Access to Medicaid for Offenders

Department of Medical Assistance Services

October 18, 2002

Study of Offenders with Mental Health Needs (SJR 97)

Requested DMAS to examine ways to provide immediate access to Medicaid benefits for eligible offenders when they are released from prisons, jails, juvenile correctional centers or detention homes.

Information Requested by the Work Group

• What happens to Medicaid eligibility when a person is incarcerated?
• What are the Medicaid system constraints a bout suspending eligibility?
• What are the current procedures for facilitating access to Medicaid when a person is released from a correctional facility?
• Is someone currently monitoring the Medicaid status for an inmate leaving the correctional system?
• Does retroactive eligibility apply?
• If there are barriers to access to Medicaid, what can be done to address them (statutory changes, Memorandum of Understanding, etc.)?

Medicaid Eligibility During Incarceration

• Federal money is not available for services provided to "inmates of public institutions" (42 CFR 435.1008)
• Correctional facilities fit the definition of an institution
• States may elect to pay for services in institutions with state-only money
• Virginia has not elected to pay for services from state-only funds
• Medicaid is terminated when an individual is incarcerated

Juveniles and Inmate Status

• Juveniles are not eligible for Medicaid:
  • when in detention due to criminal activity
  • when criminal charges are pending (no court disposition), treatment is ordered by the judge and the juvenile returns to court after treatment
• Juveniles may be eligible for Medicaid
  • when in detention due to the need for care, protection or the best interest of the child

Medicaid Eligibility During Incarceration

• Benefits are not suspended, as his/her situation may change during incarceration
• The Medicaid information system does not accommodate suspension of benefits
• The individual may apply for Medicaid during pre-release

Current pre-release procedures:

• Local DSS accepts application and processes
• Institutional status is not considered
• Correctional facility staff completes the application and obtains medical information for disability determination
• Correctional facility staff may complete the pre-admission screening for nursing homes
• Application is filed in locality of last residence
• A determination must be made within 45 days of application, or 90 days if a disability determination is required (42 CFR 435.911)
• If the individual is eligible for Medicaid, enrollment occurs after release
• Medicaid may provide for retroactive coverage for up to 3 months prior to the month of application
• Medicaid may not pay for any services rendered while the individual was incarcerated

Who Assists with the Application Process

• Parole Officers
• Regional Medicaid Specialist Locations
  • Virginia Beach (Eastern Region)
  • Abingdon (Western Region)
  • Roanoke (Piedmont Region)
  • Richmond (Central Region)
  • Warrenton (Northern Region).

Recommendations

• Recommendation 1: The Department of Medical Assistance Services, in conjunction with the Department of Social Services, should ensure that Medicaid eligibility workers in the local Departments of Social Services are aware of these procedures through memorandums and training
• Recommendation 2: The Department of Medical Assistance Services, in conjunction with the Department of Social Services, should develop a fact sheet for correctional facilities concerning Medicaid eligibility of inmates and those pending release