6.9 Inmates

6.9.3 Inmates of State Correctional Institutions

6.9.1 Definitions

An "inmate" is a person 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 which are appropriate to the person’s needs is not considered an inmate.

“Public institution” means an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. The term “public institution” does not include a medical institution (see Section 27.1 Institutions), a publicly operated community residence that serves no more than 16 residents, or a child care institution in which foster care maintenance payments are made under title IV-E.

Note: The following are not publicly operated community residences, even though they may accommodate 16 or fewer residents:

Residential facilities located on the grounds of, or immediately adjacent to, any large institution or multiple purpose complex, or
Correctional or holding facilities for individuals who are prisoners, have been arrested or detained pending disposition of charges, or are held under court order as material witnesses or juveniles.

6.9.2 Inmates Introduction

Individuals who are inmates of a public institution are not eligible for Medicaid, with two exceptions (outlined below). An inmate is a person who 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 which are appropriate to the person’s needs is not considered an inmate.

Inmates are ineligible for Medicaid services on any day in which they are residing in a public institution. Providers are prohibited from receiving payment for any services rendered to an inmate even if the inmate is still certified as eligible for Medicaid and has not received any negative notice. Inmates may never be considered temporarily absent from a household and receive Medicaid benefits. Temporary absence policies do not apply in the case of inmates.

Individuals who are inmates of a public institution are not eligible for Medicaid, with the following two exceptions:

Prenatal Exception - Pregnant women may apply for and receive BCPP while they are an inmate.
Inpatient Exception - If an inmate resides outside of a public correctional institution for more than 24 hours at any one time, he or she can qualify for Medicaid during that time period if he or she meets all other eligibility criteria. For example, if an inmate of a public institution is admitted, as an inpatient to a medical institution for 24 hours or more, and is otherwise eligible, manually certify him or her for Medicaid from the admission date through the discharge date.

Procedures for processing inmates of state facilities are covered in 6.9.3 Inmates of State Correctional Institutions below.

6.9.3 Inmates of State Correctional Institutions

Use the following process for inmates of state correctional institutions:

DOCDepartment of Corrections 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 Section 6.9.4 State Correctional Institutions for the list of state correctional facilities at which the Warden may sign the application.
Process the inmate as a one-person household with a living arrangement of “01- Independent (Home/Apt/Trlr)” on the demographics page.
If the inmate is 65 years or older or ineligible for BadgerCare Plus due to excess income, test for EBD, collecting asset information from DOC. If there is no disabilityThe law defines disability for Medicaid as "The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." determination on file, instruct, DOC to submit a Medicaid Disability Application (F-10112) along with the Medicaid application (F-10101). Suppress the verification checklist for the MADAMedicaid — Disability Application.

If the individual is eligible, close the case in CARES by changing the Health Care 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 below), 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.

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.

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

For a list of Med Stat Codes, see Process Help Section 81.5 Med Stat Code Chart.

6.9.4 State Correctional Institutions

Brown

Green Bay Correctional Institution (GBCI)

Sanger Powers Correctional Institution (SPCI)

Chippewa

Chippewa Valley Correctional Treatment Facility (CVCTF)

Stanley Correctional Institution (SCI)

Columbia

Columbia Correctional Institution (CCI)

Crawford

Prairie du Chien Correctional Institution (PDCI)

Dane

Oakhill Correctional Institution (OCI)

Oregon Correctional Center (OCC)

Thompson Correctional Center (TCC)

Mendota Juvenile Treatment Center (MJTC)

Dodge

John Burke Correctional Center (JBCC)

Dodge Correctional Institution (DCI)

Fox Lake Correctional Institution (FLCI)

Waupun Correctional Institution (WCI)

Douglas

Gordon Correctional Center (GCC)

Fond du Lac

McNaughton Correctional Center (MCC)

Taycheedah Correctional Institution (TCI)

Wisconsin's Women Correctional System (WWCS)

Grant

Wisconsin Secure Program Facility (WSPF)

Jackson

Black River Correctional Center (BRCC)

Jackson Correctional Institution (JCI)

Kenosha

Kenosha Correctional Center (KCC)

Lincoln

Lincoln Hills School (LHS)

Milwaukee

Marshall E. Sherrer Correctional Center (MSCC)

Milwaukee Secure Detention Facility (MSDF)

Milwaukee Women’s Correctional Center (MWCC)

Felmers O. Chaney Correctional Center (FCCC)

Racine

Robert E. Ellsworth Correctional Center (RECC)

Racine Correctional Institution (RCI)

Racine Youthful Offender Correctional Facility (RYOCF)

St. Croix

St. Croix Correctional Center (SCCC)

Sauk

New Lisbon Correctional Institution (NLCI)

Sawyer

Flambeau Correctional Center (FCC)

Sheboygan

Kettle Moraine Correctional Institution (KMCI)

Waushara

Redgranite Correctional Institution (RCI)

Winnebago

Drug Abuse Correctional Center (DACC)

Oshkosh Correctional Institution (OSCI)

Winnebago Correctional Center (WCC)

Wisconsin Resource Center (WRC)

This page last updated in Release Number: 14-01

Release Date: 05/01/14

Effective Date: 04/01/14