For purposes of MA eligibility, other than eligibility for inpatient hospital services, the needs of an inmate in a correctional institution are met by the government agency that runs the facility. These facilities include the following:
Correctional institutions that are supervised or controlled by the Department of Corrections.
Jails run by local authorities.
42 CFR 435.1008(2)b 42 CFR 435.1009
If an inmate meets all other rules for eligibility, he or she can apply for and get MA in any of the following situations:
The individual is an inmate of a State Correctional Institution (SCI) or County Correctional facility, and is admitted for inpatient services to a hospital that is separate from the correctional institution. See Section 392.211, Application for Inmates of Correctional Institutions.
The individual lives in any community residential facility under contract to or operated by a state, county, or local prison authority and is eligible in other ways for GA-related MA.
The individual is serving time in a correctional institution for only a portion of the week, such as weekends. The CAO must not stop MA for the days the individual is kept in jail or prison.
The individual is a juvenile in a Juvenile Detention Center while waiting for the final decision of a court to be made.
NOTE: A juvenile becomes ineligible for MA when the final decision of the court is made and the juvenile is placed in a secure residential facility, such as a Youth Forestry Camp or Youth Development Center.
The individual is living in a Community Corrections Center operated by the State Department of Corrections.
An individual is not considered an inmate of a correctional institution at any of the following times:
Before his or her arrest.
When he or she is released on bail.
After being released from custody, even though the individual may still be under a court's control through probation, parole or house arrest.
When he or she is placed in a Juvenile Forensic Unit for court-ordered psychiatric services.
NOTE: Juvenile Forensic Units are considered medical facilities.
When he or she is living in a public educational or vocational training institution to get an education or vocational training.
When he or she is living in a public institution while waiting for other living arrangements that meet his or her needs.
Applications for inmates of correctional institutions will be submitted by the correctional institution after the inpatient stay. The Central Unit (CU) will process the applications, and will consider the information on the COMPASS application and accompanying documentation is verified upon receipt.
The correctional institution must take the following steps:
Submit and e-sign the application through COMPASS as a Community Partner.
SCIs will fax or scan the SCI Inpatient Eligibility Form (PA 1890) with the e-form number and the eligibility dates to the CU. County Correctional facilities will fax or scan the County Prison Inpatient Eligibility Form (PA 1892) with the e-form number and the eligibility dates to the CU.
NOTE: The application may be used for more than one hospital admission, if the admission occur within 60 days of the date of application. For each hospital admission that occurs within 60 days of an approved inmate application, the correctional institution will notify the CU of the new admission and fax a completed Inpatient Eligibility form for the new Non-Continuous Eligibility (NCE) period.
Fax or scan the COMPASS Signature Page to the CU in instances where the inmate's Social Security Number was not obtained.
When the CAO receives an application, it must take the following steps:
Review the COMPASS application in e-CIS on the Web Application Detail screen (CAPWAD) and determine if it was submitted with the correctional facility as the permanent address.
Forward the COMPASS application to the CU (23/3). The application must be forwarded on the same business day it is received.
When the CU receives the application, it must take the following steps:
Ensure that all necessary forms are signed and completed. The IMCW will receive an e-signature or a faxed signature page. If further information is needed from the SCI, refer to the SCI Contact List by selecting the Listing of State Prison Facilities with Superintendent Names, Address/phone Numbers. If further information is needed from the County Correctional facility, refer to the County Prison List and select County Prison Contact Info.
NOTE: Income and resources are excluded for this initiative based upon their restricted availability.
Review to determine if the inmate is enrolled in a Managed Care Organization (MCO). Inmates found to be enrolled in MCOs are not covered during incarceration and must be disenrolled in order for MA payment to occur. To disenroll the inmate:
1. Select "Links" from the left hand navigation panel on the OIM Homepage.
2. Choose the "DHS-OMAP Health Choices" link.
3. Click on "Managed Care Programs" in the menu bar.
4. Select "Forms" in the "General Information" section.
5. Under "Involuntary Disenrollment Forms", click on "Incarceration (EAC, CU & Physical Health MCOs)" ; complete the form that comes up and click on "submit" when finished. Instructions are included with the form.
NOTE: The incarceration date must be entered; the date can be obtained from the PA 1890 or PA 1892 form accompanies the application.
Enter the correctional institution and hospital MA Provider Information in e-CIS.
Consider the application information as verified upon receipt.
Enter the NCE period using the dates of hospital admission and discharge as shown on the Inpatient Eligibility form. The individual's NCE period should be set for the entire duration of the hsopital stay even if the incarceration ends during the hospitalization.
Process the COMPASS application with the Inpatient Eligibility form upon receipt. The application will be processed as a Special Program Request.
Enter the correct category (PH, PC, PD, or MG) and Program Status Code 38 or 39 on the Program Request Question screen.
PSC 38 has been designated for the SCI inmate population.
PSC 39 has been designated for the County Correctional facility inmate population.
Authorizing MA benefits for:
1. Permanently disabled individuals under age 65 in category PH38 or PH39. (One of the SSA disability criteria must be checked.)
2. Individuals over age 65 in category PH38 or PH39.
3. Temporarily disabled citizens and qualified non-citizens over or exempt from the 5 year bar that do not meet SSA disability criteria and are over age 20 and under age 65 in category MG38 or MG39.
4. Temporarily disabled qualified non-citizens subject to the 5 year bar and temporary non-ciyizens that do not meet SSA disability criteria and are over age 20 and under age 65 in category PD38 or PD39.
5. Individuals age 18 to 20 in category PC38 or PC39.
6. Pregnant women in category PC38 or PC39. (An override is required for this category. The Inpatient Eligibility form will indicate pregnancy and due date.)
Reminder: Applications for newborns of pregnant inmates are to be submitted by the hospitals to the CAO in the county where the newborn is residing.
NOTE: Individuals with citizenship code 5 will be authorized for emergency MA in the appropriate federally-funded MA category. See Section 322.34, Emergency Medical Services.
Send a notice of eligibility to the individual, the correctional facility and the hospital MA provider.
In addition:
For inmates of SCIs, send a notice of eligibility to the Pennsylvania (PA) Department of Corrections (DOC)
PA Department of Corrections
Bureau of Health Care Services
1920 Technology Parkway, 3rd Floor
Mechanicsburg, Pa 17055
For inmates of County Correctional facilities, send a notice of eligibility to the County Commissioner Association of Pennsylvania (CCAP):
PIMCC
c/o Cost Management Plus
2319 Walnut Street
Harrisburg, Pa 17103
Attn: Inmate Medical
Updated June 27, 2016 Replacing February 14, 2012