SR 16-22 Dated 08/16

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION – Division of Family Assistance (DFA)

SUMMARY

This SR releases changes in Medicaid policy associated with eligibility for:

·  individuals who are, or subsequently become, incarcerated in a correctional facility. Medicaid eligibility is now placed in suspension status during the period of time an individual is incarcerated, provided that the individual meets all other Medicaid eligibility requirements except for being incarcerated; and

·  individuals residing in NH Department of Corrections (DOC) transitional housing units, also referred to as “halfway houses.” The Centers for Medicare and Medicaid Services (CMS) has clarified that if certain conditions are met by a transitional housing unit (THU), then the prohibition of paying for Medicaid covered services for inmates does not apply. The three DOC transitional housing units in NH meet these special CMS conditions. As such, DHHS is not prohibited from paying for Medicaid services for residents in NH DOC transitional housing units if the individual meets all eligibility requirements for the requested category of assistance.

POLICY

Medicaid Eligibility for Incarcerated Individuals

Incarcerated individuals may not receive Medicaid-covered services while incarcerated unless the individual becomes an inpatient in a medical facility. However, incarcerated individuals may still apply for, be determined eligible for, be enrolled in, and renew eligibility for Medicaid if the individual meets all other categorical, non-financial, and financial requirements for the requested medical assistance program except for being incarcerated. The inmate does not have to wait to apply for medical assistance until after an inpatient stay or until the inmate’s release date is approaching; the inmate may apply for medical assistance at any time.

If found eligible, the incarcerated individual’s Medicaid eligibility is placed in suspension status during the period of time the individual is incarcerated. Suspension of Medicaid eligibility during incarceration facilitates access to covered Medicaid services for eligible individuals if the individual becomes an inpatient in a medical facility while incarcerated as well as prior to and after incarceration, and helps ensure a successful transition for the individual following incarceration:

1.    The incarcerated individual’s Medicaid eligibility will still appear in New HEIGHTS as “denied” for Medicaid if the individual newly applies while incarcerated or “terminated” if the individual is a current Medicaid recipient. The following new message will be added to the Notice of Decision (NOD) to explain the situation:  You or someone in your household are incarcerated. During the period of incarceration, we have suspended your Medicaid. This is because Medicaid cannot pay for services for individuals while in a correctional facility except when an inpatient at a medical facility. If you get a letter from us while your Medicaid is suspended, you must do what it asks. You must complete all renewals of your Medicaid while your Medicaid is suspended. Doing both will allow us to lift the suspension of your Medicaid upon your release or if you must get inpatient services at a medical facility during incarceration. If you do not complete your Medicaid renewals, Medicaid will close and you will have to reapply for assistance. Please tell us immediately if your situation changes.

2.    If the incarcerated individual is a current Medicaid recipient or a new applicant in a case in which he or she is the only household member, no other action needs to be taken by the incarcerated individual except that the individual must continue to report all changes in their circumstances and complete his or her periodic Medicaid renewals within renewal timeframes if the inmate is the casehead in their case.

3.    If the incarcerated individual is a current Medicaid recipient in a case with other household members, the incarcerated individual’s Medicaid is placed in suspension status during the time the individual is incarcerated.

-        If the incarcerated individual is not the Casehead in the Medicaid case with other household members and it is a MAGI household, tax filer rules still apply (policy remains unchanged), but joint filer rules now apply. See the NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES AND IMPLEMENTATION section below for more details.

-        If the incarcerated individual is the Casehead in the Medicaid case with other household members, the other household members must be closed and deleted from the case, and the FSS must attempt to contact the household members to reapply for any programs of assistance they were receiving on their own behalf.

Incarcerated individuals enrolled in the Premium Assistance Program (PAP) or NH Medicaid Care Management (MCM), will be terminated from their health plans due to their incarceration and will revert to Medicaid fee-for-service (FFS) if the incarcerated individual requires inpatient services in a medical facility while incarcerated.

Medicaid Eligibility for Individuals Residing in NH DOC Transitional Housing Units

Per CMS, DHHS is not prohibited from paying for Medicaid covered services for residents in transitional housing units (THU) when the THU meets certain requirements and the THU resident meets all eligibility requirements for the requested category of assistance. The following NH Department of Corrections (DOC) THUs meet the special CMS requirements:

·   Calumet Transitional Housing Unit, 126 Lowell Street, Manchester, NH 03104;

·   North End Transitional Housing Unit, 1 Perimeter Road, Concord, NH 03301; and

·   Shea Farm Transitional Housing Unit, 60 Iron Works Road, Concord, NH 03302.

For individuals residing in one of the above transitional housing units, the eligibility worker must choose ‘In Apartment, House, etc’ from the living arrangement drop-down menu. Additionally, residency in one of the above NH DOC THUs does not automatically exempt the individual from PAP or NH MCM, and the individual will be required to pick a Qualified Health Plan (QHP) or MCM plan, if not otherwise exempt, in accordance with current medical assistance eligibility program requirements.

NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES AND IMPLEMENTATION

A new screen entitled ‘Prison Information’ has been added in New HEIGHTS and additional questions were added to the “People” page within NH EASY to capture incarceration dates, the duration of imprisonment for an individual, and the expected release date. The New HEIGHTS screen and NH EASY page also have an option to enter inpatient hospital stay time periods during incarceration, including multiple episodes of inpatient hospital stays during the same period of incarceration. New HEIGHTS has added a new verification field to request verification of inpatient stays if hospitalization dates are entered on this new screen. Failure to verify inpatient stays will result in a Medicaid denial due to incarceration, and the individual will remain in suspended status.

If the inmate does not provide the expected incarceration release date, the FSS must obtain this date from the correctional facility and, if needed, set an expected change. Failure to obtain the expected incarceration release date could cause a system issue should the inmate require an inpatient hospital stay.

If the incarcerated individual is a current Medicaid recipient in a case with other household members, the incarcerated individual’s Medicaid will be placed in a suspended status during the time the individual is incarcerated. If the incarcerated individual is a member of a MAGI household and not the Casehead, tax filer rules apply as it relates to joint filers. These rules will be applied based upon information on the Additional Demographics screen for joint filers.

1.    On the Casehead’s Additional Demographic screen, if “yes” is selected for “Plans to File Jointly,” the FSS must change the response to “No.”

2.    For the question “Joint Filer Living Outside the Home,” the FSS must change the response to “Yes.” This will trigger the Tax Dependent/Joint Filer screen.

3.    On the “Details” tab of the Tax Dependent/Joint Filer screen, the FSS must select the Casehead.

4.    Then go to the MAGI Details tab to enter the joint filer information for the incarcerated individual who is no longer in the household.

As the eligibility worker must choose ‘In Apartment, House, etc’ from the living arrangement drop-down menu for residents in THUs, the “Prison Information” screen will not need to be filled out and a release date is not needed for THU residents. Additionally, if retroactive Medicaid is requested by a THU resident, FSS must confirm THU residency for each retroactive month requested.

If the individual’s living arrangement is changed in New HEIGHTS or NH EASY to or from “in Jail/Prison,” the new Prison Information screen will be scheduled into the driver flow for the prison details to be added or updated.

Note: For any incarcerated individuals as well as individuals residing in NH DOC transitional housing units who are in their own case or who have been identified as the casehead for their case, the eligibility worker must:

·         Go to the “Mailing Address” tab in New HEIGHTS;

·         Go to the ‘Care of Information’ tab and enter the:

-        Facility’s name in the “First” and “Last” name fields. E.g., for Shea Farm Transitional Housing Unit, “Shea” would be entered into the “First” name field and “Farm” would be entered into the “Last” name field;

-        Facility’s address in the address information fields; and

-        The individual’s Inmate ID number into the “Additional Address Information” field. Enter the number as follows: “Inmate ID [plus the actual #].” If this number has not been provided on the application, contact the correctional facility for the information. The inmate will not receive his or her mail without this identifying number.

If “in Jail/Prison” is chosen as the living arrangement for an applicant or recipient, the following new Medicaid suspension reason explanation text (401, Suspended due to incarceration) is populated on the Notice of Decision (NOD) when the only reason the person is ineligible is due to being incarcerated:

You or someone in your household are incarcerated. During the period of incarceration, we have suspended your Medicaid. This is because Medicaid cannot pay for services for individuals while in a correctional facility except when an inpatient at a medical facility. If you get a letter from us while your Medicaid is suspended, you must do what it asks. You must complete all renewals of your Medicaid while your Medicaid is suspended. Doing both will allow us to lift the suspension of your Medicaid upon your release or if you must get inpatient services at a medical facility during incarceration. If you do not complete your Medicaid renewals, Medicaid will close and you will have to reapply for assistance. Please tell us immediately if your situation changes.

If a currently incarcerated individual’s Medicaid has been opened because the individual became an inpatient in a medical facility and the individual’s inpatient hospitalization period has now ended resulting in the individual’s return to the correctional facility, the following new suspension reason after hospitalization text (403, Suspended after hospitalization) is populated on the NOD:

You are an inmate and needed inpatient services at a medical facility. Medicaid cannot pay for services for individuals while in a correctional facility except when an inpatient at a medical facility. You have now returned to the correctional facility. Because of this, we have suspended your Medicaid again. If you get a letter from us while your Medicaid is suspended, you must do what it asks. You must complete all renewals of your Medicaid while your Medicaid is suspended. Doing both will allow us to lift the suspension of your Medicaid upon your release or if inpatient services at a medical facility are again required. If you do not complete your Medicaid renewals, Medicaid will close and you will have to reapply for assistance. Please tell us immediately if your situation changes.

A new monthly report will be generated listing the suspended Medicaid individuals, the RID number, age, and last category of assistance.

With the release of this SR, the living arrangement type ‘Incarcerated Work Release/Home Confinement’ has been removed from the living arrangement drop-down menu in New HEIGHTS and NH EASY. ‘In Apartment, House, etc’ must be chosen from the drop-down menu instead for individuals in these types of living arrangements. The 9 cases that had ‘Incarcerated Work Release/Home Confinement’ selected as the case’s living arrangement were switched over to ‘In Apartment, House, etc’ in a mass change during production deployment.

Individuals residing in a NH DOC transitional housing unit are always considered to be a household size of one (1) because the individual is not living in the community with his or her spouse, children, or relatives. The eligibility worker must link to the individual’s closed case if the individual transitions to this type of living arrangement, or establish a new case in that individual’s name to ensure correct implementation of policy.

POLICY MANUAL REVISIONS

Revised Medical Assistance Manual Topics

PART 175              MEDICAL ASSISTANCE FOR INMATES

Section 175.01       Inmates With an Approaching Release Date

Section 175.03       Inmates Who Become Inpatients in a Medical Facility While Incarcerated

PART 305              INSTITUTIONS

IMPLEMENTATION

Policy in this SR is effective August 29, 2016.

CLIENT NOTIFICATION

If “in Jail/Prison” is chosen as the living arrangement for an applicant or recipient, the following new Medicaid suspension reason explanation text is populated on the Notice of Decision (NOD) that the individual will receive:

You or someone in your household are incarcerated. During the period of incarceration, we have suspended your Medicaid. This is because Medicaid cannot pay for services for individuals while in a correctional facility except when an inpatient at a medical facility. If you get a letter from us while your Medicaid is suspended, you must do what it asks. You must complete all renewals of your Medicaid while your Medicaid is suspended. Doing both will allow us to lift the suspension of your Medicaid upon your release or if you must get inpatient services at a medical facility during incarceration. If you do not complete your Medicaid renewals, Medicaid will close and you will have to reapply for assistance. Please tell us immediately if your situation changes.

If a currently incarcerated individual’s Medicaid has been opened because the individual became an inpatient in a medical facility and the individual’s inpatient hospitalization period has now ended resulting in the individual’s return to the correctional facility, the following new suspension reason after hospitalization text is populated on the NOD that the individual will receive:

You are an inmate and needed inpatient services at a medical facility. Medicaid cannot pay for services for individuals while in a correctional facility except when an inpatient at a medical facility. You have now returned to the correctional facility. Because of this, we have suspended your Medicaid again. If you get a letter from us while your Medicaid is suspended, you must do what it asks. You must complete all renewals of your Medicaid while your Medicaid is suspended. Doing both will allow us to lift the suspension of your Medicaid upon your release or if inpatient services at a medical facility are again required. If you do not complete your Medicaid renewals, Medicaid will close and you will have to reapply for assistance. Please tell us immediately if your situation changes.

No other special client notification is planned.

TRAINING

A live remote training for eligibility workers on the policy released in this SR is scheduled for August 24 and 25, 2016. This training will be recorded for ongoing viewing by anyone who was unable to participate in the live training. NH DOC workers will also be trained on the policy released in this SR in the upcoming months.

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for DFA policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at www.dhhs.nh.gov/DFA/publications.htm, effective October 3, 2016. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Medical Assistance Manual.

DFA/JBV:s