IM-13 01/20/00 MEDICAID/MC+ COVERAGE FOR INMATES
|MEDICAID/MC+ COVERAGE FOR INMATES OF A PUBLIC INSTITUTION|
|Effective immediately this memorandum
changes the definition of when an individual is ineligible for Medicaid
or MC+ due to being an inmate in a public institution. This change
allows individuals who leave the public institution to enter a medical
institution or who are under house arrest to be eligible for Medicaid.
These changes apply to juveniles and adults.
Eligibility for Medicaid does not exist when the two following criteria exist.
1. The individual is an inmate, and
2. The facility in which the individual is residing is a public institution.
An individual is an inmate when serving time for a criminal offense or confined involuntarily in a State or Federal prison, jail, detention facility or other penal facility. An individual voluntarily residing in a public institution is not an inmate.
A facility is a public institution when it is under the responsibility of a government unit, or a government unit exercises administrative control over the facility. The following examples will help in determining when Medicaid or MC+ might be available to individuals residing in or under the control of a penal institution.
Admittance as an inpatient in a hospital, nursing facility, juvenile psychiatric facility or intermediate care facility interrupts or terminates the inmate status. Explore Medicaid or MC+ eligibility for these individuals regardless of their length of stay as an inpatient. This does not include medical facilities under the control of a penal facility.
When determining eligibility for these individuals, consider all specific eligibility groups including children, pregnant women, and elderly, blind or disabled. Persons must meet all eligibility factors of the program for which they are qualifying, e.g., MPW, MA, etc. Although confined in a public institution, these individuals may have income and resources available to them.
NOTE: Medicaid eligibility does not exist for inmates treated as outpatients in medical institutions, clinics or physician offices.
Upon an inmate's admittance as an inpatient to a hospital or nursing home the county office in which the penal institution is located will take the appropriate type of application. The individual, a relative, an authorized representative, or penal institution designee may initiate the application. If necessary, secure medical records and submit them for a Medical Review Team (MRT)disability determination. Admittance to a nursing facility requires a pre-admission screening and level of care determination.
If the individual is ineligible for Medicaid or MC+ reject the application immediately. Send the appropriate rejection notice to the individual.
The application approval is a joint
process between the caseworker and the IM Program and Policy Unit.
When the case is ready for approval, contact the IM Program and Policy
Unit to enter the information into the system. Contact the IM Program
and Policy Unit by E-mail address FO51XIX or call 573-751-2549.
It is important to confine eligibility to the days in which the individual was an inpatient in the medical institution. If the individual is eligible for Medicaid or MC+:
Some individuals may require admission into a long term care facility.