A Year Or So Ago, We Made a Change to the Eligibility Rules As They Relate to Persons In

A year or so ago, we made a change to the eligibility rules as they relate to persons in jails/prisons in order to come into compliance with the CMS interpretation of the law. In short, Medicaid beneficiaries in jail/prison now remain eligible, however, they are only eligible for off-site inpatient hospital stays. Prior to this change, MA benes. in jail/prison lost coverage. The restriction on covered services was put into place because the off-site inpatient stay is the only service that we can claim federal match for in regards to this population, per Federal law. They would have a level of care code 32 placed on system that would restrict payment to there afore mentioned off-site inpatient stays. Any other services billed for would be rejected.

Logan Dreasky

Logan Dreasky 5/1/2006

Clients can apply for MA while incarcerated. How this happens depends on the facility and whether or not that facility has any kind of working relationship/contact point with the local office. There are some facilities that have established contact points with the local DHS office (e.g., the Sheriff's Department in OaklandCounty). In most cases, it's in the facilities best interest to assist the woman in any way that they can to apply for MA - since we pay for off-site inpatient hospital stays, it would mean a lesser potential financial burden for the facility - especially local entities like Sheriff's offices and city jails. At any rate, there isn't a simplified application process for incarcerated person's and they must still meet all MA eligibility factors. For a pregnant inmate, I would expect that there wouldn't be much of a problem meeting eligibility criteria. The details are not as clear cut in terms of how an application is made. In a facility that is aware of and taking advantage of the potential for MA eligibility it's probably a facility driven process. In a facility that isn't aware of or isn't taking advantage of the potential MA eligibility, it's a process that would need outside intervention.

If you're in contact with this person, an application could be provided to her - most facilities are all for it since it has the potential to offset some of their costs.

Logan Dreasky

Michigan Department of Community Health

Medical Services Administration

Eligibility Policy Section

400 South Pine Street, 7th Floor

Lansing, Michigan48913

Phone: (517) 241-5414

Fax: (517) 241-8969