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3.6 Inmates

3.6.1 General BadgerCare Plus Application Process for Inmates of State Correctional Institutions

3.6.2 BadgerCare Plus Application Process for Inmates with Multiple Inpatient Admissions

3.6.3 Huber Law

3.6.4 DOC Pre-Release Applications from Offenders

 

 

An inmate is residing in a public institution on an involuntary basis. For example, a prisoner in a jail, prison, or other correctional facility is considered an inmate. A staff person voluntarily residing in a public institution is not considered an inmate. An individual voluntarily residing in an institution while waiting for other living arrangements to be made that are appropriate to the person’s needs is not considered an inmate. An individual who is legally confined to his or her home by a monitoring device, such as an ankle bracelet, is not considered an inmate for the purposes of BadgerCare Plus. Individuals who are inmates of a public institution are not eligible for BadgerCare Plus unless they meet the Huber criteria or the following two exceptions:

3.6.1 General BadgerCare Plus Application Process for Inmates of State Correctional Institutions

Use the following process for inmates of state correctional institutions:

  1. DOC staff submits an ACCESS application, which will be systematically routed to EM CAPO . Superintendents of state correctional facilities (wardens) or their designee may sign the application for the inmate. Refer to the Medicaid Eligibility Handbook, Section 6.9.4 State Correctional Institutions for the list of state correctional facilities at which the warden may sign the application.
  2. Process the inmate as a one-person household with a living arrangement of "01- Independent (Home/Apt/Trlr)" on the Current Demographics page.
  1. If the individual is eligible, close the case in CARES by changing the Healthcare Request page to "N." Suppress CARES-generated notices for Medicaid and any program the individual has not requested. Manually certify the individual with the appropriate medical status code (see Process Help, Section 81.5 Med Stat Code Chart, for a list of medical status codes), from the hospital admission date through the date of discharge. If the individual has not yet been discharged, certify the individual from the date of admission through the estimated discharge date. Send a manual positive notice to DOC indicating the dates of eligibility. Also, if the individual had not been discharged when you sent the initial positive notice, send a manual negative notice with the eligibility end date as soon as that is known. If you issue the notice after the discharge date, the effective date of the termination and the notice should be the date you mail the notice. The reason for the termination should be shown as "Individual is incarcerated." The legal citation should read "DHS 103.03(6)." For situations in which an inmate has multiple inpatient admissions, see Section 3.6.2 BadgerCare Plus Application Process for Inmates with Multiple Inpatient Admissions.

 

Note: It is not necessary to provide a 10-day notice of termination for Medicaid when the reason for termination is the return of the individual to prison. The notice is considered timely if it is mailed no later than the termination effective date.

 

  1. If the individual is ineligible, confirm the denial in CARES, and allow CARES-generated notices to be sent to the designated DOC staff person.

3.6.2 BadgerCare Plus Application Process for Inmates with Multiple Inpatient Admissions

Generally, a new application must be submitted for each inpatient admission for an inmate even if the inmate has already been verified as Medicaid-eligible for a previous inpatient admission.

 

Exception: If an application is pending and an inmate has multiple inpatient admissions prior to the application being approved, then all of those eligibility segments can be certified under one application.

 

Example 1: An inmate enters the hospital on April 5 and is discharged on April 7. An application is submitted on April 7. While the application is being processed, the inmate re-enters the hospital on April 10 and is discharged on April 15. The application is approved on April 16. Both the April 5–7 and April 10–15 inpatient hospital stays can be covered under the application submitted on April 7.

 

Example 2: A pregnant inmate has a pregnancy due date of December 15 and is enrolled in the BadgerCare Plus Prenatal Program with an end date of December 31. The pregnant inmate enters the hospital on December 10 and is discharged on December 11. An application is submitted on December 14 because she was admitted for the delivery of the baby. The application is approved for the December 10 and 11 inpatient hospital stays.

 

For inmates who have already had their eligibility verified and who may have another hospital admission at a later point during the year, not all information will need to be verified (e.g., citizenship, identification). Income will always have to be verified. Any information that needs to be verified will be determined by EM CAPO as the application is being processed.

3.6.3 Huber Law

Huber Law prisoners who are childless adults are not eligible for BadgerCare Plus.

 

Huber Law prisoners who are released from jail to attend to the needs of their families can become eligible for BadgerCare Plus if both the following are true:

 

Huber Law prisoners who are released for a purpose other than attending to the needs of their families are not eligible for BadgerCare Plus. They should be considered absent parents.

 

3.6.4 DOC Pre-Release Applications from Offenders

Upon release from prison, many offenders are eligible for BadgerCare Plus as parents/caretakers or as childless adults. In order to prevent a gap in medical or pharmacy coverage upon the offender’s release, DHS requires consortia and tribal IM agencies to accept telephonic applications for health care from offenders nearing their date of release.

 

Inmates who have a definitive release date may apply for health care benefits by calling their IM agency on or after the 20th day of the month before the month of release. The application must be processed at the time of the initial call. The applicant must be allowed to sign the application telephonically.

 

Eligibility begins the first of the month in which the applicant is released, but providers are prohibited from billing BadgerCare Plus for any services while the applicant is still incarcerated. The first day that a member can receive BadgerCare Plus-covered services is the day of release.

 

Most verification can be obtained through current data exchanges, but if additional verification is needed, the applicant must be given 30 days to provide the verification.  

 

When processing applications from applicants whose only source of income is through employment inside a prison in either DOC or Badger State Industries (BSI) jobs, the worker does not need to verify this income. DHS has already received verification that the maximum possible earnings in these positions are below program limits.

 

Applicants with sources of income in addition to DOC or BSI income are required to verify the income from employment within the prison, in addition to verifying the other income sources.

 

When processing an application, the worker will  verify the reported discharge date using the appropriate resource before requesting verification from the applicant or a DOC staff member. Depending on the facility type, the worker may need to use different resources or websites. See Process Help, Section 9.8 Processing Telephonic HC Applications from Offenders for more information on processing these applications and how to verify release dates.

 

The inmate’s release date may not be up to date. Consider the release date verified if the date reported is within seven calendar days of the applicant’s reported release date.

 

Example 3: Clifford is an inmate near release calling to complete his BadgerCare Plus application on June 3. He states he is being released on Tuesday, June 11. The worker checks the WI DOC Offender Locator site to verify Clifford’s release date. His Mandatory Release/Extended Supervision Date is listed as Saturday, June 15. Since his reported date release date is within seven days of what is listed on the WI DOC Offender Locator site, his release date is verified.

 

A prison or jail staff member may verbally verify the release date of the applicant but do not require a prison or jail staff member to verbally verify the release date or prevent the applicant from completing the telephonic application.

 

 

This page last updated in Release Number: 19-02

Release Date: 09/10/2019

Effective Date: 09/10/2019