1 Department of Medical Assistance Services 1 BPRO October 1, 2015 1 Department of Medical Assistance Services

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Department of Medical Assistance Services

1www.vita.virginia.gov

BPRO October 1, 2015

www.dmas.virginia.gov 1


Medicaid Eligibility for Incarcerated Individuals

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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.

M0130.050 and M0280.300

www.vita.virginia.govwww.dmas.virginia.gov 2


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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.

M0120.200www.vita.virginia.govwww.dmas.virginia.gov 3


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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 23225 (804) 887-8110

– DOC coordinator for pre-release is Donna Harrison, DOC Offender Release Services-Community Release Unit, 6900 Atmore Drive, Richmond, Virginia 23225 (804) 887-8163

• 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 23219 (804) 588-3924



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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.

M0130.050 and M0130.400



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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.

M0130.050, M0130.400 and M1510.102www.vita.virginia.govwww.dmas.virginia.gov 6


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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.

M0130.050, M0130.400 and M1510.102



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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.

M0130.050, M0130.400 and M1510.102



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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.



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Continuum of Coverage



*Aid Category 109 covers in-patient hospitalization only

Medicaid Recipient in community

Any applicable AC

Incarceration reported -

Partial Review

Correctional FacilityAC 109*

Pre-release Planning –

Partial Review

Re-entry to community -

back to applicable AC

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Need More Information? • Cindy Olson

(804) [email protected]

• Karen Packer(804) [email protected]

• Kelly Pauley(804) [email protected]

• Susan Hart(804) [email protected]



mailto:[email protected]




Documents

1 Department of Medical Assistance Services 1 BPRO October 1, 2015 1 Department of Medical Assistance Services