Coverage for Inmates Residing in Corrections-related Supervised Community Residential Facilities 510-03-95-10

(Revised 5/3/2024 ML #3835)

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Inmates of public institutions, who are held involuntarily, are not eligible for Medicaid coverage with the exception of Medicaid coverage for inmates who receive care as an inpatient in a hospital, nursing facility (nursing home), Psychiatric Residential Treatment Facility (PRTF) or an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID). Recently, the Centers for Medicare and Medicaid Services (CMS) issued guidance to states on facilitating access to all covered Medicaid services for inmates, in certain circumstances, after a stay in a public institution, who are residing in corrections-related supervised community residential facilities.

Note: Different than coverage for Inmates Receiving Inpatient Services, this coverage is available for inmates who were inmates in a Tribal jail and residing in one of the corrections-related supervised community residential facilities, provided all criteria below are met.

Inmates residing in state or local corrections-related supervised community residential facilities (whether operated by a governmental entity or a private entity) are eligible for Medicaid unless the inmate does not have the freedom of movement and association while residing at the facility. To meet this requirement, the facility must operate in such a way as to ensure that individuals living there have freedom of movement and association, and the resident:

  1. MUST be able to work outside the facility in employment available to individuals who are not under justice system supervision;
  2. MUST be able to use community resources (libraries, grocery stores, recreation, education, etc.) “at will”; and
  3. MUST be able to seek health care treatment in the broader community to the same or similar extent as other Medicaid enrollees in the state.

For this purpose, “at will” includes and is consistent with requirements related to operational “house rules” where, for example the residence may be closed or locked during certain hours or where residents are required to report during certain times and sign in and out. Similarly, an individual’s supervisory requirements may restrict traveling to or frequenting certain locations that may be associated with high criminal activity.

Currently, we have the following corrections-related supervised community residential facilities that house inmates.

Note: These facilities also house individuals who are on parole and probation. Individuals on probation or parole are not considered inmates.

Based on this guidance, and in discussion with staff at the Department of Corrections and Rehabilitation, inmates residing in these facilities meet the criteria listed in #1 through #3 above and may be eligible for Medicaid if all other factors of eligibility are met.

 

Federal inmates residing in “Residential Reentry Centers” are not eligible for Medicaid coverage under this provision as the Department of Justice (DOJ) and/or Bureau of Prisons (BOP) retains responsibility for payment of health care services rendered to individuals in Residential Re-entry Centers (RRCs).

 

If an inmate was incarcerated by another state and was sent to North Dakota for any reason, including the other state not having capacity to house the individual, the other state remains the state of residence. The inmate would retain residency for purposes of Medicaid eligibility in the other state and eligibility in North Dakota would be denied for ‘Not a Resident’.

 

Likewise, if an inmate was incarcerated by North Dakota and was sent to another State for any reason, including North Dakota not having capacity to house the individual, North Dakota remains the state of residence. The inmate would retain residency for purposes of Medicaid eligibility in North Dakota. When determining the Medicaid Unit for this individual under ACA, the household of the individual is determined based on their tax filing status. While the individual is considered NOT residing in the home, this may result in a spouse or child(ren) needing to be included in the ACA case.

 

Many of these individuals are allowed to work in the community. This income must be considered when determining eligibility.

 

Processing for these individuals can be found in the Processing Appendix at 510-03.