Page 120

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 October 2025 Subchapter Subject Page ending with Page M0280 INSTITUTIONAL STATUS REQUIREMENTS M0280.300 6

M0280.300 INMATE OF A PUBLIC INSTITUTION

A. Policy Inmates of public institutions fall into three groups: • individuals living in ineligible public institutions; • incarcerated adults; and • juveniles in detention. An individual is an inmate of a public institution from the date of admission to the public institution until discharge, or from the date of actual incarceration in a prison, county or city jail or juvenile detention facility and considered incarcerated until permanent release, bail, probation or parole. An offender sentenced to the Community Corrections Alternative Program (CCAP) is confined in a DOC facility is not considered released, and is not a parolee or probationer.

Incarcerated individuals (adults and juveniles) who are hospitalized can be eligible for Medicaid payment limited to services received during an inpatient hospitalization, provided they meet all other Medicaid eligibility requirements. An individual released from jail under a court probation order due to a medical emergency is NOT an inmate of a public institution because he is no longer incarcerated. B. Public Residential Facility Residents An individual who lives in a public residential facility that serves more than 16 residents is NOT eligible for Medicaid.

A public residential facility that does not meet the definition of a “publicly operated community residence” in section M0280.100 above, is an “ineligible public institution.” The following are ineligible public institutions: • public residential institutions with more than 16 beds

• residential facilities located on the grounds of, or adjacent to, a public institution with more than 16 beds:

C. Incarcerated Adults Offenders can be eligible for Medicaid payment limited to services received during an inpatient hospitalization of 24 hours or longer. Offenders include: • individuals under the authority of the Department of Corrections (DOC)

• individuals held in regional and local jails, including those on work release

Individuals are not eligible for full benefit Medicaid coverage while they are living in a correctional facility, regional or local jail. For a juvenile in a facility, refer to M0280.300.D below and Appendix 1.