3.1.9 INMATES

3.1.9.1 Inmates of  State Correctional Institutions

3.1.9.2 State Correctional Institutions

Individuals who are inmates of a public institution are not eligible for Medicaid, with two exceptions.  An inmate who 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 which are appropriate to the person’s needs is not considered an inmate.

“Public institution” means an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.  The term “public institution” does not include a medical institution (5.8.1), a publicly operated community residence that serves no more than 16 residents, or a child care institution in which foster care maintenance payments are made under title IV-E.

Note:  The following are not publicly operated community residences, even though they may accommodate 16 or fewer residents:  
 

1. Residential facilities located on the grounds of, or immediately adjacent to, any large institution or multiple purpose complex, or
    

2. Correctional or holding facilities for individuals who are prisoners, have been arrested or detained pending disposition of charges, or are held under court order as material witnesses or juveniles.

Inmates are ineligible for Medicaid services on any day in which they are residing in a public institution.  Providers are prohibited from receiving payment for any services rendered to an inmate even if the inmate is still certified as eligible for Medicaid and has not received any negative notice.  Inmates may never be considered temporarily absent from a household and receive Medicaid benefits.  Temporary absence policies do not apply in the case of inmates.

The two exceptions to the inmate rule are:

1. Pregnant women may apply for and receive BCPP (5.7.11) while they are an inmate.
    

2.  If an inmate resides outside of a public correctional institution for more than 24 hours at any one time, s/he can qualify for MA during that time period if s/he 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/her for MA from the admission date through the discharge date.

Procedures for processing inmates of state facilities are covered in 3.1.9.1.

3.1.9.1 Inmates of  State Correctional Institutions

Use the following process for inmates of state correctional institutions:

1. Department of Corrections ( DOC ) staff submits a paper application ( HCF 10100 or HCF 10101 ).   The mailing address for the inmate will be the DOC central office.  Superintendents of state correctional facilities ( Wardens ) may sign the application for the inmate.  Refer to 3.1.9.2 for the list of state correctional facilities at which the Warden may sign the application.
    

2. Process the inmate as a one-person household and code ANLA with a living arrangement of “01- Independent (Home/Apt/Trlr)”
    

3. If the inmate is between the ages of 19 and 64, and is  not a pregnant woman, DOC will submit a Medicaid  Disability Application ( HCF 10112 ) along with the MA application ( HCF 10100 or HCF 10101 ).  Forward the disability application to the Disability Determination Bureau ( DDB ), even if there is no Confidential Information Release Authorization – Release to Disability Determination Bureau form ( HCF 14014 ) signed by the inmate, and pend the MA application in CARES Client Assistance for Re-employment & Economic Support until a disability determination has been made.  If the disability determination is not made within the 30-day processing period, send a manual notice to the designated DOC staff person that the MA eligibility determination has been delayed because additional information is needed.

Note: In many cases a Confidential Information Release Authorization – Release to Disability Determination Bureau form ( HCF 14014 ) will not be necessary for DDB to obtain medical information from DOC.  If a release is necessary, DDB will obtain it from DOC.

4. If the client is eligible, close the case in CARES by changing the request on ACPA for MA to “N”.  Suppress CARES generated notices for MA and any program the client has not requested.  Manually certify the inmate with the appropriate medical status code (see below), from the hospital admission date through the date of discharge.  If the client has not yet been discharged, certify the client from the date of admission through the estimated discharge date.  Send a manual positive notice to DOC indicating the dates of eligibility.

Note:  It is not necessary to provide a ten-day notice of termination for MA when the reason for termination is the return of the inmate to prison.

5. If the client is ineligible, confirm the denial on CARES, and allow CARES generated notices to be sent to the designated DOC staff person.

3.1.9.2 State Correctional Institutions

Brown

Institutions Green Bay Correctional Institution

Sanger Powers Correctional Institution

Chippewa

Highview Correctional Institution

Stanley Correctional Institution

Columbia

Columbia Correctional Institution

Crawford

Prairie du Chien Correctional Facility ( Division of Juvenile Corrections )

Dane

Oakhill Correctional Institution

Oregon Correctional Institution

Thompson Correctional Institution

Dodge

John Burke Correctional Center

Dodge Correctional Institution

Fox Lake Correctional Institution

Waupun Correctional Institution

Douglas

Gordon Correctional Center

Fond du Lac

McNaughton Correctional Center

Taycheedah Correctional Institution

Grant

Supermax Correctional Institution

Jackson

Black River Correctional Institution

Jackson Correctional Institution

Kenosha

Kenosha Correctional Center

Lincoln

Lincoln Hills School ( Division of Juvenile Corrections )

Milwaukee

Marshall Sherrer Correctional Center

Milwaukee Secure Detention Facility

Milwaukee Women’s Correctional Facility

Felmers O’Chaney Correctional Center

Racine

Robert Ellsworth Correctional Center

Racine Correctional Institution

Racine Youthful Offender Correctional Facility

Southern Oaks Girls School

St. Croix

St. Croix Correctional Center

Sauk

New Lisbon Correctional Center

Sawyer

Flambeau Correctional Center

Sheboygan

Kettle Moraine Correctional Institution

Waukesha

Ethan Allen School ( Division of Juvenile Corrections )

Waushara

Redgranite Correctional Institution

Winnebago

Drug Abuse Correctional Center

Oshkosh Correctional Institution

Winnebago Correctional Center

Wisconsin Resource Center ( Department of Health and Family Services)

This page last updated in Release Number : 06-03

Release Date : 09/15/06

Effective Date : 01/01/06