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DHS home | Senate Bill 913 Implementation Procedure

Special Considerations for Incarcerated Clients (HB 3536)

Updated 10/01/17

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:

 An individual is no longer an inmate when:  

A public institution is any of the following:

As used in this rule, the term public institution does not include:

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

 

See SPD-PT-11-015

Process to susmend cases in local office:

 

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Oregon Department of Human Services
500 Summer St. NE E02, Salem, OR 97301-1073
Phone: (503) 945-5811
Toll-free: (800) 282-8096 (V/TTY)