514 RESIDENTS OF INSTITUTIONS
514 A. DEFINITIONS
Inmate: An individual who is Individualized Supports living in a penal or public institution that is not defined as a medical institution.
Inpatient: A patient who has been admitted to a medical institution and who
board and professional services in the institution for a 24 hour period
or longer, or
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 hospitals, nursing facilities (SNF Skilled Nursing Facility), intermediate care facilities (ICF), intermediate care facility for the Intellectually Developmentally Disabled (ICF/IDD Intermediate Care Facility for the Intellectually Developmentally Disabled); residential psychiatric treatment centers (RPTC Residential Psychiatric Treatment Center); and certain assisted living homes providing residential supported living and 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 Correctional Center.
Public Institution: A facility that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. A medical institution is excluded even if it is administered by a governmental unit.
514 B. MEDICAL INSTITUTION
Medicaid eligibility may be available to an individual residing in a medical institution if all eligibility criteria are met.
514 C. PUBLIC INSTITUTION
An individual residing in a public institution, regardless of whether the placement was voluntary or involuntary, is not eligible for Medicaid.
individual age 65 or older receiving active treatment in an institution
for mental disease, such as in the Alaska Psychiatric Institute (API Alaska Psychiatric Institute), may be Medicaid eligible providing
he or she has continuously resided in an inpatient psychiatric hospital
since being determined Medicaid eligible;
individual placed in a public facility on a short-term emergency basis
pending other arrangements appropriate to the individual’s needs such
as a child placed in McLaughlin Youth Center waiting for foster placement
may be Medicaid eligible; or
514 D. PENAL INSTITUTION
An individual incarcerated in a penal institution, including a juvenile committed by the court to a correctional facility, is excluded from Medicaid coverage 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:
Leaves a correctional facility but continues to be in DOC Department of Corrections custody, or
Leaves a correctional facility for treatment in an acute care medical facility.
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. A juvenile in a correctional facility receives most medical care through the Division of Juvenile Justice.
1. Incarceration and Medicaid
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.
The hospitals 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.
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.
When it has been reported that a recipient is incarcerated, the Medicaid subtype must be changed to "incarcerated" 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.
Craig, his spouse, and children are together on an on-going Medicaid case. Craig is reported incarcerated by his spouse on 06/03/16. Craig is coded out of his family's Medicaid case starting 07/01/2016. Craig is determined eligible for incarcerated Medicaid on a new case by himself. His certification period is 07/01/2016 - 06/30/2017. The Medicaid case with the other household members is processed accordingly with the household size report of change.
Applications for OCS Office of Children's Services Title IV-E children in DJJ Division of Juvenile Justice custody will continue to be processed by OCS Office of Children's Services in EIS Eligibility Information System. Applications for children in DJJ Division of Juvenile Justice custody will be processed by the Field Services Support Unit.
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 Division of Juvenile Justice 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 Division of Juvenile Justice. 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 Probations Officer at (907) 465-2212;
The OCS Office of Children's Services Medicaid Coordinator at (907) 465-3633.
See Addendum 2 for the incarceration Medicaid subtypes.
514 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 Community Residential Center). Individuals are considered to have freedom of movement if all three of the following criteria are met:
The individual can work outside the CRC Community Residential Center in employment available to individuals who are not under justice system supervision; and
The individual can use community resources such as libraries, grocery stores, recreation, education, etc. at will; and
The individual can seek health care treatment in the broader community to the same or similar extent as other Medicaid recipients.
An incarcerated individual living at a CRC Community Residential Center may or may not have freedom of movement. Do not attempt to verify freedom of movement by calling the CRC Community Residential Center directly. the CRC Community Residential Center's are not staffed by Department of Corrections (DOC Department of Corrections) employees and only DOC Department of Corrections 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 Community Residential Center address, the Eligibility Technician must send an email to firstname.lastname@example.org in order to verify if the individual is confined or on a furlough placement. Please reference Addendum 6 for a list of CRC Community Residential Center addresses. When sending the email to DOC Department of Corrections, the subject line should state "CRC Community Residential Center 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 Community Residential Center is eligible for limited inmate Medicaid benefits but an incarcerated individual who has freedom of movement in a furlough placement at a CRC Community Residential Center 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.
514 F. PARTIAL MONTH STATUS
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.
Alison applies for Medicaid on 07/03/2017. When processing the application, the ET discovers that Alison became incarcerated on 07/09/2017 with an unknown release date. She meets all other eligibility factors. As Alison was not incarcerated for the entire month of 07/2017, she is eligible for regular Medicaid benefits for 07/2017. The appropriate incarcerated Medicaid subtype will be used starting 08/2017.
514 G. CHILDREN IN TREATMENT
A child may be temporarily absent from his or her home for treatment in a residential care facility. If the child is ineligible for MAGI Modified Adjusted Gross Income Medicaid and has resided in the residential treatment facility for more than 30 days, eligibility may be determined using institutional deeming rules.
When determining the child's eligibility for Medicaid using institutional deeming rules, the child is considered to be living independently of his or her parents when the child has:
Not lived in the home of the child's parent(s) for at least 30 days immediately preceding the date of application; or
Left the home to enter a medical institution or treatment facility in Alaska that involves a residential living arrangement and that treatment has lasted 30 days or longer; or
Left the home to enter an out of state medical institution or treatment program that involves a residential living arrangement and a 30-day out of state placement is prior authorized by Conduent State Healthcare. Contact email@example.com for special case processing instructions.
A child admitted for less than 30 days is not considered to be living separately from his or her parents, unless the caseworker verifies that the child did not go home, was transferred directly to another institutional or treatment setting, and the result is a total of 30 days or longer stay away from the child's home.
This non-MAGI Modified Adjusted Gross Income category is based on institutional deeming rules and processed in EIS Eligibility Information System. The child must have monthly countable income equal to or less than the Special Long Term Care Income Standard and have less than $2,000 in countable resources. See Addendum 1.
Applications from the medical institution:
If a Medicaid application comes from a medical institution and the child is already receiving Medicaid, leave the child on the current case. In this situation, the application is treated as a report of change.
If a Medicaid application comes from a medical institution and does not include information about the parents, default to non-filer rules and determine eligibility using MAGI Modified Adjusted Gross Income rules. The case will be set up in ARIES Alaska's Resource for Integrated Eligibility Services as a child only case.
If a Medicaid application comes from a medical institution and does include information about the parents, attempt to determine eligibility using MAGI Modified Adjusted Gross Income methodology. If the child is not eligible or we are unable to make an eligibility determination because of missing information, determine eligibility for the child only in the non-MAGI Modified Adjusted Gross Income category. Pursue resource information for the child and document this information in the CANO Case Notes. Remember that the DKC Denali KidCare subtypes in EIS Eligibility Information System are programmed not to count resources so if a child has resources in excess of the income limit, the case will need to be manually denied. If eligible, the case will be set up in EIS Eligibility Information System as a child only case and the Denali Kid Care (DKC Denali KidCare) Medicaid subtypes for a single child will be used. The case should be CARC'd to 5-58.
Applications from the parent/caretaker:
If a Medicaid application comes from the child's parent/caretaker and the household is eligible for MAGI Modified Adjusted Gross Income Medicaid, authorize the family together in ARIES Alaska's Resource for Integrated Eligibility Services.
If a Medicaid application comes from the child's parent/caretaker and the household is found to be ineligible for MAGI Modified Adjusted Gross Income Medicaid, the child who has been in a medical institution for more than 30 days must be evaluated for Medicaid eligibility in EIS Eligibility Information System using non-MAGI Modified Adjusted Gross Income methodology. Pursue resource information for the child and document this information in the CANO Case Notes. Remember that the DKC Denali KidCare subtypes in EIS Eligibility Information System are programmed not to count resources so if a child has resources in excess of the resource limit, the case will need to be manually denied. If eligible, the case will be set up in EIS Eligibility Information System as a child only case and the DKC Denali KidCare Medicaid subtypes for a single child will be used. The case should be CARC'd to 5-58.
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