Inmate: An individual who is living in a public institution, which is not defined as a medical institution.
Inpatient: A patient who has been admitted to a medical institution and who:
1. receives room, board and professional services in the institution for a 24 hour period or longer, or
2. is expected by the institution to receive room, board and professional services in the institution for a 24 hour period or longer even if the patient dies, is discharged, or is transferred to another facility before 24 hours have elapsed.
Medical Institution: An institution certified under state law to provide medical care, including nursing and convalescent care, such as a hospital, skilled nursing facility (SNF), intermediate care facility (ICF), intermediate care facility for the Intellectually Developmentally Disabled (ICF-IDD), residential psychiatric treatment center (RPTC); and an assisted living home that provides residential supported living or habilitation services, such as Alaska Pioneers’ Homes.
Penal Institution: A correctional or holding facility for individuals who are held as prisoners (e.g. prison or jail), such as the Fairbanks Youth Facility.
Public Institution: A facility including a penal institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. A medical institution is not a public institution even if it is administered by a governmental unit.
Medicaid eligibility may be available to an individual residing in a medical institution if all eligibility criteria are met.
An individual age 21 receiving active treatment in a medical institution, such as in Alaska Psychiatric Institute (API), may be Medicaid eligible providing they have continuously resided in an inpatient psychiatric hospital since being determined Medicaid eligible. Eligibility ends the month of his or her 22nd birthday or discharge from the facility, whichever occurs first.
For individuals over the age of 65 please see ADLTC MS 514 C.
An individual residing in a public institution, regardless of whether the placement was voluntary or involuntary, is not eligible for Medicaid.
An individual incarcerated in a penal institution, including a juvenile committed by the court to a correctional facility, may be eligible for Medicaid while the individual is an inmate, however; covered services are suspended. The inmate status continues until the individual is released on parole, or is pardoned. An individual is still considered an inmate if he or she:
1. Leaves a correctional facility but continues to be in DOC or Federal Bureau of Prisons (BOP)** custody; or
2. Leaves a correctional facility for treatment in an acute care medical facility; or
3. Is a child who is temporarily sent to an evaluation or diagnostic center for a determination of the most appropriate institutional placement resulting from a court order for commitment under the penal system.
An individual living outside a correctional facility serving a period of temporary commitment by electronic monitoring is not considered incarcerated in a penal institution.
Most medical care for adults (including juveniles waived to adult status) who are incarcerated by the state is provided through the Department of Corrections (DOC). A juvenile in a correctional facility receives most medical care through the Division of Juvenile Justice (DJJ).
1. Incarceration and Medicaid
Medicaid benefits cannot be denied or terminated solely because an individual is incarcerated.
Even though incarcerated individuals may continue to meet all other eligibility requirements, Medicaid will not pay for medical claims while the individual is incarcerated, with one exception. Incarcerated adults and children who are Medicaid eligible and have been admitted to a hospital for more than 24 hours may have the medical charges paid by Medicaid.
All of the eligibility requirements for Medicaid must still be met to receive this coverage. If an incarcerated individual no longer meets all eligibility factors, his or her case will be closed or denied with adequate notice.
Note:
Medicare Savings Program is not requested for an incarcerated individual. Medicare will not pay for services when an individual is incarcerated.
Applications:
The hospital will assist the incarcerated individual with completing an application if the individual is not already receiving Medicaid. If eligible, the Medicaid case will be authorized for 12 months, using the correct incarceration subtype. The Medicaid case will close at the end of the certification period unless it has been reported that the individual is no longer incarcerated.
Example:
Noah is incarcerated and does not have on-going Medicaid. On 11/26/2016.he becomes ill and is admitted to the hospital for more than 24 hours. He turns in a Medicaid application on 11/30/16 and is determined eligible for Medicaid from 11/01/2016 – 10/31/2017 with the appropriate incarcerated subtype.
On-going Medicaid:
When it has been reported that a recipient is incarcerated, the Medicaid subtype must be changed to the ‘incarcerated’ subtype for the month following the report of incarceration. If the individual is on a case with other household members, the individual must be removed from the case and treated as an applicant. The first case with the other household members must be processed accordingly due to the report of change.
Example:
Davi, his spouse, and children are together on an on-going Medicaid case. Davi is reported incarcerated by his spouse on 06/03/16. Davi is coded out of his family’s Medicaid case starting 07/01/2016. Davi is determined eligible for incarcerated Medicaid on a new case by himself. His certification period is 07/01/16-06/30/2017. The Medicaid case with the other household members is processed accordingly with the household size report of change.
Applications for OCS Title IV-E children in DJJ custody will continue to be processed by OCS in EIS.
In some instances, a child is released from a correctional facility into a medical institution, treatment facility, or community setting permanently or indefinitely, but the child remains in DJJ custody. In such a case, the child may become eligible for Medicaid beginning in the first month in which the child is out of the correctional facility for at least one full day. After making a prospective eligibility determination, an ET may authorize eligibility for the child up to three working days prior to the release date, provided the release date is verified by DJJ. To verify the release date, the ET must contact (in the order given) one of the following individuals:
The Youth Corrections Operations Manager at (907) 261-4335;
The State Office Juvenile Probation Officer at (907) 465-2212;
The OCS Medicaid Coordinator at (907) 465-8420.
**If a client is in the custody of the Federal Bureau of Prisons, as verified by the Inmate Locator, please contact the Residential Reentry Management Field Office in which the inmate is assigned to verify Medicaid eligibility criteria.
815 E. SUBSTANCE ABUSE TREATMENT FACILITIES AND COMMUNITY RESIDENTIAL CENTERS (HALFWAY HOUSES)
Full Medicaid eligibility may be available to an incarcerated individual who is not confined in a penal institution. Community Residential Centers (aka halfway houses) reserve a small number of beds for individuals on probation or parole that may be ordered to live in a structured environment as a condition of their supervision.
In order for the incarcerated individual to be eligible for full Medicaid benefits, they must have freedom of movement at the Community Residential Center (CRC). Individuals are considered to have freedom of movement if all three of the following criteria are met:
An incarcerated individual living at a CRC may or may not have freedom of movement. Do not attempt to verify freedom of movement by calling the CRC directly. The CRC’s are not staffed by Department of Corrections (DOC) employees and only DOC can verify if the inmate is confined or has freedom of movement (furlough placement).
If an individual applies for Medicaid benefits and the application shows a CRC address, the Eligibility Technician must send an email to doc.idodocs@alaska.gov in order to verify if the individual is confined or on a furlough placement. Please reference Addendum 6 for a list of CRC addresses. When sending the email to DOC, the subject line should state “CRC Verification for Medicaid” and the body of the email must include the individual’s name and date of birth.
Remember to use the appropriate Medicaid subtype. An incarcerated individual who is confined at a CRC is eligible for limited inmate Medicaid benefits but an incarcerated individual who has freedom of movement in a furlough placement at a CRC is eligible for full Medicaid benefits.
An incarcerated individual receiving active treatment in a substance abuse treatment facility may also qualify for Medicaid coverage if the individual meets all eligibility criteria; however, Medicaid does not cover the cost of the treatment in the facility.
All incarcerated individuals who are placed at a substance abuse treatment facility by Department of Corrections are on a furlough placement. Department of Corrections will never place a confined inmate at a substance abuse treatment facility.
Medicaid payments are available for services received by an otherwise eligible applicant during the first and last partial months of residence in a public facility because he or she resided outside the facility for part of each month.
Example:
Emma applies for Medicaid on 07/03/16. When processing the application, the ET discovers that Emma became incarcerated on 07/09/16 with an unknown release date. She meets all other eligibility factors. As Emma was not incarcerated for the entire month of 07/16, she is eligible for regular Medicaid benefits for 07/16. The appropriate incarcerated Medicaid subtype will be used starting 08/16.
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