Medi-Cal Inmate Eligibility Program (MCIEP)

MEDI-CAL

Medi-Cal Inmate Eligibility Program (MCIEP)

Release Date

01/31/2018

Section Heading

Purpose

To convert existing policy to new webpage - No content changes

To release a new policy

Policy

Medi-Cal Inmate Eligibility Program (MCIEP) covers acute inpatient services for eligible state prison and county inmates who receive medical care in a hospital that is located off-grounds of the correctional facility for 24 hours or more. Upon release, the inmate continues to receive coverage under MCIEP until the County re-evaluates ongoing Medi-Cal (MC) eligibility.

Background

Assembly Bill (AB) 1628 (Chapter 729, Statutes of 2010) and Senate Bill (SB) 92 (Chapter 36, Statutes of 2011) authorized the California Department of Corrections and Rehabilitation (CDCR) and Department of Health Care Services (DHCS) to develop a process to maximize Federal Financial Participation (FFP) for the MCIEP for state prison inmates. Additionally, the process granted authority to the California Correctional Health Care Services (CCHCS), in collaboration with DHCS, to act on behalf of the inmate for purposes of applying and determining MC eligibility effective April 1, 2011.

Effective January 1, 2014, Assembly Bill 720 authorized counties to designate an entity or entities to assist county jail inmates with their MCIEP application.

MCIEP enables the State of California to claim federal Medicaid funds for inpatient services provided to MC eligible inmates, if those services are provided off the grounds of the correctional facility.

Definitions

Inmate

For purpose of this document, "inmate" describes an individual who is incarcerated in a public institution for a criminal offense, regardless of age.

Los Angeles County Sheriff's Department (LASD)

LASD is the law enforcement agency operating in designated service areas and are responsible for also managing inmates in seven custody facilities (jails) located within Los Angeles County.

California Department of Corrections and Rehabilitation (CDCR)

CDCR is authorized to maintain the custody and care of California's institutionalized public offenders. CDCR is responsible for the operation of the California State prison and parole systems.

Department of Health Care Services (DHCS)

The State Department that administers publicly financed health insurance and safety net programs, including Medi-Cal.

Department of Health Services (DHS)

An integrated system of providers, clinics and hospitals. DHS provides healthcare to youth in the juvenile justice system, to inmates in County jails, and to a population of children in foster care.

Deemed Eligible

Infants born to mothers, who were eligible to and were receiving MC benefits in the birth month, are Deemed Eligible to Medi-Cal until the end of the month the infant turns one year old.

Former Foster Youth (FFY)

Youth who exited foster care on their 18th birthday or at a later age. The aid code assigned to this group is 4M.

Senate Bill (SB) 87 Process

Requirement that allows the department to use information available from all sources to establish continued MC eligibility, prior to requesting information directly from the applicant/beneficiary.

Requirements

MCIEP

Individuals must meet all eligibility criteria listed below to qualify for MCIEP:

Be an inmate of a County Jail or California State Prison.
Receive inpatient hospital services off-grounds of the correctional facility.
Be hospitalized for at least 24 hours.
Receive allowable inpatient hospital services.
Meet all MC eligibility requirements.

Inmates receiving MCIEP are MC beneficiaries who are not required to reapply for MC. This is considered a change in circumstance, therefore Eligibility staff is required to follow the SB87 process when determining eligibility.

Pregnant MCIEP Inmates

If the pregnant inmate is eligible for and receiving MC under MCIEP at the time of infant's birth, then the infant is automatically deemed eligible for MC without a separate MC application until age one, as long as the infant resides in California.
If the pregnant inmate is not eligible for and not receiving MC under the MCIEP at the time of the infant's birth, then the infant is not deemed eligible. DHCS will submit a Newborn Referral (MC 330) to the MCIEP County Liaison.

Verification Docs

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Attachments

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DPSS ePolicy

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