8111.1 Penal Institutions

See PM2012-09-01, Re: Inpatient Hospital Coverage for Inmates of State Correctional Institutions and PM1999-10-02, Law Enforcement Custody and State Psychiatric Hospital Admissions .

The following provisions apply to an individual in a penal institution:

There is no eligibility for medical assistance [except as indicated in subsection (2) below] for an individual who is: Physically residing in a jail or penitentiary. An accused person or convicted criminal under the custody of the juvenile or adult criminal justice system. A person can receive assistance if there is no indication of custody, or if in a status of: Pardoned. Released on his or her own recognizance. On probation, parole, bail or bond; or Participating in a prison diversion program which is operated by a privately supported facility (i.e., a facility which operates without financial or administrative support from the State). In rare instances a person considered in custody could also be in one of the statuses referenced in this paragraph. Such person could receive assistance. Either the court record or a document in the possession of the client should be available to clearly establish any of these statuses. NOTE : Since "house arrest" is a term used across the state for a variety of situations, this status cannot be used to confirm eligibility requirements. It is only an indication to look for another status in determining eligibility. It is recognized that many clients considered in house arrest will be eligible for assistance as there will be no actual custody indication. Placed in a detention facility. Except as indicated in subsection (2) below, an individual in a detention facility cannot attain status as an inpatient of a medical facility for purposes of medical eligibility. Visits to physicians and other medical practitioners outside a penal institution or transfers to public or private medical facilities do not in any way affect the person's ineligibility for medical coverage. However, if the individual was not actually living in the penal institution prior to transfer to a medical facility, he or she could obtain medical eligibility for the medical stay. Even if the inmate has not been transferred from a prison or other correctional institution (e.g., for a mental examination or because he has been found mentally incompetent to stand trial), he is not considered a patient therein for purposes of medical coverage. However, if the court commitment to a mental institution were to allow a verdict of "not guilty by reason of 'insanity'," the individual is not in custody as an accused person nor as a convicted criminal and so may be entitled to medical coverage (if he is otherwise eligible).

An inmate of a correctional facility administered by the Kansas Department of Corrections (KDOC), or the Kansas Juvenile Justice Authority (JJA) may be eligible for medical assistance to cover inpatient hospital services. No other medical services are covered under this exception. The following provisions apply to this group. An inmate otherwise qualifying for medical assistance to cover inpatient hospital services must meet all non-financial and financial eligibility criteria for the appropriate medical program. For purposes of this provision, an inmate is defined as an individual serving time for a criminal offense or confined involuntarily in a state correctional facility managed by the Kansas Department of Corrections (KDOC) or the Kansas Juvenile Justice Authority (JJA). Inmates in other correctional facilities within the state, such as county or city jails, are not eligible under this policy (see subsection (1) above). Only inpatient hospital services, known as a qualifying event, are covered under this policy. There is no coverage for outpatient care provided outside of the correctional facility or for medical services provided on the premises of the correctional facility An application shall be filed by the inmate with designated correctional facility staff indicated as “facilitator”. All applications will be processed by KDHE-DHCF staff at a central clearinghouse. A supplemental form ( ES- 3100.1a – Qualifying Event ) shall be attached to the initial application for assistance and also submitted any time there is an additional qualifying event within an established 12-month eligibility period (see subsection (c) below). The application and/or qualifying event form shall be filed only after the inmate has been treated and released from the hospital. An application received prior to release shall be held for processing until the date of discharge has been verified. Since these individuals are incarcerated in a non-Medicaid approved correctional facility, eligibility shall be determined using independent living budgeting methodologies. Eligibility shall be determined under the MAGI programs for children (under age 19) and pregnant women, and under the Medically Needy program for adults (over age 18). There is no eligibility for this group under either the state funded MediKan or the CHIP programs. For budgeting purposes, each inmate shall be treated as a household of one. Neither the income nor resources of the parent(s) or spouse of the inmate shall be included in the eligibility determination. Since only the qualifying event is covered, the case shall only be approved for the month(s) of the event. However, once approved for coverage, a 12-month eligibility period shall be established beginning with the month of approval. The case will not be open during the eligibility period, but any new qualifying event which occurs during the eligibility period may be approved without a new application by submitting a completed ES-3100.1a (Qualifying Event) form. Eligibility for the Medicare Savings Programs (QMB, LMB, Expanded LMB) shall not be determined for this population. Nor will the state assume responsibility for the Medicare Part B premium through the normal buy-in process. In addition, pursuit of either SSA/SSI disability or of Medicare Part B is not an eligibility requirement. Inmates eligible under this policy will not receive a medical card. If approved for coverage, the medical ID number will be included on the approval notice with instructions to present the notice to the medical provider for billing. Due to the limited coverage package for this special population, qualifying inmates are not subject to managed care. The covered inpatient hospital services will be paid for under the fee for service plan.

Incarcerated Minors – Federal regulations prohibit states from fully terminating Medicaid or CHIP eligibility for children under the age of 21 and Aged Out Foster Care (AGO) recipients who become inmates of a public institution, i.e., correctional facilities, on or after October 24, 2019. When a Medicaid or CHIP recipient in this category becomes institutionalized in this manner, coverage is suspended vs. terminated, meaning that while coverage is inaccessible while they are in a detained/incarcerated status, it will be reinstated upon their release without a new application being required as long as they remain eligible based on current circumstances. Likewise, if the individual is considered a qualifying youth under the CAA 2023 reentry requirements, they will be eligible for a limited pre-release benefit program, which covers specific services for the 30 days prior to release. Upon release, they will remain eligible and continue on the appropriate full-benefit plan. NOTE : If the child was not released prior to the expiration of the CE/review period, coverage would not be reinstated without a new application or review form. See 8111.3 regarding qualifying youth under the CAA and limited services provided under Medicaid/CHIP in the 30 days prior to release .