1 Department of Medical Assistance Services 1 BPRO October 1, Department of Medical Assistance Services Medicaid Eligibility for Incarcerated Individuals

2 Department of Medical Assistance Services 2 Incarcerated Individuals Incarcerated individuals include: –individuals under the authority of the Virginia Department of Corrections (DOC) –individuals held in regional and local jails, including those on work release –youth held in Virginia Department of Juvenile Justice (DJJ) facilities Juvenile in detention center due to care, protection or in best interest of child may be eligible for full benefit Medicaid or FAMIS coverage. M and M Department of Medical Assistance Services

3 3 Incarcerated Individuals Inmates of correctional facilities & individuals under age 21 in a DJJ facility may apply for Medicaid: 1.as part of pre-release (re-entry) planning or 2.after inpatient hospitalization. Applications are not to be refused because applicant is an inmate of public (ineligible) institution at time of application. Individuals are not eligible for full benefit Medicaid coverage while they are living in a correctional facility, regional or local jail, or a DJJ facility. M Department of Medical Assistance Services

4 4 How Incarcerated Individuals May Apply Individuals in DOC facilities use paper applications; inmates do not have access to computers. –DOC coordinator for inpatient hospitalization is Myra Smith, DOC Health Services Unit, 6900 Atmore Drive, Richmond, Virginia (804) –DOC coordinator for pre-release is Donna Harrison, DOC Offender Release Services-Community Release Unit, 6900 Atmore Drive, Richmond, Virginia (804) Individuals in regional and local jail inmate can use any method to which they have access. Youth in DJJ facilities use CommonHelp. –DJJ coordinator for both pre-release and inpatient hospitalization is Melissa Smith, DJJ Re-entry Services Unit, 600 E. Main Street, Richmond, Virginia (804) Department of Medical Assistance Services

5 5 Pre-release Planning Application is processed by LDSS in locality of residence prior to incarceration. –If individual is discharged to a different locality, case is transferred after processing and enrollment. –If individual is not a resident of VA at time of incarceration but intends to remain in Virginia, application is processed by LDSS where facility is located. Medicaid application is processed based on anticipated living arrangement and pended until release. Eligible individual is enrolled as soon as possible upon release, with coverage beginning on the date of release. M and M Department of Medical Assistance Services

6 6 Coverage of Inpatient Hospital Services Individual must meet a Medicaid covered group: –Pregnant Women –Child Under 19 –ABD With Income < 80% Individual continues to meet definition of a disabled individual while incarcerated even if SSA disability benefits are suspended, unless it is reported that he is no longer disabled. –Cannot be LIFC while incarcerated—not “living with a dependent child.” CMS determined that an inmate is not “living in an ineligible institution” while hospitalized in an inpatient facility. M , M and M Department of Medical Assistance Services

7 7 Inmate Receives Inpatient Hospital Care Inmates who have an inpatient hospitalization and are determined eligible for Medicaid are enrolled in AC 109, regardless of covered group. AC 109 limits Medicaid payment to inpatient hospital services only. Once enrolled in AC 109, coverage for inpatient hospital services is ongoing and subject to reporting requirements and annual renewals. M , M and M Department of Medical Assistance Services

8 8 Enrollee Status Changes Current enrollee becomes incarcerated –Partial review to determine continued eligibility Must still meet a covered group; disabled individuals continue to be considered disabled even though SSA and Medicare benefits are suspended. If eligible, AC is changed to 109 regardless of covered group. Inmate with active coverage must have annual renewals; responsibility for ongoing case maintenance provided by locality where individual lived prior to incarceration. Inmate scheduled for release –If active enrollee, partial review to determine continued eligibility based on prospective living arrangement –If not active, eligible for pre-release planning. M , M and M Department of Medical Assistance Services

9 9 Acting on Changes It is important to act on report of an enrollee becoming incarcerated as quickly as possible. –Monthly managed care fees continue to be paid until coverage is cancelled or individual is moved to AC 109. Reports may be verbal from enrollee or correctional facility staff. Data sharing agreements are in development so that reports can be generated on DOC and DJJ individuals Department of Medical Assistance Services

10 Department of Medical Assistance Services 10 Continuum of Coverage Department of Medical Assistance Services *Aid Category 109 covers in-patient hospitalization only Medicaid Recipient in community Any applicable AC Incarceration reported - Partial Review Correctional Facility AC 109* Pre-release Planning – Partial Review Re-entry to community - back to applicable AC

11 Department of Medical Assistance Services 11 Need More Information? Cindy Olson (804) Karen Packer (804) Kelly Pauley (804) Susan Hart (804) Department of Medical Assistance Services