home | Senate Bill 913 Implementation Procedure
Special Considerations for Incarcerated Clients (HB 3536)
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.
An inmate is an individual living in a public institution who is:
- Confined involuntarily in a local, state or federal prison, jail, detention facility, or other penal facility, including a person being held involuntarily in a detention center awaiting trial or a person serving a sentence for a criminal offense;
- Residing involuntarily in a facility under a contract between the facility and a public institution where, under the terms of the contract, the facility is a public institution;
- Residing involuntarily in a facility that is under governmental control;
- Receiving care as an outpatient while residing involuntarily in a public institution; or
- In the OSIPM and QMB programs, released from the public institution during a temporary period of hospitalization in a medical institution outside of the correctional facility.
An individual is no longer an inmate when:
- The person is released on parole, probation, or post-prison supervision;
- The person is on home- or work-release, unless the person is required to report to a public institution for an overnight stay; or
- The person is staying voluntarily in a detention center, jail, or county penal facility after his or her case has been adjudicated and while other living arrangements are being made for the individual.
A public institution is any of the following:
- A state hospital (as defined by ORS 162.135) such as the Oregon State Hospital and any other hospital established by law for similar purposes, including the "SAIP" means Secure Adolescent Inpatient Program (SAIP), and the Secure Children’s Inpatient Program (SCIP).
- A local correctional facility (as defined in ORS 169.005): a jail or prison for the reception and confinement of prisoners that is provided, maintained and operated by a county or city and holds persons for more than 36 hours.
- A Department of Corrections institution (as defined in ORS 421.005): a facility used for the incarceration of persons sentenced to the custody of the Department of Corrections, including a satellite, camp, or branch of a facility.
- A youth correction facility (as defined in ORS 162.135):
- A facility used for the confinement of youth offenders and other persons placed in the legal or physical custody of the youth authority, including a secure regional youth facility, a regional accountability camp, a residential academy and satellite, and camps and branches of those facilities; or
- A facility established under ORS 419A.010 to 419A.020 and 419A.050 to 419A.063 for the detention of children, wards, youth, or youth offenders pursuant to a judicial commitment or order.
As used in this rule, the term public institution does not include:
- A medical institution as defined in 42 C.F.R. 435.1009;
- An intermediate care facility as defined in 42 C.F.R. 440.140 and 440.150;
- A publicly operated community residence that serves no more than 16 residents, as defined in 42 C.F.R. 435.1009; or
- A child-care institution as defined in 42 C.F.R. 435.1009 with respect to:
- Children for whom foster care maintenance payments are made under title IV-E of the Social Security Act; and
- Children receiving TANF-related foster care under title IV-A of the Social Security Act.
If this policy indicates that the medical benefits of a client are suspended, a client meeting the eligibility requirements of a program covered under chapter 461 of the Oregon Administrative Rules is not required to submit a new application for the benefits to be reinstated.
Suspended Medicaid cases will remain in suspend status indefinitely. 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 APD 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. The effective date is the date the decision is made to suspend the benefits and the date the notice is sent.
OPAR will be taking the following actions on APD 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 in the mainframe system at the end of 12 months, but the individual will remain in suspended status while they are incarcerated; 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.
Incarcerated clients who are released temporarily in order to receive treatment in a hospital or other medical facility can be eligible for medical benefits during the time that they are temporarily released. 5503 has a reporting process by which inmates who are temporarily released get medical procedures done, and they then determine eligibility for MAGI medical programs. If the temporarily released client is not eligible for MAGI, 5503 will refer the client’s information to APD for a determination of OSIPM or Medicare Savings Programs.
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 Tammy Mazon, 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 Tammy Mazon 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 Eligibility 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. The 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. Contact the Buy-In unit via email (Buy-In.Medicare@dhsoha.state.or.us) and request Part B Buy-In. If the client has maintained Medicare eligibility while incarcerated, QMB can be restarted the beginning of the month following release and no new application is required, SMB/SMF would be restored the first of the month of release. If Medicare eligibility 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.
- DOC case descriptor: Some MAGI CMS cases will have a DOC case descriptor put on the case when the client becomes incarcerated. If you need to convert one of these cases, you will need to get the DOC case descriptor removed. Branch staff are unable to remove this code. If you need to remove the
DOC case descriptor (for instance to change the case to a D4) contact Lauren Mitchell.
Process to susmend cases in local office:
- On the Medical Assistance tab in ACCESS choose incm code of SUSM. Use todays date or date you are going to send the notice. 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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