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Virginia Medical Assistance Eligibility M02 October 2025 Subchapter Subject Page ending with Page M0280 INSTITUTIONAL STATUS REQUIREMENTS M0280.300 7

An offender who transfers temporarily to a halfway house, residential re- entry center (RRC), or residential treatment facility prior to a formal probation release order is still an inmate of a public institution and can only be eligible for Medicaid payment limited to services received during an inpatient hospitalization. Note: some drug or alcohol rehabilitation centers may be referred to as a “halfway house”; the eligibility worker should confirm the individual is not an inmate or incarcerated. Once an incarcerated individual who is enrolled in Medicaid is released from the correctional facility, he may be eligible for all benefits available under the Medicaid covered group he meets. D. Juveniles in Detention In determining whether a juvenile (individual under age 21 years) is incarcerated, the federal Medicaid regulations distinguish between the nature of the detention, pre- and post- disposition situations, and types of facilities. 1. Held for Care, Protection or Best Interest A juvenile who is in a detention center due to care, protection or in the best interest of the child can be eligible for full benefit Medicaid or Family Access to Medical Insurance Security (FAMIS) coverage. A child who is incarcerated in a Department of Juvenile Justice Facility is considered to be temporarily absent from home. 2. Held for Criminal Activity a. Prior to Court Disposition

The following juveniles can be eligible for Medicaid payment limited to services received during an inpatient hospitalization. • juvenile who is in a detention center due to criminal activity • juvenile who has criminal charges pending (no court disposition has been made) who is ordered by the judge to go to a treatment facility, then come back to court for disposition when the treatment is completed

b. After Court Disposition Juveniles who are on probation with a plan of release which includes residence in a detention center are inmates of a public institution. If they go to any of the secure juvenile correctional facilities, they are inmates of a public institution and can only be eligible for Medicaid payment limited to inpatient hospitalization. A list of secure detention facilities in Virginia is available on the Department of Juvenile Justice’s web site at Juvenile- Detention-Centers-and-Homes-Contacts.pdf (virginia.gov). Because this list is subject to change, consult the list whenever eligibility must be evaluated for a juvenile who is reportedly in a detention center. If the juvenile goes to a non-secure group home, he can be eligible for Medicaid or FAMIS because a non-secure group home is not a detention center.