Effective Date: March 1, 2020 - May 31, 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.
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 with the exception of:
o Individuals under age 21 (Including individuals under age 21 on Adult Expansion); and
o Individuals suspended on the Former Foster Care (FFC) program.
3. For applications received while incarcerated or for an inpatient stay see 703-7.
B. Removing the Suspension
1. Prior to reinstating Medicaid benefits for suspended individuals under age 21 or on FFC, a redetermination of eligibility is required. Review eligibility and request any updated information needed to make a determination.
2. Reinstate Medicaid coverage as of the day of release. The following will requirements apply:
o Review month will not change (Individuals under age 21 and FFC individuals will have a new review month once the determination is completed).
o Workers need to determine if the individual is still eligible for the suspended program (such as, still eligible for PCR or PW). If not eligible, determine eligibility for another Medicaid program, such as Adult Expansion.
3. To lift the suspension for an individual determined disabled prior to incarceration see 303-10.