*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: November 1, 2014 |
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07.15.15 - Minnesota Health Care Programs (MHCP) and Incarcerated Individuals |
Archived: June 1, 2016 (Previous Versions) |
Minnesota Health Care Programs (MHCP) provides two special application procedures for some incarcerated individuals to facilitate prompt provision of health care coverage when they reenter the community. This helps assure continued treatment of chronic health conditions and successful transition to community life. Some incarcerated individuals may use a shortened application process for Medical Assistance (MA). Others may receive application assistance from facility staff when applying for any health care program.
Incarcerated individuals who do not fit into one of these two groups must follow all standard policies when applying for health care.
See Correctional Facilities for more information on eligibility for incarcerated individuals.
Shortened Application Process for Certain Incarcerated Individuals.
Processing Requests for MA Re-opening.
Application Assistance for Certain Incarcerated Individuals.
Processing New Applications from Incarcerated Individuals.
Shortened Application Process for Certain Incarcerated Individuals
One group of incarcerated individuals may have their MA coverage re-opened without a new application. The majority of people in this group are incarcerated in city and county facilities, but some individuals may be incarcerated in state prisons.
Incarcerated individuals may have their MA coverage reopened without a new application if they:
l Were enrolled in MA on the day of incarceration, including enrollment in Medicare Savings Programs, Emergency MA (EMA), State-funded MA (NMED), MA-EPD or residence in an IMD, and
l Are incarcerated for no more than 12 months. Count the first calendar month the person was incarcerated through the calendar month in which he or she is released.
MA closing notices will notify enrollees who are closed due to incarceration of this shortened process. However, all individuals who meet the criteria above are eligible for the shortened process, regardless of the reason MA was closed.
Incarcerated individuals who qualify for the shortened application process are not required to submit an application if they request health care as follows:
n The incarcerated individual may complete the Request to Re-Open MA (DHS-5038) or any application or renewal (annual, six-month or one-month) to request to have MA re-opened. City, county or prison facility staff may give the DHS-5038 to incarcerated individuals or individuals may request this form from DHS. They must submit the form no sooner than 45 days prior to their release date and no later than 10 calendar days after their release date.
Note: The Request to Re-Open MA cannot be used to determine MinnesotaCare eligibility. See Processing Requests for MA Re-opening for more information.
n The MHCP household reports on a renewal that an incarcerated individual will be returning to the household. The release date must occur within the renewal processing period or within 45 days of the receipt of the renewal.
Example:
The renewal month is June; the agency receives the renewal on May 15. The household reports the individual is being released on June 10. Consider the renewal to be a request to re-open MA.
n Both of the following criteria must be met if the MHCP household reports that an incarcerated individual will be returning to the household without using any form:
m The release date must occur within 45 days from the date the household reported the change, and
m The incarcerated individual must be included in the existing MA household under household composition rules.
Processing Requests to Re-Open MA
n Determine if the incarcerated individual qualifies for the shortened application process.
Note: If the individual is not qualified to use the shortened application process, consider any written request to re-open MA to set the date of application. The individual must provide a completed application within the processing period following the date the request is received by the county agency to retain the date of application.
n Verify the date of incarceration and the anticipated or actual date of release.
n Obtain a release if information cannot be verified with DHS-5038. This information may be verified using:
m The Facility Section on DHS-5038.
m Phone or fax contacts with the facility;
m Official correspondence from the facility with the release date listed;
m Official lists provided to the county agency by the facility containing the incarcerated individual’s name and release date;
m Department of Corrections Web site; or,
m Official jail roster.
n Use the facility’s address as the client’s mailing address until the individual is released.
Exception: Do not change the client’s mailing address to the facility address if other household members are open on the same case.
m Update the address from the facility address to the client’s address on the release date if the individual indicates on the request to reopen or any time prior to release that they know their future address.
m If the individual indicates on the request to reopen that the address upon release is unknown, send a Verification Request Form (DHS-3271) requesting that the individual inform the county of where he or she is living within 30 days of the date of release. Eligibility may be approved before receipt of this information.
n Determine eligibility.
m Review eligibility for MA.
m Obtain a HCAPP to determine eligibility for MinnesotaCare if an individual does not have an MA basis of eligibility.
Note: All verifications that are required for an annual health care renewal are required for the shortened process. See Verification Requirements.
n Approve eligibility for the date of release if all eligibility requirements are met. This action can be taken in advance of the anticipated release date when the request to reopen is filed within 45 days prior to the anticipated release date.
n Confirm the individual has been released if eligibility was approved prior to the actual release date. Obtain a release if necessary. Document the confirmation in case notes. Acceptable forms of confirmation include:
m Phone or fax contacts with the facility;
m Official correspondence from the facility with the release date listed;
m Official lists provided to the county agency by the facility containing the incarcerated individual’s name and release date;
m Department of Corrections web site; or,
m Official jail roster.
n Take the following action based on the confirmation obtained:
m If the actual release date will be delayed, but for no more than ten calendar days from the anticipated release date, do not take any action. Re-confirm release on the new anticipated date of release.
m If the actual release date is delayed for more than ten calendar days from the anticipated release date, close eligibility due to incarceration for the end of the month providing adequate notice. Reinstate eligibility if the individual is actually released prior to the effective date of closing.
Note: As long as the rescheduled release date is within 45 days of the request to re-open, the incarcerated individual does not need to complete a new application.
Application Assistance for Certain Incarcerated Individuals
Incarcerated individuals may receive assistance from correctional facility staff when applying for health care. The majority of people in this group are incarcerated in state prisons.
Under this process, workers may:
l Approve eligibility while the person is incarcerated,
l Send notices sent to the correctional facility or the field services agent for the applicant, and
l Send the MHCP card to the correctional facility in advance of the effective date.
Department of Corrections (DOC) case managers may help incarcerated individuals complete the health care application (either Health Care Programs Application (HCAPP) (DHS-3417) or ApplyMN) and the Individual Discharge Information Sheet (IDIS) (DHS-3443).
Note: Incarcerated individuals should only use ApplyMN if the DOC case manager can electronically attach DHS-3443 to ApplyMN.
The DHS-3443 supplements the application. The form includes a release of information to allow information to be shared between the worker, the correctional case manager and the correctional field service agent.
The case manager sends the completed application and DHS-3443 to the county in which the individual resided before entering the correctional system. If the previous county of residence is unknown or the person came from another state, the case manager will send the completed forms to the county in which the person plans to live.
Note: If applying with ApplyMN, the applicant/case manager should enter the county in which the incarcerated individual resided before entering the correctional system in the county field. The applicant/case manager should enter the county in which the individual plans to live in the county field if the county is unknown or the individual came from another state. This will ensure that the application routes to the correct county.
Case managers should submit the incarcerated individual’s application no sooner than 45 days prior to the individual’s scheduled release date. Deny applications submitted more than 45 days prior to the scheduled release date.
Processing New Applications from Incarcerated Individuals
Follow policy established in Processing Applications unless specified otherwise in this section.
l Determine if the individual is applying for all health care programs or MinnesotaCare only and transfer the application as necessary. See Informed Choice and Shared and Transferred Applications.
Note: If the individual applies for MinnesotaCare only, ApplyMN will route the application to MinnesotaCare Operations if the county listed in the county field is not a MinnesotaCare enrollment site.
l Accept the incarcerated individual's estimate of anticipated income to determine eligibility. Verify any income the individual receives while incarcerated to determine eligibility: for example, income earned through work release.
Note: Do not count gate money as earned income for the incarcerated individual.
l Determine eligibility in the following order:
1. MA, including Medicare Savings Programs (MSP) and MA for Employed Persons with Disabilities (MA-EPD).
2. MinnesotaCare (MCRE).
Note: Do not determine eligibility for MA if the individual requests MinnesotaCare only.
l The incarcerated individual must meet state residency requirements. See State and County Residence.
l Refer incarcerated individuals who report a disability, but do not have a current Social Security disability determination, to the State Medical Review Team (SMRT).
Note: SSA ends RSDI and SSI payments to incarcerated individuals after 30 days of confinement for SSI or one full calendar month for RSDI. SSA will not allow people to reapply for benefits until the actual day of release.
l Enter the correctional facility’s address as the mailing address. The incarcerated individual must provide his or her new address no later than 30 days following the release date.
n If the incarcerated individual fails to provide a new address, update the mailing address to the address of the field service agent listed on the DHS-3443.
Close coverage for the first available month giving 10-day notice. This will allow the field agent to assist the incarcerated individual with providing required information to continue coverage.
Reinstate eligibility if appropriate when the needed information is received.
l Enter a worker comment on the approval notice stating the incarcerated individual's eligibility starts the date of release.
Example:
The county receives an application on April 22. The DHS-3443 shows an expected release date of June 5. The worker approves MA eligibility effective June 1.
Action:
Add worker comments to the notice stating that eligibility for MA will begin on June 5.
l The Minnesota Health Care Programs membership card and approval notice will be mailed to the correctional facility. The facility will give the card to the incarcerated individual on the date of release.
The begin date for a person who applies for health care before their release is different for each program:
l MinnesotaCare: The begin date is the month following the month the initial premium is paid or the release date, whichever is later. Process the application as soon as possible to allow billing to occur immediately if the client is eligible.
l MA: The earliest eligibility begin date is the date of release.
Exception: MA-EPD will not begin until the premium is paid.