514           RESIDENTS OF INSTITUTIONS

514 A.      DEFINITIONS

Inmate:  An individual who isIndividualized 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

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 hospitals, nursing facilities (SNFSkilled Nursing Facility), intermediate care facilities (ICF ), intermediate care facility for the Intellectually Developmentally Disabled (ICF/IDDIntermediate Care Facility for the Intellectually Developmentally Disabled); residential psychiatric treatment centers (RPTCResidential 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.

Exceptions:

• An individual age 65 or older receiving active treatment in an institution for mental disease, such as in the Alaska Psychiatric Institute (API) may be Medicaid eligible providing he or she has continuously resided in an inpatient psychiatric hospital since being determined Medicaid eligible;
   
• An 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
   
• An individual living in a public facility may be Medicaid eligible providing he or she is there solely in order to receive educational or vocational training, such as in Mt. Edgecumbe High School.

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 DOCDepartment 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.

Applications:

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.

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 "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.

EXAMPLE:  

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 OCSOffice of Children's Services Title IV-E children in DJJDivision of Juvenile Justice custody will continue to be processed by OCSOffice of Children's Services in EISEligibility Information System.  

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 DJJDivision 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, a caseworker may authorize eligibility for the child up to three working days prior to the release date, provided the release date is verified by DJJDivision of Juvenile Justice.  To verify the release date, the caseworker 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 OCSOffice 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 (CRCCommunity Residential Center).  Individuals are considered to have freedom of movement if all three of the following criteria are met:

1. The individual can work outside the CRCCommunity Residential Center in employment available to individuals who are not under justice system supervision; and
    
2. The individual can use community resources such as libraries, grocery stores, recreation, education, etc. at will; and
    
3. 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 CRCCommunity Residential Center may or may not have freedom of movement.  Do not attempt to verify freedom of movement by calling the CRCCommunity Residential Center directly.  the CRCCommunity Residential Center's are not staffed by Department of Corrections (DOCDepartment of Corrections) employees and only DOCDepartment 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 CRCCommunity Residential Center address, the Eligibility Technician must send an email to doc.idodoc@alaska.gov in order to verify if the individual is confined or on a furlough placement.  Please reference Addendum 6 for a list of CRCCommunity Residential Center addresses.  When sending the email to DOCDepartment of Corrections, the subject line should state "CRCCommunity 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 CRCCommunity Residential Center is eligible for limited inmate Medicaid benefits but an incarcerated individual who has freedom of movement in a furlough placement at a CRCCommunity 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.

EXAMPLE:

Alison applies for Medicaid on 07/03/2017.  When processing the application, the caseworker 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 MAGIModified Adjusted Gross Income Medicaid and has resided in the residential treatment facility for more than 30 days, eligibility may be determined in the Special LTCLong Term Care category explained in ADLTC MS 550(C).

If the hospitalized child is determined eligible for the Special LTCLong Term Care category, their effective date of eligibility is retroactive to the first day of the 30-day period of institutionalization.

Example:

A child who is not receiving Medicaid was hospitalized on May 14.  We received a Medicaid application for the child on June 22, after the child had been in the hospital for more than 30 days.  The child is ineligible for MAGIModified Adjusted Gross Income Medicaid due to parental income so the caseworker must determine the child's eligibility for the Special LTCLong Term Care category.  An interview is completed and all factors of eligibility are checked, including resources.  If determined eligible, Medicaid eligibility in the Special LTCLong Term Care category would start May 1.

When determining the child's eligibility for Medicaid in the Special LTC category, the child is considered to be living independently of his or her parents when the child has:

1. Not lived in the home of the child's parent(s) for at least 30 days immediately preceding the date of application; or
    
2. 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
    
3. 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 Health Management Systems (HMS).  Contact hss.dpa.policy@alaska.gov 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.

The Special LTCLong Term Care category is processed in EISEligibility Information System.  The child must have monthly countable income equal to or less than the Special LTCLong Term Care Income Standard and have less than $2,000 in countable resources.  See Addendum 1.

Processing Note:

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 MAGIModified Adjusted Gross Income rules.  The case will be set up in ARIESAlaska'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 MAGIModified 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 Special LTCLong Term Care category.  Pursue resource information for the child and document this information in the CANOCase Notes. Remember that the DKCDenali KidCare subtypes in EISEligibility 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 EISEligibility Information System as a child only case and the Denali Kid Care (DKCDenali 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 MAGIModified Adjusted Gross Income Medicaid, authorize the family together in ARIESAlaska'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 MAGIModified Adjusted Gross Income Medicaid, the child who has been in a medical institution for more than 30 days must be evaluated for the Special LTCLong Term Care category. Pursue resource information for the child and document this information in the CANOCase Notes.  Remember that the DKCDenali KidCare subtypes in EISEligibility 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 EISEligibility Information System as a child only case and the DKCDenali KidCare Medicaid subtypes for a single child will be used.  The case should be CARC'd to 5-58.