5035            RESIDENTS OF INSTITUTIONS

5035 A.       DEFINITIONS

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 Skilled Nursing Facility), intermediate care facility (ICF Intermediate Care Facility), intermediate care facility for the mentally retarded (ICF-MR), residential psychiatric treatment center (RTC Residential Treatment Center); 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.  

5035 B.       MEDICAL INSTITUTION

Medicaid eligibility may be available to an individual residing in a medical institution if all eligibility criteria are met.  

5035 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 21 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.  Eligibility ends the month of his or her 22nd birthday or discharge from the facility, whichever occurs first.

• An individual placed in a public facility on a short-term emergency basis pending placement in a living arrangement 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.

5035 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.  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 on temporary furlough,

• Leaves a correctional facility for treatment in an acute care medical facility, or

• Is living outside a correctional facility serving a period of temporary commitment by electronic monitoring.

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 their medical care through the Division of Juvenile Justice (DJJ Division of Juvenile Justice).  

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 is also considered an inmate, and is not eligible for Medicaid.

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 or Denali KidCare 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 DJJ Division of Juvenile Justice.  To verify the release date, the caseworker must contact (in the order given) one of the following individuals:  

1. The Youth Corrections Operations Manager at (907) 261-4335;

2. The State Office Juvenile Probation Officer at (907) 465-2212;

3. The OCS Medicaid Coordinator at (907) 465-3633.

5035 E.       TREATMENT FACILITIES AND HALFWAY HOUSES

Medicaid eligibility may be available to an individual who is not in the custody of the state, but who is residing in a substance abuse treatment facility or a correctional halfway house on contract with the state of Alaska to provide treatment.  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.  These individuals are not in custody of the Department of Corrections.  If there is confusion on the part of an applicant about their custody, verify the applicant's status with the appropriate agency.  

An individual receiving active treatment in a community substance abuse program 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.

5035 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.