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MEDICAL SERVICES POLICY MANUAL, SECTION D D-300 State Residency

D-373 Suspension of Medicaid Coverage for an Inmate

 NOTE: Inmates may be approved for retroactive coverage 30 days prior to the date of application in the Adult Expansion Group, if eligible. Retroactive coverage for the Adult Expansion Group is date specific. EXAMPLE: James applies for medical coverage on September 15. He asks for retroactive coverage for a medical bill with an inpatient hospital begin date of August 1. He is not eligible for retroactive coverage on this date because his bill is for August 1 and retroactive coverage can only begin August 16, thirty (30) days prior to the September 15 application date. EXAMPLE: James applies for medical coverage on September 20. He asks for retroactive coverage for a medical bill with an inpatient hospital begin date of September 15. He is eligible for retroactive coverage on September 15, as this date is within the 30 days prior to the application date. D-373 Suspension of Medicaid Coverage for an Inmate MS Manual 07/01/2026 The appropriate correctional facility will notify DHS when a Health Care or Adult Expansion Group recipient enters the ADC, ADCC, the county jail, city jail, or a juvenile detention facility. When this notification is received, DHS will place that individual’s Health Care coverage in suspended status for up to twelve (12) months from the initial approval or most recent renewal. When an individual with suspended Health Care eligibility receives eligible medical treatment off the grounds of the detention facility or is released from custody, the individual’s case will be reopened if the reopen date is within the twelve (12) month period from the individual’s initial approval or most recent renewal. For those individuals receiving eligible treatment while off the correctional facility grounds, Health Care will be reopened for a fixed eligibility period from the date of hospitalization to the date of hospital discharge. The case will be re-suspended following the fixed eligibility period.

D-374 Juveniles Entering Public Institutions MS Manual 07/01/2026 When an “eligible juvenile” becomes an inmate of a public institution and is past their adjudication, they must be provided with coverage for the 30 days before and after their release. This coverage may be through a Medicaid or CHIP category, but must cover at minimum the following services: • Physical and/or behavioral health screenings • Diagnostic Services • Case Management Services