Medi-Cal Inmate Eligibility Program (MCIEP)

The Medi-Cal Inmate Eligibility Program (MCIEP) allows California to claim Federal Financial Participation Medi-Cal Inmate Eligibility Program (MCIEP) funding when an inmate receives inpatient hospital services for more than 24 hours off the grounds of the correctional facility if the inmate is otherwise eligible for MC.

State MCIEP

Assembly Bill (AB) 1628 and Senate Bill (SB) 92 authorize the California Department of Corrections and Rehabilitation (CDCR) and the Department of Health Care Services (DHCS) to work together to provide eligible inmates with MC benefits limited to inpatient hospital services off the grounds of the correctional facility for a minimum of 24 hours. The California Correctional Health Care Services (CCHCS) staff complete MC applications on behalf of the state inmate population for CDCR and submit to the DHCS for processing. MC can be suspended for the entirety of an individual's incarceration (regardless of age). DHCS began accepting and processing MC applications for adult inmates in a state prison in collaboration with CCHCS on April 1, 2011. Although the MC eligibility determinations are conducted by DHCS, counties have certain roles and responsibilities.

County MCIEP

Per AB720 the county can act on behalf of county inmates and help county inmates apply for health care coverage. The Santa Clara County Health and Hospital System (HHS) staff complete MC applications on behalf of Santa Clara County inmate patients and submit to Santa Clara County Social Services Agency (SSA) for processing. The county where the inmate is incarcerated is responsible for processing the county inmate MCIEP application and maintenance of the coverage. If the county receiving the MCIEP application is not the inmate’s county of incarceration, the application and all received document must be forwarded to the county of incarceration within fifteen (15) days from the application received date for initial eligibility determination and follow-up. If the inmate claims to be disabled, a disability application packet is part of the MC application process. Applicants determined eligible for MCIEP will have eligibility in the Medi-Cal Eligibility Data System (MEDS) on a secondary eligibility screen (INQ1, INQ2, etc.). However, inmates eligible for MCIEP will not receive a BIC.

Note: Inmates who are active in an MCIEP aid code may also apply for regular MC. MC applications received for an inmate currently receiving MCIEP are treated as an AB720 Pre-Release application. MCIEP coverage and regular MC coverage can both be received in the same month.

Eligibility Requirements

Applications for inmates are submitted by CCHCS to DHCS for state inmates or by HHS to SSA for county inmates. DHCS or SSA reviews the MC application, completes the eligibility determination, performs the MC redetermination, and maintains the case record for the inmate population.

In accordance with federal guidelines, an inmate must meet ALL of the following criteria to be eligible for MCIEP:

Be an inmate of a California State prison or a California County Jail,
Receive inpatient hospital services off the grounds of the correctional facility for more than 24 hours, AND
Meet all MC eligibility requirements.

Summary of Responsibilities

CCHCS or SD/HHS Staff

Identify inmates admitted for inpatient services off the grounds of the correctional facility.
Forward completed MC applications for inmates to DHCS or SSA.
Forward all needed documentation.
Forward medical records if a DDSD referral is needed.
Receive eligibility information from DHCS or SSA regarding an inmate’s MC determination.
Update case information as needed.

DHCS or SSA Staff

Perform state and county inmate eligibility determinations.
Notify CCHCS of eligibility determination.
Complete an annual MC RDs if MCIEP is active for 12 months or more.
Enter information into MEDS and perform ongoing case maintenance.
Complete a DDSD referral if a disability determination is required.

Billing and County Responsibility

With the implementation of moving all State and County inmate MC aid codes from the primary segment (INQM) to the secondary segment (INQ1/INQ2/INQ3) in MEDS as of July 1, 2016, both full scope MC coverage and restricted scope inmate coverage can now co-exist in the same month with a different county of responsibility in these segments for an eligible inmate. MEDS also allows for payment of claims for Inmate and non-Inmate coverage within the same month. Therefore, it is imperative that a county MCIEP application must be processed by the County of Incarceration even though a MC client has residency in another county (County of Residency). This will prevent the incorrect county being billed for the non-federal share incurred by the medical services provided to the MCIEP eligible county inmate. The correct county residency address of incarceration and county responsibility code must be displayed in the secondary segment in MEDS.

Note: For providers reporting any billing issue scenarios they may contact MCIEP directly via email at DHCSIMCU@dhcs.ca.gov for assistance.

The following scenarios provide guidance on the actions to take for different circumstances:

Scenario 1

County A receives an application from County B for an inmate who is incarcerated in County B, but the inmate claims he resides in County A on the MCIEP application.

Action 1

County A should return the application back to County B for eligibility determination and maintenance of case.

Scenario 2

County A receives an application from the jail in County B for an individual who is incarcerated in County B, but received inpatient services off the grounds of the correctional facility in County A.

Action 2

County A should return the application to County B, as County B is the county responsible for processing the MCIEP application and maintenance of case.

Scenario 3

Inmate was incarcerated in County A from 1/29/16 to 4/5/16. The inmate reported to the county eligibility worker at the jail facility who took the application he was planning on returning to County B once he was released. This inmate was not living in County A at the time of the arrest.

Action 3

County A is the county responsible for processing the MCIEP application and maintenance of case.

Scenario 4

County A receives MCIEP application for an incarcerated individual in County A. There is an active MC case that was suspended in County B.

Action 4

County A sends a request to County B to lift the suspension. The two counties would need to communicate to ensure the correct county removes the suspension, as only the county which suspended the MC eligibility can remove the suspension. County A is the county responsible for processing the MCIEP application and maintenance of case.

County Involvement with MCIEP State Inmates

Although DHCS administers MCIEP for state inmates, there are some situations in which county involvement is necessary for proper administration of the program. The following situations address circumstances in which the county may come into contact with a State MCIEP case.

State Inmates and Parole

When it is discovered that an individual is currently receiving MCIEP and released from prison, this is considered a change in circumstances. DHCS should provide the inmate’s county of residence with the inmate’s case information. When notified that the MCIEP individual is released, the County must follow the Ex Parte process to evaluate eligibility for ongoing MC benefits. The parolee remains in the MCIEP aid code until the Ex Parte process is complete.

If the parolee is determined. . .	Then . . .
Eligible for MC,	SSBS must place the parolee in the appropriate MC aid code for ongoing eligibility. Request that a BIC be sent to the beneficiaries’ address.
Not eligible for MC,	Follow procedures for discontinuing MC eligibility.

When a state inmate is paroled, the parole agent may give the parolee a letter with details about their possible eligibility for MC. If the former inmate is released/paroled and he/she applies for aid at the county Social Services office, and he/she has eligibility in MEDS under MCIEP, consider this application a change of circumstance and transition the individual into an ongoing MC aid code following the AB720 application process, if otherwise eligible.

Inpatient Services for Pregnant Inmates

When a pregnant inmate is eligible for and receiving MC or MCIEP at the time of the infant’s birth, the infant is automatically deemed eligible for MC without a separate MC application until age one, as long as the infant resides in California.

DHCS will notify SSA of the infant’s birth through the “MCIEP DHCS-County Transmittal Form.” The county of responsibility will be the county where the infant resides, unless the infant is in Foster Care placement or is pending adoption. In those cases, the County must follow the current process for deemed infant, Foster Care, and/or adoption eligibility.

In circumstances when a pregnant inmate is not active on MC or MCIEP, the infant does not qualify under Deemed Eligibility. For state inmates, CCHCS has an established MC application process in place for the mother to apply for the infant. For county jail inmates, the infant does not qualify under Deemed Eligibility, but may qualify through the regular MC application process.

MCIEP Recipient Applies for MC After Release

The basis for keeping the incarcerated individual active on MCIEP is not determined by the length of their inpatient stay and follows existing MC rules for change in circumstance (CIC) and annual redeterminations. If an incarcerated individual remains otherwise eligible, they can remain in MCIEP for the duration of their incarceration. If the designated entity or the member requests that MCIEP be discontinued, the SSBS may discontinue MCIEP. If an MCIEP individual applies for MC through SSA, consider the application a change of circumstance and transition the individual into the aid code he/she would be eligible for if not incarcerated, if otherwise eligible.

Although benefits for MCIEP are limited to inpatient services, clients cannot be required to reapply for MC if released within 12 months of their MCIEP application. For state inmates, DHCS should inform our agency and transfer the case information along with copies of documents when an MCIEP individual is about to be released from prison. The SSBS must follow the Ex Parte process to determine continuing MC eligibility and if eligible, discontinue MCIEP, place the inmate in an appropriate MC Aid Code, and mail the BIC.

Open MC Case

If DHCS finds an open MC case, DHCS will advise SSA of the findings. The SSBS must discontinue the individual from the case effective the first day of the following month and send a Notice of Action (NOA) to the last known address. If the inmate was part of a family case, then the family must be redetermined using the Ex Parte process.

State Inmate Aid Codes

The following aid codes are used by DHCS staff to establish eligibility for state inmates who are eligible for the MCIEP program.

Aid Code	MC Benefits	SOC	Program/Description
F1	Limited Non-MAGI	No	MC no share-of-cost (SOC) for Aged, Blind and Disabled State Inmates. MC benefits limited to covered inpatient hospital (Title XIX) services only, for inmates in state correctional facilities who receive those services off the grounds of the correctional facility.
F2	Restricted; Limited Non-MAGI	No	MC no SOC for Aged, Blind and Disabled undocumented State Inmates. MC benefits limited to covered inpatient hospital emergency (Title XIX) and pregnancy-related (Title XXI) services only, for inmates in state correctional facilities who receive those services off the grounds of the correctional facility.
N5	Limited MAGI	No	Medi-Cal benefits limited to covered inpatient hospital only, for adult inmates aged 19 through 64 years of age in state correctional facilities who receive those services off the grounds of the correctional facility.
N6	Restricted; Limited MAGI	No	Medi-Cal benefits limited to covered inpatient hospital and pregnancy services, for undocumented adult inmates aged 19 through 64 years of age in state correctional facilities who receive those services off the grounds of the correctional facility.
G1	Limited	No	MC no SOC for State Juvenile Inmates. MC benefits limited to covered inpatient hospital and inpatient mental health (Title XIX) services only, for juvenile inmates in state correctional facilities who receive those services off the grounds of the correctional facility.
G2	Restricted; Limited	No	MC no SOC for undocumented State Juvenile Inmates. MC benefits limited to covered inpatient hospital emergency and inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for juvenile inmates in state correctional facilities who receive those services off the grounds of the correctional facility.

County Inmate Aid Codes

The following aid codes have been implemented in MEDS for use by the counties.

Aid Code	MC Benefits	SOC	Program/Description
F3	Limited Non-MAGI	No	MC no SOC for County Inmates for Aged, Blind and Disabled adult inmates. MC benefits limited to covered inpatient hospital (Title XIX) services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
F4	Restricted; Limited Non-MAGI	No	MC no SOC for undocumented County Inmates for Aged, Blind and Disabled adult inmates. MC benefits limited to covered inpatient hospital emergency (Title XIX) and pregnancy-related (Title XXI) services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
K6	Full Scope MAGI	No	Full Scope MC with no SOC for County Compassionate Release Program (CCRP) and County Medical Probation Program (CMPP) for newly eligible adult group 19 through 64 years old and citizen/lawfully present with income at or below 138% FPL, including disabled/blind with income over 128% up to 138%; Title XIX; 100% Federal Medical Assistance Percentages (FMAP), 90% Federal and 10% County for Family Planning Services
K7	Restricted Scope MAGI	No	Restricted Scope MC with no SOC for CCRP and CMPP for newly eligible adult group 19 through 64 years old undocumented county inmates with income at or below 138% FPL, including disabled/blind inmates with income over 128% up to 138% FPL; Title XIX/Title XXI; 88% Federal /12% State FMAP; (Title XXI) limited to pregnancy-related services; 100% FMAP, (XIX) for emergency services including labor and delivery; 100% State funding for postpartum and Long Term Care (LTC) services
K8	Full Scope MAGI	No	Full Scope MC with no SOC for CCRP and CMPP for not newly eligible adult group 19 through 64 years old, including disabled /blind recipients without SSI/Medicare and citizen/lawfully present with income at or below 128% FPL; Title XIX; 50% Federal/50% State FMAP for Full Alternative Benefit Plan Services.
K9	Restricted Scope MAGI	No	Restricted Scope MC with no SOC for CCRP and CMPP for not newly eligible undocumented adult group 19 through 64 years old, including disabled /blind recipients without SSI/Medicare with income at or below 128% FPL; Title XIX/Title XXI; 50% Federal/50% State FMAP (TitleXIX) for emergency services including labor and delivery; 88% Federal/ 12% State FMAP (XXI) for pregnancy-related services; 100% State funding for postpartum and LTC services; 100% State funding for postpartum and LTC services.
N7	Limited MAGI	No	Medi-Cal no SOC for County Adult Inmates. Medi-Cal benefits limited to covered inpatient hospital services only, for adult inmates aged 19 through 64 years of age in county correctional facilities who receive those services off the grounds of the correctional facility.
N8	Restricted MAGI	No	Medi-Cal no SOC for undocumented County Adult Inmates. Medi-Cal benefits limited to covered inpatient hospital services only, for adult inmates aged 19 through 64 years of age in county correctional facilities who receive those services off the grounds of the correctional facility.
G3	Restricted; Limited Non-MAGI	Yes	MC SOC for County Inmates. MC benefits limited to covered inpatient hospital (Title XIX) services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
G4	Restricted; Limited Non-MAGI	Yes	MC SOC for undocumented County Inmates. MC benefits limited to covered inpatient hospital emergency (Title XIX) and pregnancy-related (Title XXI) services only, for inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
G5	Restricted; Limited	No	MC no SOC for County Juvenile Inmates. MC benefits limited to covered inpatient hospital and inpatient mental health (Title XIX) services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
G6	Restricted; Limited	No	MC no SOC for undocumented County Juvenile Inmates. MC benefits limited to covered inpatient hospital emergency and inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
G7	Restricted; Limited	Yes	MC SOC for County Juvenile Inmates. MC benefits limited to covered inpatient hospital and inpatient mental health (Title XIX) services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.
G8	Restricted; Limited	Yes	MC SOC for undocumented County Juvenile Inmates. MC benefits limited to covered inpatient hospital emergency and inpatient mental health emergency (Title XIX) and inpatient pregnancy-related (Title XXI) services only, for juvenile inmates in county correctional facilities who receive those services off the grounds of the correctional facility.

MCIEP Application Process

The following is the MCIEP Application Process:

Sheriff’s Department or Health and Hospital Systems (HHS) Financial Counselor
1. Complete, sign and send the inmate's MC Application (SAWS 1), and the "MCIEP Cover Letter" (SCD 2456) to the designated AB720 inbox. The cover letter includes:
  1. The inmate's name,
  2. The jail name,
  3. Date of admission to jail,
  4. The hospital name,
  5. The number of days in the hospital,
  6. A yes/no field for current MC benefits,
  7. CalSAWS case number, if applicable,
  8. Citizenship/Immigration status.
AB720 Clerical
1. Receives the SCD 2456 and application (SAWS 1) via e-mail.
2. Reviews applications to determine if the inmate has an open case assigned to an office or a SSBS.

If the Individual...	Then...
Has an open/active case,	Scans application into Imaging Creates a Task for the assigned Office/SSBS/Unit with the description of “MCIEP Request”
Not known to CalSAWS, MEDS, or CalHEERS, (No existing CIN)	Completes Application Registration to assign a CIN. Assign the MCIEP Application via the office process Saves the application to the Shared Drive/MCIEP folder
Known to CalSAWS, MEDS, or CalHEERS, but no open/active case	Assigns the MCIEP Application via the office process Saves the application on the Shared Drive/MCIEP folder
Is only known to CalHEERS	Search for an application in CalSAWS. Complete the full application registration process Mark application type as AB720 Hospital. Create a Task and assign the application via the office process.

SSBS
1. For Individuals with no open/active case:
  1. Reviews application forms.
  2. Performs an Ex Parte review.
  3. Contacts the Rehabilitation Officer (RO) for more information, if necessary.
  4. Determines the correct aid code to use via County Inmate Aid Codes table.
  5. Submits an SCD 1296 to update the secondary segment of MEDS (INQ1, INQ2, etc.). If there are no available secondary segments, submit a Gadwin ticket.
  6. Checks MEDS in 2 days to confirm the client is active on the correct aid code.
  7. Ensures that the MCIEP aid code is approved for the period in which the inmate was seen in the hospital.
  8. Sends the appropriate MCIEP NOA to the case address on file.
    1. MC 0377IN for Approval of full-scope MCIEP, and MC 0377IR for Approval of restricted-scope MCIEP.
  9. IMPORTANT! If a new case was opened as a result of a CalHEERS application, approve the “regular” Medi-Cal aid code if otherwise eligible and follow the MC suspension process.
  10. NOTE: Do not make MCIEP entries in CalSAWS. At this time MCIEP eligibility is determined outside of the SAWS system and the aid code is updated directly in MEDS.
2. For individuals with an open/active case:
  1. Suspends current MC aid code, if applicable.
  2. Reviews application forms.
  3. Performs Ex Parte review.
  4. Contacts the Rehabilitation Officer (RO) for more information, if necessary.
  5. Determines the correct aid code to use via the County Inmate Aid Codes table.
  6. Submits an SCD 1296 to update the secondary segment of MEDS (INQ1, INQ2, etc.). If there are no available secondary segments, submit a Gadwin ticket.
  7. Checks MEDS in 2 days to confirm the client is active on the correct aid code.
  8. Ensures that the MCIEP aid code is approved for the period in which the inmate was seen in the hospital.
  9. Sends the appropriate MCIEP NOA to the case address on file.

Note: A full Medi-Cal application is not required if the individual is only applying for MCIEP. The SAWS 1 may be used. Signature requirements still apply.

Reminder: The basis for keeping the incarcerated individual active on MCIEP is not determined by the length of their inpatient stay and follows existing MC rules for change in circumstance (CIC) and annual redeterminations. If an incarcerated individual remains otherwise eligible, they can remain in MCIEP for the duration of their incarceration.

Medi-Cal Inmate Eligibility Program NOAs

A notice of action is required for the approval or denial of MCIEP. Current system functionality does not allow for the appropriate Notice of Action (NOA) to be generated. The following MCIEP NOAs are located in the DEBS form library:

• MC 0377 IN-”Approval MCIEP Full-scope” for MCIEP (full scope) aid codes F3,G3,N7,G5 and G7.

• MC 0377IR- “Approval MCIEP Restricted” for MCIEP (restricted scope) aid codes F4, G4 and N8.

For MCIEP denials, use the appropriate denial/discontinuance NOA from CalSAWS and add the following language as Freeform Text prior to printing: “The Authority for this notice is Pen. Code 5072, Welf. & Inst. Code 14053.7, 14053.8, 14053.9”

MCIEP Cover Letter

The MCEIP cover letter (SCD 2456)MCEIP cover letter (SCD 2456) is used to identify applications submitted for inmates who have received hospital services for over 24 hours.

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