Medical Assistance for Hospitalized Incarcerated People

2.5.5.1.1 Applications

A person who is incarcerated and applying for MA for hospitalized people who are incarcerated must apply using a paper application. Applying with a paper application ensures that eligibility dates for health care coverage are correct.

Health Care Application

The demographics of a person who is incarcerated determine which paper application they must complete. See the Minnesota Health Care Programs (MHCP) Application Forms policy for more information.

The Medical Assistance Payment for Inpatient Hospital Care for Incarcerated People (DHS-6696G) is also required.

A correctional facility staff member must help the person complete the application process.

The completed paper application and DHS-6696G must be submitted :

After the person is discharged from the hospital but no later than three calendar months after the month in which the person was admitted, or
If the person is hospitalized, or expected to be hospitalized, for more than three calendar months, then within three calendar months after the month the person was admitted to the hospital, or
After the preadmission screening (PAS) has been completed and the person has met institutional level-of-care (LOC) requirements for payment of long-term care.

The correctional facility is responsible for notifying the hospital or LTC facility of the person’s eligibility status and the person’s Person Master Index (PMI) number.

Legal Citations

Minnesota Statute 256B.055, subdivision 14