Medicaid Enrollment

Given the volume of short stays in jails, for individuals who are enrolled in Medicaid at the time of detention, facilities can work with the state Medicaid agency (SMA) to maintain the individuals’ Medicaid enrollment for 30 days, rather than suspending and then reactivating their Medicaid enrollment. Note that facilities that adopt this practice must establish markers and edits in the claims processing system to deny claims for excluded services.

For individuals who are not enrolled in Medicaid at the time of detention, correctional facilities can begin the application process at intake or as early as possible. SMAs may consider activating presumptive eligibility to support timely access to coverage. Presumptive eligibility is a provision that allows certain individuals to receive temporary Medicaid coverage based on a preliminary assessment of their eligibility. This means that if an individual is presumed to meet the eligibility criteria, they can access health care services immediately while their full Medicaid application is being processed.

To promote continuous coverage for all lengths of stay:

• Support individuals in applying for Medicaid or renewing their coverage at any time during their incarceration
• Leverage navigators, application assisters, or eligibility workers to assist individuals in applying for Medicaid coverage — and facilitate meetings with these navigators, either in person or by telephone or telehealth
• Consider using correctional staff to enroll individuals and interact with the Medicaid eligibility and enrollment system

SMAs can establish a specialized Medicaid eligibility unit dedicated to processing applications for justice-involved individuals.

Correctional facilities can provide information and education to individuals in custody about Medicaid eligibility, the application process, and covered benefits.