Medi-Cal Suspension

 

EW Action to Suspend MC for Inmates Upon notification that a client is incarcerated in a public institution, the individual’s MC benefits must be suspended effective the date the individual becomes an inmate of a public institution or when the county is notified of the incarceration (Refer to the 28-day MC Suspension Policy). When MC benefits are suspended, 10-day notice of action is required. The method of “suspension” will be determined based on the household (HH) composition.

 

The EW must take the following actions:

 

Review the household composition of the MC case.

If..	Then..
The client is the only individual on the case.	To initiate a suspension, add a [Living Arrangement Detail]. On the [Living Arrangement Type], Select Incarcerated and on the [Arrival Date] field, enter the date that the individual became incarcerated if known or the date the county was notified of the incarceration status. Type in the name of the Correctional Facility on the [Name of Location] field. Mail the “Suspension of Medi-Cal Benefits” NOA (MC 0466A), 10-Day Notice is required. Set a [Manual Task] to follow up on the day of release to update the [Living Arrangement Detail] page to lift the suspension. To set a Manual Task [Refer to CATS CB: How to create a Manual Task in CalSAWS]   Note: When the [Living Arrangement] page is updated in CalSAWS a batch transaction is sent to MEDS on the 10th day to align with noticing requirements. A 10-Day Notice is required via the MC 0466A NOA.    [Refer to MEDS Quick Reference Guide for Restriction Codes of incarceration (800 series) and Eligibility Status Codes (69X - full month) or (X5X - partial month]
The client’s case has additional household members,	Follow the same process mentioned above to initiate a suspension in the [Living Arrangement Detail] page. Set a Manual Task for the release date The EW must mail the “Suspension of Medi-Cal Benefits for an Incarcerated Individual” (MC 0466A) for the “Suspended” individual. Eligibility must be re-evaluated for the remaining household members, excluding the incarcerated individual. If the re-evaluation results in a negative action, follow all noticing requirements.

 

28-day Medi-Cal Suspension Policy

 

When an individual has a short-term incarceration stay with an expected release less than 28 days from the date when the county is notified, the EW must not suspend or report the incarceration to MEDS. If an individual is expected to be incarcerated more than 28 days, suspend the Medi-Cal benefit. The inmate will remain on suspended MC through the duration of their sentence. Set a Manual Task [Refer to CATS CB: How to create a Manual Task in CalSAWS] with the individual's scheduled release date for the follow-up to lift the MC suspension. 

 

Reminder: Medi-Cal benefits must be suspended effective on the date when the EW32 online/batch transaction is submitted to MEDS. MEDS determines the Suspend Date and Suspend End Date (found on the [INQU] MEDS screen). In addition, Restriction Codes and Eligibility Status Codes in MEDS are used to indicate incarceration for both partial and full month.

[Refer to MEDS Handbook Chapter 1.9.29 for more information of the Incarceration and Suspension Information screen and MEDS QRG for Restriction Codes and Eligibility Status Codes.]

 

MC Suspension NOAs

 

Ten Day notice of action is required when MC is suspended, and the “Notice of Action Suspension of Benefits Notice” (MC 0466A) must be issued. When the MC Suspension is lifted, send the “Notice of Action Suspension of Medi-Cal Benefits Activated” (MC 0466F). Your Hearing Rights” NA Back 9 form must be sent in addition to the MC 0466A NOA or MC 0466F NOA. All forms are located in the DEBS form library.

 

Lifting the MC Suspension

 

When the individual is released from the public institution, the suspension must be lifted and eligibility restored. The EW must restore the Medi-Cal benefit effective on the release date or when it is known that the individual is no longer incarcerated. MC benefits must be activated without submitting a new application. The suspension of MC Benefits will end for any of these reasons:

• On the day of release from incarceration, • No longer an inmate in a public institution,

• At the end of the month that the individual becomes ineligible for MC and is IE for any other MC program,

• Death of the inmate.

 

The suspension must be lifted by following the process below:

 

Review the household composition of the MC case.

If..	Then..
The client is the only individual on the case.	To lift the suspension, Update the [Departure Date] field (to the release date) on the [Living Arrangement Detail] page. If the individual is already released, enter the date the person was released if known or the date the county was notified of the release on the [Departure Date] field.    Note: 10-day advance notice is not required for lifting the suspension, however the NOA needs to be sent no later then the date the county activates the MC benefit.
The client’s case has additional household members,	Follow the same process above to lift the suspension. The “ Suspension of Medi-Cal Benefits Activated” (MC 0466F) must be mailed to the client. Eligibility must be re-evaluated for the remaining household members, including the previously incarcerated individual. If the re-evaluation results in a negative action, follow all noticing requirements.

 

Immediate Need Activation in MEDS

 

MC benefits must be activated (MC suspension lifted) for individuals on the day of their release or in cases where there is an immediate need for services (ex. unexpected release). The county must follow the Immediate Need (IN) process in MEDS by using the EW 15 transaction in addition to the EW 32 transaction to activate MC coverage. The EW 15 transaction allows IN benefits to be issued when a MEDS record is indicated as incarcerated. For MC eligibility to reflect for the remainder of the month, the EW 32 transaction must be submitted on the same day as the EW 15. MEDS IN process can be found in MEDS Uggs 5.5.19.

 

Eligibility Changes During Suspension Period

 

During the MC suspension period, if the basis for ongoing eligibility changes such as child turns 19, adult turns 65 then eligibility should be updated as appropriate in MEDS (i.e. new aid code) with the suspension still in effect. Beginning January 1, 2023, if an inmate is incarcerated for more than a year, their MC will no longer discontinue, if otherwise eligible. Annual renewals are not required for adult and youth inmates for the duration of their incarceration. Change in circumstance RD requirements for adult inmates remain in place.

ExampleExample:

 

Termination of Medi-Cal During the Suspension Period

 

When MC eligibility is terminated for an incarcerated individual while under suspension, the EW must mail the MC 0377 D “Discontinuance of Benefits” with appropriate 10 day NOA.

 

Redetermination after Release from Incarceration

 

Upon an inmate’s release from incarceration, an RD is only required if one has not been completed within 12 months prior to the release, eligibility must be activated without submitting a new application if the information available to the County is sufficient. If a redetermination is needed, the EW must perform an ex parte review using available information to conduct the change in circumstance RD. The EW may contact the beneficiary once they have been released if the EW is unable to complete the CIC RD via ex parte review.

 

Courtesy Notification with active MC in a Different County

 

Information may be received from different sources, such as the MCIEP application, county jail or juvenile detention facility, that an individual has been incarcerated or released. If, after a review of the case in the system (SAWS and MEDS) if it is determined that the inmate in Santa Clara County is active on a Medi-Cal case in a different county, a courtesy notification (ex., email or phone call) should be communicated to that county advising of the incarceration status as they can follow the suspension policy and process accordingly.

Example:Example: 

 

 

 

Related Topics