Individuals Covered (Coverage for Inmates Receiving Inpatient Care in Certain Medical Institutions) 510-05-35-95-05-15

(Revised 1/1/2025 ML #3916 )

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Inmates of a public institution for whom Medicaid eligibility is suspended are eligible for payment of their Medicaid-covered services received while an inpatient in one of the following Medical Institutions for a 24-hour period or longer:

A hospital,

A nursing facility (nursing home),

A Psychiatric Residential Treatment Facility (PRTF),

An Intermediate Care Facility for the Intellectually Disabled (ICF-ID),

The inmate must apply for and meet all other Medicaid factors of eligibility.

Individuals who are aged or disabled will have their eligibility determined based on Non-ACA Medicaid Policy defined in Manual Chapter 510-05.

Note #1 : Individuals who become incarcerated will have their Social Security and SSI benefits terminated by the Social Security Administration. However, these individuals continue to be considered disabled for Medicaid purposes.

Note #2: Individuals who are under age 65, disabled, and do not have Medicare coverage, who fail the asset limits, can have their eligibility determined under ACA Medicaid.

Eligibility begins on the date the inmate is admitted as an inpatient in a medical institution and ends the day they are discharged from the medical institution. Any services received before the inmate is admitted into a medical institution, or after the inmate is discharged from the medical institution will not be covered by Medicaid.

Individuals who are:

Aged or disabled will be assigned a COE of M073.

Regardless of the COE assigned individuals eligible under this provision:

Will have their eligible inpatient care paid through the Traditional Medicaid Fee for Service benefit plan.

Will receive notification of their Medicaid ID Number from ND Health Enterprise MMIS;

Will not be issued a Medicaid ID Card;