20-04 Version of 13.2 Covered Services

Individuals who are inmates of a public institution may be eligible for suspended SSI-related Medicaid or Wisconsin Well Woman Medicaid if they otherwise meet eligibility requirements. See Chapter 24 SSI Related Medicaid and Deductibles or Chapter 36 Wisconsin Well Woman Medicaid for information about these programs.

If a member of a different health care program becomes incarcerated, eligibility for that program will be terminated. However, the member will be evaluated for eligibility in a program that can be suspended.

During the suspension, Medicaid will only cover inpatient services received while the member is outside of jail or prison for 24 hours or more.

While enrolled in suspended Medicaid, members are not eligible to enroll in an HMO.

Copay limits still apply to suspended members for any services they receive.

This page last updated in Release Number: 20-04
Release Date: 11/23/2020
Effective Date: 10/24/2020

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030