Medicaid Eligibility for Incarcerated Individuals 510-05-35-95-15

(New 1/1/2025 ML #3916 )

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Incarceration status is not a condition of Medicaid eligibility and does not make an individual ineligible. A person who applies for or is enrolled in Medicaid, and who is or becomes incarcerated, is eligible for Medicaid if they meet all Medicaid eligibility factors. If an inmate meets all eligibility factors for Medicaid, Medicaid will be suspended while the individual remains an inmate in the public institution. Medicaid will not pay for medical services for inmates in a public institution except for inpatient care per 510-05-35-95-05-15 .

People who are incarcerated may apply for Medicaid at any time. The zone agency must accept Medicaid applications from, or on behalf of, inmates of public institutions at any time during their incarceration and process these applications promptly. They are not to be held for later processing (refer to 510-05-25-05 ).

If determined eligible for Medicaid while incarcerated, the individual’s Medicaid will be placed in a suspended eligibility status.

Individuals who are incarcerated will continue to have Medicaid eligibility reviews while their eligibility is in suspend status. Passive reviews will be completed and if an incarcerated person fails reasonable compatibility, a review form will be mailed. Review forms received are not to be held for later processing.

Incarceration is not an exception to a child’s CE period. Therefore, if a child is released from the carceral setting before their CE period ends, benefits must be reinstated without conducting a redetermination of eligibility, unless the child has experienced an exception per Continuous Eligibility Periods 510-05-53-15.

Example : Alex is 17 and his eligibility period is January 1, 2024 through December 31, 2024. Due to Alex’s age, he has 12 months of CE. Alex becomes incarcerated in May 2024, and is released on October 1, 2024. A review prior to his release is not needed because Alex is released prior to the end of Alex’s current CE period.

A review of eligibility is required for certain eligible individuals prior to their release from a carceral setting. If a Medicaid determination was conducted while an individual was incarcerated and within 12 months of date of release, another redetermination upon release is not required.

Example : Sally is determined eligible for Medicaid in January, becomes incarcerated in March, and is released from incarceration in May. Sally's Medicaid eligibility determination, which was completed pre-incarceration in January, would not fulfill the pre-release redetermination because the eligibility determination was made before Sally was incarcerated in March. Therefore, Sally’s eligibility needs to be reviewed prior to Sally’s release.

Example : Sally is determined eligible for Medicaid in May 2024 and becomes incarcerated in January 2025. She had a passive review complete in May 2025, and was released in July 2025. Sally does not need a review upon release as she had one completed while incarcerated and within 12 months of last review.