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.

MEDICAID AVAILABLE:

• Infants living with the inmate in the public institution.
• Paroled individuals.
• Individuals on probation.
• Individuals on home release (except when reporting to a public institution for overnight stay).
• Individuals living voluntarily in a detention center, jail or county penal facility after their case has been adjudicated and other living arrangements are being made for them (for example, transfer to a community residence).  NOTE:  Clear cases fitting this description with State Office.
• Inpatients in a hospital or nursing facility.

• Individuals (including juveniles) who are being held involuntarily in detention centers awaiting trial.
• Inmates involuntarily residing at a wilderness camp under governmental control.
• Inmates involuntarily residing in half-way houses under governmental control.
• Inmates receiving care on the premises of a prison, jail, detention center, or other penal setting.
• Inmates receiving outpatient care.

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.

APPLICATION PROCESSING

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.
 

HOSPITAL ADMISSION

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+:

• Do not approve the application until after the individual returns to the penal institution.
• Verify the actual inpatient dates in the medical institution.
• When ready to approve the application contact the IM Program and Policy Unit to enter the information into the system.
• Notify the individual of their approval via the appropriate notice.  Include in the approval notice the individual's specific eligibility dates and that they are not currently eligible because they are an inmate in a public institution.

Some individuals may require admission into a long term care facility.

• When the anticipated inpatient stay is 45 days or less (from application date), do not approve the application until after the individual returns to the penal institution.  Contact the IM Program and Policy Unit to enter the correct eligibility dates into the system.
• When the anticipated inpatient stay is more than 45 days (from application date), approve the individual for the anticipated stay. Contact the IM Program and Policy Unit to enter the correct eligibility dates into the system.
• Notify the individual of their approval via the appropriate notice.  Include in the notification the eligibility dates.  Advise the nursing home facility to contact the Division of Family Service's caseworker if the individual's stay exceeds the eligibility end date.
• If the nursing home stay exceeds the approved dates, reverify the new anticipated dates of stay.  Contact IM Program and Policy to enter the new dates into the system.
• Notify the individual of the extended dates of eligibility as stated above.

• Review this memorandum with appropriate staff.

 
• Effective immediately, apply these guidelines to Medicaid and MC+ applicants.