Health Coverage for Inmates

Inmate Re-entry Assistance

Effective September 1, 2015 – (HEA 1269) Before discharge or release from a county jail of an offender incarcerated for at least thirty (30) days, the sheriff, in consultation with the county executive or a person designated by the county executive in the county in which the incarcerated person is located shall assist the offender in applying for Medicaid, if eligible, as the authorized representative as described in IC 11-10-3-7 or as a health navigator under the requirements of IC 27- 19-2-12, so that the offender might be eligible for coverage when the offender is subsequently released from the county jail.

The application that is filed while the individual is incarcerated, if approved, is placed in suspension until their release. The offender is to report their release date to FSSA so their coverage can be activated.   FSSA will then provide notice of request for updated information (income, household composition and income changes).

As an extension of ClaimAid’s services to healthcare providers, ClaimAid Advocates, as Certified Navigators are assisting inmates as their Authorized Representatives in this process as designated by the county sheriff.  The ClaimAid Advocates and county sheriffs have discovered that many inmates are extremely appreciative of the assistance and have received the benefit of health coverage upon release.  The hope and intent is to reduce re-entry into the correctional system.  A large majority of inmates are found to have untreated mental health or/or substance abuse issues which have contributed to their incarceration.

 

In-mate coverage for Inpatient Hospitalization

The Social Security Act Section 1905(a) prohibits Federal Financial Participation (FFP) for medical care or services for any individual who is an inmate of a public institution.

Currently the Medicaid Act provides an exception to the inmate prohibition for federal matching funds.  Medical Institution Exception:

  • Incarcerated individuals who are expected to be hospitalized for a 24 hour period or longer at a medical institution are not considered to be an inmate during that time and can be covered by Medicaid if otherwise eligible.

Effective July 1, 2015 HEA 1269 allows for reimbursement for medical care and services provided by a health care provider, including a hospital, to an inmate for inpatient services.   The state utilizes the Presumptive Eligibility (PE) System to review eligibility and provide payment to hospitals for covered services.

Acute care hospitals that are enrolled as a PE qualified provider (QP) may assist qualifying individuals in certain aid categories to receive temporary coverage until eligibility is determined by FSSA. To normally qualify for PE coverage, applicants may not be incarcerated.  Inmates enrolled through the PE process will not receive a standard benefits package; rather, inmates are eligible for inpatient hospitalization services only.  Claims are submitted and paid through the fee-for-service delivery system. However, the county jail must have a Memorandum of Understanding with FSSA for the QP to be able to file the PE.

Coverage for inpatient hospitalization services is available for one year from PE application date (or notification upon release).  A full application must be filed subsequent to the PE approval or the coverage ends on the last day of the month following the PE application date.

The goal of this program is to reduce the current cost for the correctional institution. The institution is only responsible for the State portion when PE is approved for the inpatient stay of the inmate.

The typical match rate for PE only individuals is:

67% Federal   33% State

HIP newly eligible match rate:

100% Federal     0% State in 2016

90% Federal   10% State in 2020

The inmate must meet the following requirements for PE coverage:

  • Be an inmate from a correctional facility operating under the memorandum of understanding or contract with the Indiana Family and Social Services Administration (FSSA)
  • Not be on house arrest
  • Not be pregnant or admitted for labor and delivery
  • Be admitted for inpatient hospitalization
  • Be under the age of 65
  • Meet all other standard PE requirements

 

ClaimAid can guide the county jail through this process and assist inmates with the full application and enrollment process.  We also offer training to hospital staff on the Inmate PE process and coverage. Call us today at 800.842.4052 for more information.