Table of Contents. B. Not Incarcerated at the time of application, but released in the same month...3

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1 Table of Contents I. Introduction 1 II. Issuing Benefits..1-2 III. Intake in EIS and ARIES 2 A. Incarcerated at the time of the application EIS MAGI Incarceration Medicaid.3 B. Not Incarcerated at the time of application, but released in the same month EIS MAGI Medicaid..4 C. Not incarcerated at the time of the application, but caseworker becomes aware of the incarceration while processing the application 4 1. EIS MAGI Medicaid..5 IV. Pending Ongoing EIS and ARIES EIS MAGI household and PI incarcerated and loss of contact.6 2. ARIES Loss of contact and correspondence returned 6 V. Medicaid System Issuance Dates 6-7 VI. Ongoing Information Received in EIS and ARIES.7 A. A new certification period Ongoing EIS Information received Ongoing ARIES Information received B. No new certification period Ongoing EIS Information received Ongoing ARIES Information received C. Released from the Correctional Facility Ongoing EIS Information received. Released from correctional facility Ongoing ARIES Information received. Individual released from correctional facility VII. Sending Notices and Correspondence to DOC..23 VIII. Incarceration Notice Verbiage

2 Incarceration Medicaid Process Guide I. INTRODUCTION The Center for Medicare & Medicaid Services (CMS) encourages states to suspend Medicaid benefits rather than terminate eligibility when an individual is incarcerated. This allows federal funding to pay for medical claims for inmates who receive inpatient services in a medical institution. Suspension of Medicaid coverage permits an individual who is incarcerated to be newly enrolled or remain enrolled in the state Medicaid program as Medicaid eligible, while ending benefits for services during incarceration. This temporarily suspends an individual from payment status without terminating them completely from the Medicaid program. While the individual s benefits are suspended, the only claims paid are for inmates who are hospitalized for more than 24 hours in a medical facility. Please note: Although these clients are suspended for regular Medicaid eligibility, their Medicaid does not show as suspended in EIS or in ARIES. To help identify when an individual is incarcerated, both EIS and ARIES have been programmed with new Medicaid subtypes. When an individual is released from the correctional facility during their Medicaid certification period, Medicaid benefits can be reinstated without a new application by changing their subtypes back to regular Medicaid the month that they are released. NOTE: The existing eligibility period should not be extended unless a full redetermination is completed. A simplified application (MED 50), referred as Application for Inmate Inpatient Medicaid Coverage, was created for Department of Corrections (DOC). Department of Corrections submits the MED 50 application to Division of Public Assistance for Medicaid determination when an inmate who does not already have Medicaid benefits is hospitalized in a medical facility for more than 24 hours. The MED 50 application is only utilized by DOC. In addition, DOC will also notify Division of Health Care Services (DHCS) when the inmate is hospitalized to ensure that inpatient medical claims are paid appropriately. II. ISSUING BENEFITS Most incarceration Medicaid cases are processed in EIS. If the individual has an open case in ARIES with other household members, the caseworker will code the incarcerated individual out of the household and open a new incarceration Medicaid case in EIS for the individual. However, if the individual is the PI and the only person on the ARIES case, the caseworker will use the ongoing ARIES case to change the subtype and issue Medicaid Incarceration Process Guide (rev 1/17) Page 1

3 incarceration Medicaid. (Refer to MAGI Medicaid Manual Addendum 3 and ADLTC Addendum 2 for the appropriate Incarceration Medicaid subtypes.) EIS and ARIES do not allow the caseworker to authorize subtypes for specific dates or partial months for incarceration Medicaid cases. Medicaid subtypes are issued for the entire month and only one subtype remains active at a time when issuing Medicaid. Therefore, the caseworker must ensure the appropriate subtype is used for the entire month in order for medical claims to be paid for the days the individual was not incarcerated. The caseworker may be required to issue different Medicaid subtypes for each month separately, depending on the individual s living situation at the time of the application and when the individual was incarcerated. III. INTAKE IN EIS & ARIES New applications for incarcerated individuals are processed in EIS, unless the individual is receiving benefits on an ongoing PI only case in ARIES. In this situation, the caseworker continues to use the ongoing ARIES case to process the application as a report of change. The individual s subtype is changed to incarceration and the existing certification period remains unchanged. If the application is registered in ARIES and not yet processed, and there is no ongoing PI only case, it must withdrawn and worked in EIS. When an application or report of change is received and a household member is identified as incarcerated, the caseworker will make an eligibility determination to ensure that the individual meets all non-financial and financial criteria. If the individual meets all Medicaid eligibility criteria, the case is processed using the appropriate subtype. The application will be denied if the individual does not meet Medicaid eligibility requirements. Depending on the individual s status at the time of the application and the date of incarceration, the application month can be processed either using the incarceration or regular Medicaid subtype. When the case is processed using an incarceration subtype, it remains open until either the individual s certification period ends or the caseworker is notified that they are released from the correctional facility and benefits are re-determined. No medical claims are paid when using an incarceration subtype except when the inmate is hospitalized for more than 24 hours. A. Incarcerated at the time of application If the application has not been processed and the caseworker is aware of all the information, the caseworker determines eligibility month by month, including requested retroactive months. If the individual is incarcerated at the time of the application but not the entire month, regular Medicaid benefits are issued in the application month. However, if the individual is incarcerated the entire application month (or starting from Medicaid Incarceration Process Guide (rev 1/17) Page 2

4 the 1 st of the month to when the application is processed) and remains incarcerated, then the case is processed using the incarceration subtype (i.e. CI, KI, MI, TI, etc ), in the application and subsequent months. 1. EIS - MAGI Incarceration Medicaid If the individual is not incarcerated the entire month, issue regular Medicaid in the application month, if eligible. If the individual remains incarcerated the 1 st of the following month and has not been released from the correctional facility, issue Medicaid with the appropriate incarceration subtype in the 2 nd and subsequent months. Scenario 1: The individual was remanded on 2/13/16. DOC submits an application on 2/23/16 for an inmate who was hospitalized in February and does not have current Medicaid coverage. a. Register the application in EIS b. The address entered is the DOC contact address c. On the MIBW, determine eligibility for regular Medicaid and enter a 12-month cert period from 2/16 thru 1/17. d. Enter PCN and authorize benefits on the MIAU e. Initialize to 3/16 on the APEM or CAMM screen f. Go to the 3/16 MIBW. Update the appropriate incarceration subtype for 3/16. g. Complete CANO including the date the client became incarcerated h. Send notice to the client at the DOC address B. Not Incarcerated at the time application is received. Individual released in the same month. If the individual applies after their release from the correctional facility in the same month, the caseworker processes the application for regular Medicaid benefits and not incarceration. If eligible for retroactive Medicaid, authorize using the appropriate Medicaid subtype. For example, if the individual was incarcerated the entire retro month use the appropriate incarceration Medicaid subtype (i.e. CI, EI, FI, II, KI, MI, NI, TI, XI). If the individual was an inmate then released in the same retro month, use appropriate regular Medicaid subtype (i.e. MX, AF, PR, TO, etc ) to cover unpaid medical expenses for the days the individual was not incarcerated. Medicaid Incarceration Process Guide (rev 1/17) Page 3

5 1. EIS - MAGI Medicaid Example: Individual is not incarcerated at the time of the application, but was released from the correctional facility earlier in the same month. Retroactive Medicaid requested. Scenario 1: On 1/16/16, DOC submits an application for an individual who was remanded on 10/1/15 and released from the correction facility on 1/13/16. DOC requests retroactive coverage for the month of 11/15 when the inmate was hospitalized for 24 hours from 11/15/15 11/16/15. a. Code PI in the household on the SEPA and process application following standard procedure. b. If eligible, authorize regular Medicaid from 1/16 thru 12/16 since individual was not incarcerated at the time of the application. c. Establish retro on the APEM for month 11/15. On the MIBW, use the appropriate incarceration Medicaid subtype since the inmate was incarcerated for the entire retro month. Authorize benefits on the MIAU. d. Complete CANO including the date the client became incarcerated e. Send notice to the mailing address listed on the application. Use the correctional facility address only if the individual is still incarcerated when the application is processed. C. Individual not incarcerated at the time the application is received, but incarcerated at the time application is processed. If the application has not yet been processed and the caseworker is aware of all the information prior to working the case, the caseworker determines eligibility month by month (from the date of application to the current month, including retroactive months). This may require the caseworker to issue different Medicaid subtypes for each month, depending upon the individual s living situation. While processing an application in EIS, the caseworker will need to authorize the new certification period on the MIBW then change the Medicaid subtype for each month accordingly. If the individual applies before they are incarcerated and is eligible for Medicaid in the month, the caseworker issues Medicaid using a regular Medicaid subtype (for example, MX, PR, AF, TO, etc ) in the application month. If the individual is not incarcerated during any subsequent months or was not incarcerated at least one day Medicaid Incarceration Process Guide (rev 1/17) Page 4

6 during the month, regular Medicaid is also issued for those months. This ensures any unpaid medical bills they may have for days when they were not incarcerated can be paid. Note: Incarceration Medicaid is issued when the individual is incarcerated the entire month(s) or remains incarcerated the 1 st day of the following month. 1. EIS - MAGI Medicaid Example: Individual applies for Medicaid prior to incarceration and the caseworker discovers while processing the application the individual is now incarcerated. Scenario: On 12/9/15 the individual submits a GEN 50C. On 2/24/16 as the application is processed, the caseworker becomes aware the individual was incarcerated on 1/29/16. Since the application has not yet been processed, the case is worked month by month. a. Issue 12/15 and 1/16 with regular Medicaid benefits since the individual was not incarcerated during those entire months. Issue 2/16 and ongoing months as incarceration. i. Code PI IN on the SEPA ii. Enter the appropriate address. Use mailing address listed on the application and correctional facility as the residence address. iii. On the MIBW screen, use the appropriate regular Medicaid subtype and enter a cert period from 12/15 thru 11/16. Authorize benefits on the MIAU. iv. Initialize case to 3/16 v. On the MIBW screen, change the subtype to the appropriate incarceration subtype starting 3/16 and enter through the screen vi. CANO information and send notice IV. PENDING ONGOING EIS & ARIES If it is reported that an individual is released from custody and the caseworker does not have sufficient information regarding the individual s situation to determine continued eligibility, a request for verification is sent to the individual. Additional information may also be required if it is found the individual has returned home with other household members. The caseworker should pend for the current address and household Medicaid Incarceration Process Guide (rev 1/17) Page 5

7 composition, as well as any additional information needed regarding other members in the household that may be included on the case. The notice should be sent to the last known address, and if there is no response by the due date or the letter is returned as undeliverable, the case will be closed with adverse action. If a response is received, the caseworker will process the case based on the information provided. 1. EIS Household of one, PI is released and correspondence is returned (loss of contact) because the client hasn t reported a new address a. Current SEPA coding remains as is b. Last known address remains the same c. Send Pend notice to the client at last known address d. Complete CANO on need for verification of new address e. Set an alert for the information due date HH comp/incar info due XX/XX/XX f. If information is not received or notice is returned as undeliverable close the case for loss of contact g. Send loss of contact notice with adverse action for case closure to the last known address 2. ARIES - Ongoing Household of one, PI is released and correspondence is returned (loss of contact) because the client hasn t reported a new address a. Leave last known address remains the same b. Change the incarcerated individual s Household Status verification to Unverified c. Send Request for Verification correspondence requesting current address and living situation to the client s last known address d. If information is not received or notice is returned as undeliverable close the case for loss of contact e. Send loss of contact notice with adverse action for case closure to the last known address V. MEDICAID SYSTEM ISSUANCE DATES A 10-day notice of adverse action is not required to change the Medicaid subtype for an incarcerated individual. If it is too late to end regular Medicaid benefits when the report of the incarceration is acted on because the regular run has already occurred, then the incarceration coding is not changed until the following month. If regular Medicaid Incarceration Process Guide (rev 1/17) Page 6

8 Medicaid benefits have already been issued for the month, then the caseworker moves to the next unpaid month in order to update to the appropriate incarceration subtype. If the caseworker did not act timely to affect the regular Medicaid coverage and benefits have already been issued for that month, the caseworker must look at the next month and so forth. Once regular Medicaid benefits are issued to an ongoing case, the caseworker cannot change the Medicaid subtype until the first of the next month after the caseworker becomes aware of the incarceration. VI. ONGOING INFORMATION RECEIVED IN EIS & ARIES When requested information is received for an ongoing case and the incarcerated individual is eligible for Medicaid, depending on who is in the household and receiving benefits, the caseworker either: 1) changes the Medicaid subtype to incarceration if it s a PI only case; or 2) opens a separate case for the incarcerated individual in EIS with a new certification period if the individual was living with other household members. By changing the Medicaid subtype to incarceration, the caseworker ends the regular Medicaid benefits on the case. A. A new certification period A new certification period is established when a new case is opened for the incarcerated individual. If the individual who is reported incarcerated is already receiving regular Medicaid benefits with other household members, the caseworker codes the incarcerated individual out of the household on the ongoing case. The caseworker will then open a separate case for the incarcerated individual only (as the PI) with a new certification period in EIS. Do not include other family members on the new incarceration case. Once an incarceration case is opened, it will close at the end of the certification period. 1. Ongoing Eligibility in EIS Information received Example 1: - MAGI household of more than one and Spouse or non-pi is incarcerated case is pended and information regarding household is received Scenario: A 26 year old PI and 23 year old spouse are receiving regular Medicaid benefits with MX subtypes and the current certification period is 10/15 through 9/16 on the ongoing case. Medicaid Incarceration Process Guide (rev 1/17) Page 7

9 On 2/15/16, the caseworker becomes aware the spouse was incarcerated on 11/4/15. Pend the case and request information on the household s living situation and status. a. Attempt phone call to PI b. If PI can be contacted, confirm information and move to step (h) for next processing step c. If unable to contact PI follow all the steps listed below (d-g) d. Current SEPA coding remains as is e. Last known address remains the same f. Send Pend notice to the client at last known address g. Set an alert for the information due date HH comp/incar info due XX/XX/XX On 2/19/16, the caseworker receives information on the household s address, living situation and household status. h. On the ongoing case, code Spouse OU on SEPA i. Confirm the current household s address j. Process case as per normal Medicaid processing. Do not extend the certification period unless a full redetermination is completed. k. Complete CANO on household s current situation l. Send notice of change to the household m. Identify if the incarcerated Spouse is still eligible for Medicaid. n. If the incarcerated Spouse is not eligible, no additional steps need to be taken o. If the incarcerated Spouse is eligible for Medicaid, open new Medicaid case with the incarcerated individual as the PI. Register and open a separate case for Spouse as the PI only starting 3/16 in EIS p. Code PI IN on SEPA q. Process case following standard Medicaid procedure r. Enter appropriate address s. Code MIBW with appropriate incarceration coding and authorize a new certification period for 3/16 through 2/17 t. As long as regular Medicaid benefits were not issued for 3/16 on the original case, the caseworker can authorize Medicaid as incarceration on PI s new case. i. If 3/16 regular Medicaid benefits were already issued on the original case, caseworker will use BSD of 4/1/16 and authorize a Medicaid Incarceration Process Guide (rev 1/17) Page 8

10 new 12-month certification period as incarceration on PI s new case from 4/16 3/17. u. Complete CANO on individual s current situation v. Send notice of Medicaid change to last known mailing address Example 2 - MAGI household and PI is incarcerated information regarding household is received but new household is not on Medicaid and does not want to apply for Medicaid. Scenario: Pregnant PI and children are receiving Medicaid through certification period 12/16. A report of change was received on 2/1/16 indicating the PI was incarcerated on 1/4/16. Case was pended and information received 2/10/16. The children are now living with a grandparent who does not want to apply for benefits. a. Code PI as OU on SEPA as of 3/16 b. Leave children coded IN on SEPA c. Allow current Medicaid case to continue through end of children s current CEP of 12/16 d. Complete CANO on household situation and CEP continuing for children e. Send notice of Medicaid change to the existing address on the case f. Register a new MAGI Medicaid case with PI as only person on the case using BSD of 3/1/16 in EIS g. Code PI as IN on new case h. Process case as per usual Medicaid processing i. Use last known mailing address and DOC as the residence address j. Code MIBW with incarceration Medicaid subtype k. Authorize incarceration Medicaid (KI) with a new certification period from 3/16 the month of the estimated due date. l. Complete CANO on household situation and PI s incarceration date m. Send notice of Medicaid change 2. Ongoing Eligibility in ARIES Information received Example 1: Household of more than one, PI becomes incarcerated; request for information is received and we know what happened to the non-pi on the case. If other household members are also receiving Medicaid benefits on the ongoing ARIES case, the caseworker codes the incarcerated individual out of Medicaid Incarceration Process Guide (rev 1/17) Page 9

11 the household, opens a separate PI only case in EIS, and issues a new certification period for the incarcerated individual, if eligible. Scenario: Thirty-nine year old PI is currently receiving regular Medicaid benefits as parent caretaker relative (AF 20) on the ongoing ARIES case. The PI and children s certification period is 9/15 through 8/16. On 1/15/16, the caseworker receives notification the PI was incarcerated on 12/10/15. a. Leave address as the current address reported b. Change the incarcerated individual s Household Status verification field to Unverified c. Send Request for Verification correspondence (add all items needed in the Notes from Caseworker section) to the household at last known address requesting: i. new residence address, ii. household composition and iii. living situation d. If correspondence is not responded to and/or correspondence is returned as undeliverable, close the case for all household members for loss of contact e. Send case closure correspondence to the last known address f. CANO loss of contact as the closure reason On 1/20/16, the information is received regarding the household status. g. In Case Change mode, establish a new CSCD date of 12/10/15 and mark the PI Out of the Household with the absence reason of incarceration on the Person Household Status page. Change Requesting Assistance from YES to NO on Program Request page for PI. Then establish a new CSCD date of 12/10/15 and select Penal Institution on the Living Situation page. h. Depending on the information received about the children, follow steps starting at either l or q prior to running eligibility. Register and open new case for the incarcerated individual in EIS i. Register and open a new case for the incarcerated individual starting 2/16 as the PI only, using DOC as the residence address and last known mailing address. j. Process case per EIS procedure Medicaid Incarceration Process Guide (rev 1/17) Page 10

12 k. Authorize Medicaid as incarceration (MI) with new certification period 2/16 through 1/17 on the MIBW l. CANO information and send M701 notice Children join another existing Medicaid household l. On the Individuals - Person Household Status page, establish a new CSCD date 12/10/15 (or whatever date the children left) and mark the children as Out of the Household and Absence Reason as In Another Home. Change Requesting Assistance from YES to NO on Program Request page for children. (Note: A withdrawal reason may be required on Program Request Details to close the case.) Then establish a new CSCD date and select any other type such as child living with another parent or homeless/homeless shelter on the Living Situation page. There should be a history of the children both in and out on both Person Household Status and Living Situation pages m. Run eligibility, authorize, and close the original case in ARIES n. Add the children to an existing case using Case Change or Redetermination mode o. Process case as per normal Medicaid processing p. If the children have an ongoing CEP, and they are not eligible on the new case, they will continue their existing CEP on the case they just joined. If they join a new home and want continued Medicaid but do not want to reapply q. On the Individual Person Household Status page, establish a new CSCD date 12/10/15 and mark PI as Out of the Household and the Absence Reason is marked as Incarcerated. Change Requesting Assistance from YES to NO on Program Request page for PI. Then establish a new CSCD date 12/10/15 and select Penal Institution on the Living Situation page. r. Leave other household members as living in the household s. Run eligibility and authorize benefits t. Ensure children are still eligible on this case Medicaid Incarceration Process Guide (rev 1/17) Page 11

13 Example 2: Household of more than one, non-pi is incarcerated Scenario: Both PI and Spouse are 22 years old and receive regular Medicaid benefits as Expansion (MX) and the current certification period is 10/15 through 9/16 on the ongoing ARIES case. On 2/15/16, the caseworker becomes aware spouse was incarcerated on11/10/15. a. Attempt phone call to PI i. If PI can be contacted, confirm information and move to step (h) for next processing step ii. If unable to contact PI follow all the steps listed below b. Leave address as the current address reported c. Change Person Household Status for spouse to Out of the Household, the Absence Reason is Incarcerated and Absence Verification is Unverified d. Send Request for Verification correspondence to the PI at last known address e. If correspondence is not responded to or correspondence is returned as undeliverable, close the case of all household members for loss of contact f. Send case closure correspondence to the last known address g. CANO loss of contact closure reason On 2/19/16 the caseworker receives information. Mark the spouse out of the household. Send a correspondence to the household. Notify the household that the spouse s Medicaid benefits will end on the case since we received information the spouse is no longer in the home and now incarcerated. h. Put the case in Case Change mode, unless there is enough information to determine a new certification period for the remaining household members. In that situation, enter the case in Redetermination-Recertification mode. i. On the Individual Person Household Status page, establish a new CSCD date 11/10/15 and mark spouse as Out of the Household and the Absence Reason is marked as Incarcerated. Change Requesting Assistance from YES to NO on Program Request page for spouse. Then establish a new CSCD date 11/10/15 and select Penal Institution on the Living Situation page. Confirm the current household s address. Medicaid Incarceration Process Guide (rev 1/17) Page 12

14 j. Process case as per usual Medicaid processing k. If the incarcerated individual is a parent caretaker, add NCP details to existing case as needed l. Run eligibility and authorize, ending the spouse s coverage 2/29/16. If a full redetermination is completed, a new certification period can be given. m. Case note and send correspondence Open new case with only the incarcerated individual as the PI in EIS n. Register case and use benefit start date of 3/1/16 o. Process case as per EIS procedures p. Enter appropriate mailing and residence address q. Authorize incarceration Medicaid with a new certification period 3/16 through 2/17 on the MIBW r. As long as regular Medicaid benefits were not issued for 3/16 on the original case, the caseworker can authorize Medicaid as incarceration on the PI s new case starting 3/16. s. If 3/16 benefits were already issued as regular Medicaid on the original case, caseworker will use benefit start date of 4/1/16. t. CANO information and send notice B. No new certification period A new certification period is not given when it requires merely changing the subtype to an ongoing PI only case. If the incarcerated individual is the only member in the household, the caseworker changes the subtype from a regular Medicaid to an incarceration subtype (MI, CI, KI, TI, etc ) through the original certification period. The subtype is changed the first month after the caseworker becomes aware of the incarceration, as long as regular Medicaid benefits were not already issued and paid in that month. Otherwise if regular Medicaid benefits were already issued and paid in the month, the caseworker changes the subtype on the next unpaid month, if the individual remains incarcerated. Do not open a new case and issue a new certification period for cases that require merely a subtype change to a PI only case. The incarceration Medicaid case will close at the end of certification period. A new application is required for the individual to receive additional Medicaid benefits. Medicaid Incarceration Process Guide (rev 1/17) Page 13

15 1. Ongoing Medicaid Eligibility EIS Information received Example 1: Ongoing household of one and PI is incarcerated Scenario: PI is receiving regular Medicaid benefits with med subtype MX and the current certification period is 10/15 through 9/16. On 4/1/16, the caseworker becomes aware that the PI was incarcerated on 11/4/15. a. Enter the appropriate mailing and residence address b. Change the subtype on the MIBW with appropriate incarceration code (i.e. CI, KI, MI, TI, etc ). For this example, the incarceration med subtype is MI which starts 5/16 since regular Medicaid benefits were already issued for 4/16 as MX. c. Issue incarceration Medicaid using MI through original certification period 9/16. Do not authorize a new certification period since a new case is not opened. d. Complete CANO including the date the client became incarcerated and change of address e. Send notice of Medicaid change to the client 2. Ongoing eligibility in ARIES Information received Example 1: Ongoing Household of one; PI is receiving Medicaid Scenario: Individual is receiving regular Medicaid benefits under Expansion category (MX) through the current month. Current cert period is 3/16 2/17. On 11/7/16, the caseworker receives a report of change that the client was incarcerated on 6/3/16. Since regular Medicaid benefits were already issued from 6/16 through 11/16 as MX, the caseworker cannot change the subtype to incarceration for those months. Note: Do not open a new case or authorize a new certification period as the caseworker is only changing the Medicaid subtype for a PI only case. Authorize 12/16 as incarceration Medicaid (MI) since 11/16 benefits were already issued as regular Medicaid (MX). Medicaid Incarceration Process Guide (rev 1/17) Page 14

16 a. Enter case under Case Change mode b. On the Living Situation Details page, the current living situation is In Home and CSCD is 12/1/15 c. Change the CSCD date to 6/3/16 (date PI was incarcerated) Note: If the case worker takes action to complete the change in ARIES after adverse action, the incarceration subtype will not change until the month following next month. In this example, if action to change the Living Situation is not done until 11/22/16, the subtype will not change from MX to MI until 01/17. d. Enter 6/3/16 as the date the Client Became Aware. This is the date the client was incarcerated. e. Select living situation type to Penal Institution Medicaid Incarceration Process Guide (rev 1/17) Page 15

17 f. Press Continue to the Person Demographics Summary page g. Use the left navigation to get back to Living Situation Summary page h. Click on the pencil icon. Current living situation is Penal Institution. i. On the Living Situation Details page, a historical record is created. The individual s current living situation is now Penal Institution. (Note: The up and down arrow in the left-hand corner changes from gray to blue indicating there is other Living Situation history. By clicking on the arrow, it takes the caseworker to the previous details. The end date on the previous details automatically changes to 6/2/16 because the new CSCD date of 6/3/16 was entered as Penal Institution.) Medicaid Incarceration Process Guide (rev 1/17) Page 16

18 Previous Living Situation Current Living Situation j. Run eligibility and authorize benefits k. Enter case notes and send correspondence Medicaid Incarceration Process Guide (rev 1/17) Page 17

19 C. Released from the Correctional Facility Once DPA is notified that an individual is released from the correctional facility and receives the pended information regarding the household status and living situation, the caseworker changes the Medicaid subtype from incarceration to regular Medicaid benefits starting back to the first of the month of their release from the correctional facility. If the individual who is released reports living in another household, the caseworker changes the subtype to regular Medicaid benefits and closes the PI only case in EIS or ARIES with adverse action, and adds the person to the other case. 1. Ongoing eligibility in EIS Information Received; individual released from correctional facility. Scenario: An individual is receiving incarceration Medicaid from 7/16 6/17. On 12/15/16 the client reports to DPA that he was released from DOC on 10/6/16. Individual is currently receiving incarceration Medicaid as an inmate (MI) through current month. Medicaid Incarceration Process Guide (rev 1/17) Page 18

20 Change Medicaid subtype from incarceration (MI) to regular Medicaid (MX) starting back to 10/1/16, the first day of the month when the individual is released from the correctional facility. a. Go to the MIBW screen in the month (10/16) the individual was released from DOC and changed the subtype from MI to MX. Then pass the MIAU screen. b. Check the MERE screen to ensure the subtype changed to MX in the correct months Medicaid Incarceration Process Guide (rev 1/17) Page 19

21 c. Enter new address provided by the client d. Complete CANO with date of release e. Send notice of change 2. Ongoing eligibility in ARIES Information received; individual released from correctional facility Scenario: An individual is receiving incarceration Medicaid since 3/16. He was released from the correctional facility on 9/5/16 but the caseworker was notified on 11/2/16. If the individual is eligible for Medicaid, the caseworker changes the subtype from incarceration to a regular Medicaid subtype starting 9/1/16. Individual is currently receiving incarceration Medicaid as an inmate (MI) through current month. On 11/2/16, the caseworker becomes aware that the individual is no longer incarcerated and was released on 9/5/16. The caseworker receives information from the individual regarding new address and living situation. PI continues to be the only person in the household. Change Medicaid subtype from incarceration (MI) to regular Medicaid (MX) starting back to 9/1/16. Medicaid Incarceration Process Guide (rev 1/17) Page 20

22 a. Enter case under Case Change mode b. Change address based on information provided by the individual after release c. On Living Situation Details page, change the CSCD to 9/1/16 d. Select living situation type as In Home e. Press Continue f. Return to the Living Situation Details page and click on blue arrow to preview the previous and current details. i. Previous CSCD is 12/1/15 ii. End Date is 8/31/16 iii. Living Situation type is Penal Institution iv. Current CSCD is 9/1/16 v. End Date is (none) vi. Living Situation type is In Home Previous Living Situation Medicaid Incarceration Process Guide (rev 1/17) Page 21

23 Current Living Situation g. Run wrap-up and authorize benefits. Generate manual coupon for months 9/16 11/16 on the Medical Insurance Manual Issuance page to reissue benefits as MX since the client was released 9/5/16 and is no longer incarcerated. h. Case note and send notice of change to the individual. Notify the client that the Medicaid benefits are reinstated starting 9/1/16 since they are no longer incarcerated and will continue through the original certification period. Medicaid Incarceration Process Guide (rev 1/17) Page 22

24 VII. Sending Notices/Correspondences to DOC The caseworker must document the date of incarceration in the case notes. Send the notice to the mailing address the individual provided at the time of the application. If the individual is incarcerated, use the correctional facility as the residence address. Individuals must report all address changes to DPA once they are released from the correctional facility. If the correctional facility address is unknown, use the following address: c/o Dept. of Corrections 550 W. 7 th Ave. Ste Anchorage, AK Do not send any notices or correspondences that contain information regarding other household members to DOC or the correctional facility. VIII. INCARCERATION NOTICE VERIBAGE Include the following information when sending correspondence and notices on incarceration Medicaid cases. A general correspondence will need to be used. Refer to 1. Approval of inmate application (N011) Your application for Medicaid benefits was received on XX/XX/XXXX. You are not eligible for Medicaid benefits while you are incarcerated. Since Medicaid can pay for some of the hospital expenses when an inmate is hospitalized for more than 24 hours, your Medicaid benefits will be put into a suspension status until either we are notified of your release from custody or your certification period ends, whichever comes first. This action is supported by 42 CFR Change to inmate subtype (M701) Add text: We received notification that you are now incarcerated. You are not eligible for Medicaid benefits while you are incarcerated. Since Medicaid can pay for some of the hospital expenses when an inmate is hospitalized for more than 24 hours, your Medicaid benefits will be put into a suspension status starting XX/XX/XX. Your Medicaid benefits will also be suspended for the entire month you were incarcerated. This suspended status Medicaid Incarceration Process Guide (rev 1/17) Page 23

25 will continue until either we are notified of your release from custody or your certification period ends, whichever comes first. This action is supported by 42 CFR Closure at end of certification (N011) Your suspended Medicaid benefits are ending XX/XX/XXXX as your certification period is over and we have not been notified that you have been released from custody. You are not eligible for Medicaid benefits while you are incarcerated. Please apply with a new application if Medicaid benefits are needed. This action is supported by 42 CFR Medicaid Incarceration Process Guide (rev 1/17) Page 24