House Bill 3536 Procedures

3/1/12

House Bill 3536 mandates DHS/OHA suspend Medical benefits on any client who is receiving Medicaid and who becomes incarcerated at a local jail. This bill extends the process created under SB913, where benefits of clients who have a severe mental impairment were suspended.

Suspended Medicaid cases will remain in suspend status for up to 12 months. If the client is released within a year, Medicaid will be reinstated if the client is still eligible for assistance, the bill does not extend Medicaid eligibility to an ineligible person. For SPD programs, not all clients will be eligible upon release, even if they are released within the 12 month time frame. Clients who had been receiving Waivered services, may need a new assessment before benefits can be reinstated. If SSA has terminated Medicare benefits, a QMB client would need to provide verification that Medicare has been reinstated before their QMB case can be reopened.

To reduce field staff workload, if OPAR receives incarceration information and the inmate has a projected release date within the current month, OPAR will take no action on the case.

OPAR will be taking the following actions on SPD clients who become incarcerated and who have a release date after the current month. If a case is put into 'Susmend' status it will auto close at the end of 12 months. However, any action taken on the case will re-start the 12 month time frame. If action must be taken on a case in Susmend status, an ACCESS tickler should be set up to remind staff to close the case if the inmate has not been released within 12 months.

OPAR process for incarcerated clients

• Local jails and Department of Corrections (DOC) submit incarceration data to DHS twice a month. The incarceration information is used to identify recipients of SNAP and Medicaid benefits. When a client is identified as receiving SNAP or Medicaid benefits and is incarcerated, OPAR will take the following actions:
  • If there is just one person on the case (either SNAP or Medicaid) OPAR will take action. An exception to this is Medicaid cases coded with case descriptors APD, ICP, NFC, DAN or DDS or cases in pending status. These cases will be referred to Lauren Mitchell, who will contact the financial worker or case manager handling the case. The financial worker or case manager will be responsible for susmending/closing those cases.
  • Medicaid cases will be 'susmended' and SNAP cases will be sent timely notice and closed when appropriate. OPAR will send Medicaid clients an auto generated notice. Click here for copy of notice.
  • OPAR will narrate action taken in ACCESS and field staff will be notified by tickler. Cases, other than OHP, will have 913 case descriptor added. OHP cases will have a DOC case descriptor.
  • If a case has more than one person on the case, it will be referred to Lauren Mitchell who will contact the appropriate field worker.
• Jails will be asked to inform clients who have had their benefits susmended to contact their local office. Inmates must contact the local office within 10 days of their release. If the client has been released within 12 months of incarceration, and contacts the branch within 10 days, take these actions based on the specific type of case:
  • SSI recipient: Client was receiving SSI when they became incarcerated and case has been in susmend status for less than one year. Reopen the case without a new application, and tell the client they need to contact SSA and let SSA know they have been released. Client must provide proof of SSI reinstatement. If proof of reinstatement is not provided, determine eligibility for any other program.
  • Protected Eligiblity Groups: (DAC/Pickle etc). If the case has been in susmend status for less than one year, reopen the case without a new application, and tell the client they need to contact SSA and let SSA know they have been released.Client must provide proof of SSA benefit restoration. If proof of reinstatement is not provided, determine eligibility for any other program.
  • PMDDT client: If the client is released prior to a medical review due date, reopen the case. If the client was incarcerated when the medical review was due, they will need to complete a new application and reapply for PMDDT and be redetermined to meet the disability criteria.
  • QMB/SMB/SMF: SSA does not maintain Medicare Part B eligibility for inmates. Typically an inmate will be released with Part A and no Part B Medicare. If this is the case, restore the case using an MIB 2 code. Have the client contact SSA and request part B be reinstated, when part B has been reinstated change the MIB code to 3. If the client has maintained Medicare eligiblity while incarcerated, QMB can be restarted the beginning of the month following release and no new application is required, SMB/SMF would be restared the first of the month of release. If Medicare eligiblity has ceased completely, the client will need to complete a new application when Medicare has been reinstated. Follow OAR guidelines to determine the effective date for beginning benefits.
  • Service cases: If the client is incarcerated for less than 30 days, the incarceration is not considered a break in services and Medicaid can be restored without a new assessment or a new application. If the client is incarcerated for over 30 days, a new period of care begins and the client will need a new assessment and a new application. 461-001-0030
  • EPD cases: If the client is incarcerated for less than 30 days and can verify continuing employment upon release, restore EPD case. If client is incarcerated less than 30 days and can not verify employment or is incarcerated over 30 days, they would no longer qualify for the EPD program and will need to complete a new application.
  • OHP cases: Reopen the case and process redetermination at regular review period. If client was incarcerated when their redetermination came due, redetermine their eligibility for OHP. If they continue to be eligible, restore the case and update the redetermination date, no new application is required. If they are no longer eligible send continuing benefit decision notice. These cases will have a DOC case descriptor instead of the 913. If you need to remove the
    DOC case descriptor (for instance to change the case to a D4) contact Lauren Mitchell. The DOC case descriptor can not be removed by field staff.

See SPD-PT-11-015

Process to susmend cases in local office:

• On the Medical Assistance tab in ACCESS choose incm code of SUSM. Use effective date that is date of incarceration or todays date if unable to use date of incarceration (or if date of incarceration is not known). Use reason code NI and add a case descriptor of 913. During integration add the notice code of IC. CMS will stay in Susmend status for 12 months, and will auto close at the end of 12 months. The client will have been sent a notice of closure if you use the notice code IC, so no further action is required. If the client is released within the 12 month period, the case can be restored. If any action is taken on the case after it is susmended, it will impact the auto close and you will need to set a tickler and manually close the case in 12 months if the client has not been released.

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Oregon Department of Human Services
500 Summer St. NE E02, Salem, OR 97301-1073
Phone: (503) 945-5811
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