Coverage for Inmates Residing in Corrections-related Supervised Community Residential Facilities 510-05-35-95-10

(Revised 1/1/2025 ML #3916 )

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Inmates residing in state or local corrections-related supervised community residential facilities (whether operated by a governmental entity or a private entity) are eligible for Medicaid unless the inmate does not have the freedom of movement and association while residing at the facility. To meet this requirement, the facility must operate in such a way as to ensure that individuals living there have freedom of movement and association, and the inmate:

MUST be able to work outside the facility in employment available to individuals who are not under justice system supervision;

MUST be able to use community resources (libraries, grocery stores, recreation, education, etc.) “at will”; and

MUST be able to seek health care treatment in the broader community to the same or similar extent as other Medicaid enrollees in the state. For this purpose, “at will” includes and is consistent with requirements related to operational “house rules” where, for example the residence may be closed or locked during certain hours or where inmates are required to report during certain times and sign in and out. Similarly, an inmates supervisory requirements may restrict traveling to or frequenting certain locations that may be associated with high criminal activity.

Examples of (not limited to) corrections-related supervised community residential facilities that house inmates include:

Bismarck Transition Center Transitional Housing and Work Release Program

Centre Inc. in Mandan

Centre Inc. in Fargo

Centre Inc. in Grand Forks

Lake Region Residential Reentry Center

Note: These facilities also house individuals who are on parole and probation. Individuals on probation or parole are not considered inmates.

Federal inmates residing in supervised community residential facilities are not eligible for Medicaid coverage under this provision as the Department of Justice (DOJ) and/or Bureau of Prisons (BOP) retains responsibility for payment of health care services rendered to individuals in supervised community residential facilities.

If an inmate was incarcerated by another state and was sent to North Dakota for any reason, including the other state not having capacity to house the individual, the other state remains the state of residence. The inmate would retain residency for purposes of Medicaid eligibility in the other state and eligibility in North Dakota would be denied for ‘Not a Resident’.

Likewise, if an inmate was incarcerated by North Dakota and was sent to another State for any reason, including North Dakota not having capacity to house the individual, North Dakota remains the state of residence. The inmate would retain residency for purposes of Medicaid eligibility in North Dakota. When determining the Medicaid Unit for this individual under ACA, the Medicaid Unit of the individual is determined based on their tax filing status. While the individual is considered NOT residing in the home, this may result in a spouse or child(ren) needing to be included in the ACA case.

Many of these individuals are allowed to work in the community. This income must be considered when determining eligibility.

Processing for these individuals can be found in the Processing Appendix at 510-05-110