6.9 Inmates

6.9.1 Definitions

An inmate is a person 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. A person voluntarily residing in an institution while waiting for other living arrangements to be made that are appropriate to his or her needs is not considered an inmate.

A public institution is an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. A public institution does not include a medical institution (see Section 27.1 Institutions), 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:

Residential facilities located on the grounds of, or immediately adjacent to, any large institution or multiple purpose complex.
Correctional or holding facilities for people who are prisoners, have been arrested or detained pending disposition of charges, or are held under court order as material witnesses or juveniles.

6.9.2 Introduction

People who are inmates of a public institution are not eligible for Medicaid, with two exceptions (outlined below). An inmate is a person 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 person voluntarily residing in an institution while waiting for other living arrangements to be made which are appropriate to his or her needs is not considered an inmate.

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.

Individuals who are inmates of a public institution are not eligible for Medicaid with the following two exceptions:

Prenatal Exception: Pregnant women may apply for and receive BadgerCare Plus Prenatal Program benefits while they are an inmate.
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 Medicaid 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 Medicaid from the admission date through the discharge date.

Procedures for processing inmates of state facilities are covered in 6.9.3 Inmates of State Correctional Institutions below.

6.9.3 General Medicaid Application Process for Inmates of State Correctional Institutions

Use the following process for inmates of state correctional institutions:

DOC staff submits an application using ACCESS, which will then be systematically routed to EM CAPO. Superintendents of state correctional facilities (wardens) or their designee may sign the application for the inmate. Refer to Section 6.9.5 State Correctional Institutions for the list of state correctional facilities at which the warden may sign the application.
Process the inmate as a one-person household with a living arrangement of “01 – Independent (Home/Apt/Trlr)” on the Current Demographics page.
If the inmate is 65 years old or older or ineligible for BadgerCare Plus due to excess income, collect asset information from DOC and test for EBD .
1. If the inmate ineligible for BadgerCare Plus is younger than 65 years old and if there is no disability determination on file, instruct DOC to submit a Medicaid Disability Application (F-10112) along with the Medicaid application (F-10101 or through ACCESS) and the Authorization to Disclose Information to Disability Determination Bureau form (F-14014). Suppress the verification checklist for the Medicaid Disability Application.
2. If the inmate is 65 years old or older, instruct DOC to submit the Medicaid application (F-10101 or through ACCESS).

If the individual is eligible, close the case in CARES by changing the Health Care Request page to “N.” Suppress CARES-generated notices for Medicaid and any program that the person has not requested. Manually certify the person 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 person has not yet been discharged, certify the person from the date of admission through the estimated discharge date. Send a manual positive notice to DOC indicating the dates of eligibility. For situations in which an inmate has multiple inpatient admissions, see Section 6.9.4 Medicaid 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 a person to prison.

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

6.9.4 Medicaid 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.

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

6.9.5 State Correctional Institutions

Brown

Green Bay Correctional Institution (GBCI)

Sanger Powers Correctional Institution (SPCI)

Chippewa

Chippewa Valley Correctional Treatment Facility (CVCTF)

Stanley Correctional Institution (SCI)

Columbia

Columbia Correctional Institution (CCI)

Crawford

Prairie du Chien Correctional Institution (PDCI)

Dane

Oakhill Correctional Institution (OCI)

Oregon Correctional Center (OCC)

Thompson Correctional Center (TCC)

Mendota Juvenile Treatment Center (MJTC)

Dodge

John Burke Correctional Center (JBCC)

Dodge Correctional Institution (DCI)

Fox Lake Correctional Institution (FLCI)

Waupun Correctional Institution (WCI)

Douglas

Gordon Correctional Center (GCC)

Fond du Lac

McNaughton Correctional Center (MCC)

Taycheedah Correctional Institution (TCI)

Wisconsin's Women Correctional System (WWCS)

Grant

Wisconsin Secure Program Facility (WSPF)

Jackson

Black River Correctional Center (BRCC)

Jackson Correctional Institution (JCI)

Kenosha

Kenosha Correctional Center (KCC)

Lincoln

Lincoln Hills School (LHS)

Milwaukee

Marshall E. Sherrer Correctional Center (MSCC)

Milwaukee Secure Detention Facility (MSDF)

Milwaukee Women’s Correctional Center (MWCC)

Felmers O. Chaney Correctional Center (FCCC)

Racine

Robert E. Ellsworth Correctional Center (RECC)

Racine Correctional Institution (RCI)

Racine Youthful Offender Correctional Facility (RYOCF)

St. Croix

St. Croix Correctional Center (SCCC)

Sauk

New Lisbon Correctional Institution (NLCI)

Sawyer

Flambeau Correctional Center (FCC)

Sheboygan

Kettle Moraine Correctional Institution (KMCI)

Waushara

Redgranite Correctional Institution (RCI)

Winnebago

Drug Abuse Correctional Center (DACC)

Oshkosh Correctional Institution (OSCI)

Winnebago Correctional Center (WCC)

Wisconsin Resource Center (WRC)

This page last updated in Release Number: 16-01

Release Date: 06/10/2016

Effective Date: 02/15/2016