he is actively receiving MO HealthNet for Families Adult. Steve is the head of household of a multiple member household with no other responsible adult in the home; therefore, FSD will require Steve to appoint an authorized representative or appoint a responsible contact for the remaining eligibility unit members, unless the remaining eligibility unit members are in care of the State.
Example: FSD receives a report that Eric is incarcerated and he is actively receiving MO HealthNet for Families Adult. Eric is the head of household of a multiple member household with no other responsible adult in the home. FSD determines the remaining eligibility unit members are in care of the State. FSD will remove the eligibility unit members who are in State care and Eric is now a head of household for a single member household.
It is reasonable to assume that earned income for the incarcerated participant has ended. Income for the incarcerated participant will end the month in which the incarceration was reported to the FSD. Supplemental Security Income (SSI) will be suspended after 30 days of incarceration. Social Security Disability and Social Security Retirement income will end after an incarcerated individual is convicted, but may continue during incarceration prior to conviction. If the source of unearned income is pension/retirement (income not based on eligibility factors), it is reasonable to assume that the incarcerated participant’s income will NOT end.
Example: DOC reports on 9/9/2019 that John was placed in custody on 7/23/2019. John works for McDonalds and it is reasonable to assume that he will no longer receive paychecks from his employer. Income for John will end in September 2019.
Example: Pettis County Jail reports on 9/9/2019 that Steven was placed in custody on 9/2/2019. Steven works for Wal-Mart and it is reasonable to assume that he will no longer receive paychecks from his employer. Income for Steven will end in September 2019.
Example: St. Louis City Jail reports on 9/9/2019 that Mary was placed in custody on 9/3/2019. Mary’s income source is her pension/retirement from General Motors. Mary’s income will still count in the MAGI eligibility unit budget.
Example: Jefferson City Jail reports on 9/9/2019 that Sue was placed in custody on 9/3/2019. Sue’s income source is her pension/retirement from Unilever. Sue’s income was not ended in MEDES. Her husband, John, later reports that Sue’s pension/retirement from Unilever has ended and he provides a letter from Unilever advising that her pension/retirement will be terminated on a particular date. End the income source as of that date.
Example: Kansas City Jail reports on 9/9/2019 that Jane was placed in custody on 9/3/2019. Jane’s income source is her pension/retirement from Garmin. Jane’s income was not ended in MEDES. Her husband, Bob, later reports that Jane’s pension/retirement from Garmin has ended and he did NOT provide verification. FSD will send a request verification (IM-31A) and send the Authorization for Release of Information (IM-6) to the eligibility unit.
Example: Cole County Jail reports on 9/9/2019 that Bill was placed in custody on 9/2/2019. Bill is receiving SSA benefits (disability). It is reasonable to assume that his unearned income will end because the benefit is based on eligibility factors. Income for Bill will end in September 2019.
NOTE: If it is reported that the incarcerated participant’s pension/retirement (unearned income) has ended, request verification and send the Authorization for Release of Information (IM-6) form. If remaining adult or suspended participant is not able to obtain verification (i.e. no legal relationship or unauthorized) the remaining adult or suspended participant must provide a signed clarifying statement regarding the situation.
NOTE: The act of suspension is an Adverse Action and requires proper notification. MHN benefits are to remain suspended as long as the incarcerated person remains incarcerated.
Applications Pending for Incarcerated Individuals
If an application is pending and the participant becomes incarcerated, continue processing the application. All requests for verification must be sent according to policy.
If staff are able to approve the application, approve benefits for any period including any prior-quarter months they are eligible for prior to incarceration, but the participant must be suspended beginning the first day of incarceration.
EXAMPLE: Anthony applied for MAGI 10/5/2019. He was incarcerated on 10/16/2019. His application was processed on 10/27/2019 and all information required was provided with his application. Staff approved his application with MO HealthNet for Families Adult benefits beginning 10/1/2019. His benefits were suspended 10/16/2019.
If staff are unable to complete the application with information received, and if information is not provided during the application timeframes, reject the application for the appropriate reason, such as “Failure to provide verification” or “Failure to cooperate.”
EXAMPLE: Amelia applied for MAGI on 11/16/2019. She was incarcerated on 11/26/2019. While processing the application, staff sent a Request for Information (IM-31A) and requested pay stubs on 11/19/2019, with information due 12/2/2019. The information was not received and a second request was sent 12/3/19, due 12/13/2019. The information was not received. The application was rejected on 12/16/19 for failure to provide verification.
Suspension of Time Limited Benefits
If the incarcerated participant is receiving Transitional MO HealthNet (TMH), suspend the medical benefit. Upon release, the participant will resume the remaining TMH period. Additional Quarterly Reports will be used for the eligibility unit to report income to determine continued eligibility for TMH. He or she maybe be the only person receiving/eligible for TMH in the eligibility unit for the remaining period of which he or she is eligible for after the incarceration period. Suspended MHN benefits will NOT count towards the three of the last six months test for TMH eligibility.
Example: Tom’s TMH eligibility was suspended due to his incarceration of six months. The remaining eligibility unit members’ TMH ended three months prior to his release. When Tom was incarcerated the eligibility unit was in the 2nd Quarterly Report period, therefore, Tom’s TMH eligibility will be restored upon release after a redetermination and he will need to complete additional quarterly reports for 7th and 10th months to continue Tom’s TMH eligibility for the remaining six months. The other eligibility unit members are no longer eligible for TMH.
Example: John is receiving MO HealthNet for Families – Adult for one month prior to his incarceration. During John’s incarceration the remaining adult, Susie, reports new earned income that puts the eligibility unit over the threshold of MHF (report is timely). Because John and Susie are married, Susie’s income is countable for John’s eligibility unit. Upon release, a redetermination is made and John is no longer eligible for MHF. FSD will explore TMH. John is not eligible for TMH because he was not eligible for and did not receive MHF in three of the last six months.
Example: Matt is receiving MO HealthNet for Families – Adult for three months prior to incarceration. During Matt’s incarceration of two and a half (2 ½) months the remaining adult, Mary, reports new earned income that puts the eligibility unit over the threshold of MHF (report is timely). Because Matt and Mary are married, Mary’s income is countable for Matt’s eligibility unit. Upon release, a redetermination is made and Matt is found eligible for TMH because he meets the test of three of the last six months.
If the incarcerated participant is receiving MO HealthNet for Pregnant Women (MPW), suspend the medical benefit. If the delivery occurs prior to release, inpatient services will be paid and the participant’s medical benefit will remain in a suspended status until release and FSD redetermines eligibility. If the release and redetermination occurs within the post-partum period the participant will remain eligible through the end of the month in which the 60th day falls from delivery and will transition to Extended Women’s Health Services if applicable.
Example: Mary was approved for MPW effective 11/1/2018 with a due date of 6/15/2019 and FSD receives a report of incarceration effective 2/5/2019. Therefore, FSD will suspend Mary’s MPW eligibility during the incarceration period. On 5/26/2019, FSD receives notice of inpatient services for labor and delivery; FSD will only be restored for the dates of service.
In June, FSD is notified of Mary’s release and eligibility is redetermined as post-partum through 7/31/2019 then EWHS effective 8/1/2019 unless Mary meets MHF Adult eligibility requirements.
If the incarcerated participant is receiving MO HealthNet for Kids (non-premium/premium) and turns 19 years old while incarcerated, FSD will complete an ex parte for all other MO HealthNet programs when notified of the participant’s release date. If no longer eligible for MO HealthNet, the participant will receive a ten (10) day Adverse Action period upon release. If found eligible for another MO HealthNet program FSD will notify the participant using a ten (10) day Adverse Action period that will expire the day before release.
Example: Alex is incarcerated while receiving MO HealthNet for Kids (non-premium) and his benefits are suspended. FSD is notified of his release date and begins the redetermination. During his redetermination, FSD discovers that Alex turned 19 years old while he was incarcerated and he is no longer eligible for MHK. FSD explores all other programs and he is found to be eligible for MO HealthNet for the Aged, Blind, and Disabled (MHABD) upon his release on 7/5/2019. FSD sends an adverse action notice on 6/25/2019 advising Alex of the change in his benefit. On 7/5/2019, the suspension is lifted and Alex’s eligibility is changed to MHABD.
Example: Beth is incarcerated while receiving MO HealthNet for Kids (non-premium) and her benefits are suspended. FSD is notified of her release date and begins redetermination. During her redetermination, FSD discovers that Beth turned 19 years old while she was incarcerated and she is no longer eligible for MHK. FSD explores all other programs and she is found to be ineligible for all other MO HealthNet programs upon her release on 7/5/2019. FSD sends an adverse action notice on 7/5/2019 advising Beth of the change in her benefit. On 7/15/2019, the suspension is lifted and Beth will have no eligibility, as the last day of her suspension is 7/15/2019.
Renewals and Interim Changes While Suspended
Suspending an incarcerated individual will not result in a Floating Renewal action, unless there is another change reported that would result in a Floating Renewal action (refer to 1880.010.00 FLOATING RENEWAL). The certification period will not extend and the eligibility unit will remain on schedule for an Annual Renewal. The incarcerated participant’s eligibility will NOT be excluded from the Annual Renewal process; however, if there is a change to the incarcerated participant’s eligibility, FSD will maintain the Level of Care (LOC) that was suspended.
It is the responsibility of the suspended individual or the remaining adult to report changes in a timely manner and FSD will take action on the reported changes within a timely manner. If the reported changes results in a change to eligibility, notices will be sent to the mailing address or home address as described above.
If the MAGI case closes while a suspended individual is incarcerated, the FSD will maintain the suspension and complete an ex parte once notified of the participant’s release date.
If an incarcerated participant requires inpatient care for 24 hours or more, while he or she is incarcerated, the suspended individual may still be eligible for inpatient services. FSD will review the inpatient service request and completed actions on the MAGI case to determine if additional information is needed to determine the eligibility of the incarcerated participant. A new application is NOT required for inpatient services when a participant is suspended and FSD has been able to complete Annual Renewals as well as the incarcerated participant remains eligible except for their institutional status.
Once FSD is notified of an incarcerated participant’s release, or pre-release, a redetermination must be completed and benefits restored upon release if the incarcerated participant remains eligible for the any level of care under MAGI.
If suspended participant is found ineligible, an ex parte review (refer to 1890.000.00 EX PARTE REVIEW PROCESS) for all other MO HealthNet programs must be completed. If the suspended individual is found ineligible for all MO HealthNet programs the participant will receive a ten (10) day Adverse Action period before the suspension is terminated regarding the reason for ineligibility.