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Example 7: A suspended member submits bank statements showing they are under the resource limit, but it is unknown how the resources were spent down. A 2032 must be sent to verify how the funds were spent. • 03/01 – The Medicaid (MA) is suspended • 03/30 – Verification is received that the member was under the resource limit as of 04/01, but there is no verification showing how the resources were spent down; the resources are updated in the eligibility system • Worker updates the resource but adds a penalty to the TOP screen as unverified • A 2032 is mailed requesting verification of how the funds were spent (due 04/13) • 04/14: o No verifications were submitted, or o Verification that the funds were given away is received • In both scenarios, the worker updates the transfer of property • The Medicaid (MA) is reinstated 04/01 with a transfer of property penalty

2237.05.00 SUSPENSION INCARCERATION/PSYCHIATRIC ADMISSION

When a recipient becomes incarcerated or is admitted to a psychiatric facility that results in ineligibility, the individual’s health coverage should be suspended, not discontinued.3 The case action for either condition is always suspension, provided the incarceration or psychiatric facility stay will last at least 30 days. Health Coverage benefits will be suspended until the member is released from the facility.4 There is no limit on the number of times a recipient can be suspended.

For applications and category changes which require a data gathering interview (refer to 2005.00.00 and 2005.05.15), whenever possible, the interview should occur prior to the individual’s release from the institution. This ensures that individuals will have health coverage at release, if eligible.5 Coverage cannot be reinstated prior to an individual’s release (refer to 2237.10.00).

For incarcerated individuals, the suspension policy applies to all MED categories regardless of the age of the recipient. For information on members in a State Operated Facility, see IHCPPM 1623.00.00.

Incarceration or psychiatric admissions which will last for less than 30 days do not require review of the change in circumstances.

Upon receiving notification that a recipient is institutionalized for at least 30 days, a review of the change in circumstances is required to determine whether the recipient remains eligible in the institution (in the case of psychiatric admission) and what impact there is on other case members and other program eligibility. For children who enter juvenile detention facilities, correctional