Medicaid Policy
Medicaid Policy
Effective Date: June 1, 2025
Introduction
Do not close or deny individuals who are incarcerated (such as, a jail, prison or juvenile correctional facility). While incarcerated an individual will still be Medicaid eligible, but their Medicaid benefits will be suspended. Individuals with suspended benefits qualify only for coverage of inpatient hospital services unless they are within 90 days of release. Incarcerated individuals may be eligible for pre-release services. See 600.
A. Setting Suspensions and Completing Reviews
The following requirements apply to suspending Medicaid benefits.
1. For an ongoing member, suspension of benefits will begin the day following incarceration.
o The suspended individual’s review month will not change.
2. The agency must conduct reviews for cases under suspension. Reviews will follow the review process outlined in 721-1 (Conduct an ex parte review whenever possible). Reviews are required every 12 months for suspended individuals.
3. For applications received while incarcerated see 703-7.
B. Removing the Suspension
1. End the suspension the day before the release. The following will requirements apply:
o Review month will not change.
o The member should be placed on the program that they are eligible for.
2. An individual determined disabled prior to incarceration remains disabled upon release see 303-10.