State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

3.6 Inmates

 

 

An inmate is residing in a public institution on an involuntary basis. For example, a prisoner in a jail, prison, or other correctional facility is considered an inmate. A staff person voluntarily residing in a public institution is not considered an inmate. An individual voluntarily residing in an institution while waiting for other living arrangements to be made that are appropriate to the person’s needs is not considered an inmate. An individual who is legally confined to his or her home by a monitoring device, such as an ankle bracelet, is not considered an inmate for the purposes of BadgerCare Plus. Individuals who are inmates of a public institution are not eligible for BadgerCare Plus unless they meet the Huber criteria or the following two exceptions:

• Prenatal exception: Pregnant women may apply for and enroll in the BadgerCare Plus Prenatal Program (see Chapter 41 BadgerCare Plus Prenatal Program) while they are inmates.

• Inpatient exception: If an inmate resides outside a public correctional institution for more than 24 hours at any one time, he or she can qualify for BadgerCare Plus during that time period if he or she meets all other eligibility criteria. For example, if an inmate of a public institution is admitted as an inpatient to a medical institution for 24 hours or more and is otherwise eligible, manually certify him or her for BadgerCare Plus from the admission date through the discharge date.

3.6.1 General BadgerCare Plus Application Process for Inmates of State Correctional Institutions

Use the following process for inmates of state correctional institutions:

1. DOCDepartment of Corrections staff submits an ACCESS application, which will be systematically routed to EM CAPO . Superintendents of state correctional facilities (wardens) or their designee may sign the application for the inmate. Refer to the Medicaid Eligibility Handbook, Section 6.9.4 State Correctional Institutions for the list of state correctional facilities at which the warden may sign the application.
2. Process the inmate as a one-person household with a living arrangement of "01- Independent (Home/Apt/Trlr)" on the Current Demographics page.

3. If the individual is eligible, close the case in CARES by changing the Healthcare Request page to "N." Suppress CARES-generated notices for Medicaid and any program the individual has not requested. Manually certify the individual with the appropriate medical status code (see Process Help, Section 81.5 Med Stat Code Chart, for a list of medical status codes), from the hospital admission date through the date of discharge. If the individual has not yet been discharged, certify the individual from the date of admission through the estimated discharge date. Send a manual positive notice to DOC indicating the dates of eligibility. Also, if the individual had not been discharged when you sent the initial positive notice, send a manual negative notice with the eligibility end date as soon as that is known. If you issue the notice after the discharge date, the effective date of the termination and the notice should be the date you mail the notice. The reason for the termination should be shown as "Individual is incarcerated." The legal citation should read "DHS 103.03(6)." For situations in which an inmate has multiple inpatient admissions, see Section 3.6.2 BadgerCare Plus Application Process for Inmates with Multiple Inpatient Admissions.

 

Note: It is not necessary to provide a 10-day notice of termination for Medicaid when the reason for termination is the return of the individual to prison. The notice is considered timely if it is mailed no later than the termination effective date.

 

4. If the individual is ineligible, confirm the denial in CARES, and allow CARES-generated notices to be sent to the designated DOC staff person.

3.6.2 BadgerCare Plus Application Process for Inmates with Multiple Inpatient Admissions

Generally, a new application must be submitted for each inpatient admission for an inmate even if the inmate has already been verified as Medicaid-eligible for a previous inpatient admission.

 

Exception: If an application is pending and an inmate has multiple inpatient admissions prior to the application being approved, then all of those eligibility segments can be certified under one application.

 

Example 1: An inmate enters the hospital on April 5 and is discharged on April 7. An application is submitted on April 7. While the application is being processed, the inmate re-enters the hospital on April 10 and is discharged on April 15. The application is approved on April 16. Both the April 5–7 and April 10–15 inpatient hospital stays can be covered under the application submitted on April 7.

 

Example 2: A pregnant inmate has a pregnancy due date of December 15 and is enrolled in the BadgerCare Plus Prenatal Program with an end date of December 31. The pregnant inmate enters the hospital on December 10 and is discharged on December 11. An application is submitted on December 14 because she was admitted for the delivery of the baby. The application is approved for the December 10 and 11 inpatient hospital stays.

 

For inmates who have already had their eligibility verified and who may have another hospital admission at a later point during the year, not all information will need to be verified (e.g., citizenship, identification). Income will always have to be verified. Any information that needs to be verified will be determined by EM CAPO as the application is being processed.

3.6.3 Huber Law

Huber Law prisoners who are childless adults are not eligible for BadgerCare Plus.

 

Huber Law prisoners who are released from jail to attend to the needs of their families can become eligible for BadgerCare Plus if both the following are true:

• They intend to return to the home.

• They continue to be involved in the planning for the support and care of the minor children.

 

Huber Law prisoners who are released for a purpose other than attending to the needs of their families are not eligible for BadgerCare Plus. They should be considered absent parents.

 

 

 

This page last updated in Release Number: 17-03

Release Date: 08/21/2017

Effective Date: 08/21/2017

---

The information concerning the BadgerCare Plus program provided in this handbook release is published in accordance with: Titles XI, XIX and XXI of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapter 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2 and 101 through 109 of the Wisconsin Administrative Code.

Publication Number: P-10171