Suspension/Restoration of Benefits for Inmates

MEDI-CAL

Suspension/Restoration of Benefits for Inmates

Release Date

03/01/2018

Section Heading

Purpose

To convert existing policy to new webpage - No content changes

Policy

Effective January 1, 2014, Assembly Bill (AB) 720 amended Senate Bill (SB) 1147, requiring the suspension of Medi-Cal (MC) benefits rather than termination, for all inmates (regardless of age) upon entry into a public institution. Benefits are suspended for up to 12 months or until the inmate is released, whichever occurs first. Additionally, AB 720 requires the restoration of MC benefits on the day the inmate is released from the public institution, if they are released within 12 months of their incarceration date.

Notice of Action (NOA)

A 10-day Discontinuance NOA is not required when suspending benefits for inmates. However, a MC 377 Suspension of Medi-Cal Benefits for an Inmate NOA must be mailed to the beneficiary's household by the date the suspension begins. An adequate and timely notice of action is required for the remaining household members whose benefits are negatively impacted due to the beneficiary’s incarceration.

Background

SB 1147

Effective January 1, 2010, SB 1147 required the suspension rather than the termination of MC benefits for individuals under 21 years of age, who were MC beneficiaries at the time they became inmates of a public institution. SB 1147 also required restoration of MC benefits on the day the beneficiary was released from a public institution.

Definitions

Terms and Descriptions

Inmate

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

Minor

For purposes of this document, “minor” is defined as a person, under the age of 21.

Public Institution

An institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. The following are public institutions:

State or federal prisons;
Correctional facilities;
County, city or tribal jails;
Detention centers;
California Youth Authority (CYA) camps; and
California Department of Corrections and Rehabilitation’s (CDCR), Custody to Community Transitional Reentry Program (CCTRP)/Enhanced Alternative Custody Program (EACP), Female Offender Treatment and Employment Program (FOTEP), or Male Community Reentry Program (MCRP) facilities.

Department of Health Care Services (DHCS)

The State department that administers publicly financed health insurance and safety net programs, including MC.

Probation Detention Juvenile (PDJ) Number

The identification number assigned to a juvenile inmate by the Probation Department for tracking purposes.

Los Angeles County Sheriff’s Department (LASD)

The LASD is the law enforcement agency responsible for daily securing approximately 18,000 inmates in 7 custody facilities (jails) located within Los Angeles County.

Inmate Information Center

The LASD website used to obtain general custody related questions and help with inmate location.

Probation Juvenile Hall

Facility that provides secure housing for both pre-adjudicated and post-disposition wards of the juvenile court. There are currently three halls located in Los Angeles County.

Camp

A Probation residential treatment facility. The camp provides a valuable and cost effective intermediate sanction alternative between probation in the community and incarceration in the CYA. There are 12 camps located throughout Los Angeles County.

CDCR

The CDCR is responsible for the operation of the California state prison and parole systems. They are tasked with maintaining the custody and care of California’s institutionalized public offenders.

Nationwide Prisoner Match (NPM) System

The system that matches MC beneficiary information with the Social Security Administration’s (SSA) Prisoner Update Program System database, which contains data from jails, prisons, and incarceration facilities. DHCS uses the NPM system for the Incarceration Verification Program (IVP).

Department of Health Services (DHS)

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

Requirements

MC benefits must be suspended, rather than discontinued, for all MC beneficiaries entering a public institution regardless of age:

The suspension period is limited to one year from the date of incarceration, or until the date of release, whichever occurs first.
The NOA Suspension of MC Benefits for an Inmate (MC 377) must be mailed to the last known address by the date the suspension begins.
Inmates must comply with the annual renewal process during the suspension period. Failure to meet this requirement will result in termination of benefits and 10-day NOA regulations must be applied.
If an inmate with suspended MC benefits is released before the one year suspension period ends, his/her eligibility must be restored, without a new application, effective the day the inmate is released from the public institution.

Verification Docs

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Attachments

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DPSS ePolicy

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