016.20.15 Ark. Code R. 002
Arkansas Department of Human Services Division of County Operations
Policy Issuance Number: MS 15-19
Medical Services Policy Manual Issuance Date: September 21, 2015
From: Delia Anderson, Director Expiration Date: Until Superseded
Subj: Procedure for Inmates Being Released from Custody to Apply for Medicaid and Case Suspension While Incarcerated
Pages to be Deleted: | Date: | Pages to be Added: | Date: |
MS Appendix C | 07-01-15 | MS Appendix C | 08-01-15 |
MS D-350-370 | 01-01-14 | MS D-350-380 | 01-01-14 |
01-30-15 | |||
08-01-15 |
Summary of Changes:
MS Appendix C has been revised to incorporate acceptable documents that will prove identity.
MS D-370 has been revised to incorporate the policy reference number for the exception for inmates to receive Medicaid.
MS D-371-D-373 have been developed to incorporate procedures for an inmate being released from custody to apply for Medicaid forty five days before being released and an inmate's case can be suspended up to a year while incarcerated.
Inquiries to:
Kristie Hayes, 501-682-8259, Kristie.hayes@dhs.arkansas.gov
Carla Droughn, 501-682-8254, carla.droughn@dhs.arkansas.gov Renita Honorable, 501-682-1562, renita.honorable@dhs.arkansas.gov
Medical Services Policy Manual, Section D
MS Manual 01/01/14
Residency regulations are intended to assure uniform application of residency rules and to assure that no otherwise eligible individual is denied Medicaid because no State recognizes him as a resident.
MS Manual 01/30/15
State residency determinations are as follows:
Exception:An individual aged 18-22 and a full-time student at an Arkansas school, is not a resident of Arkansas if:
When more than one State could be an individual's residence, and you cannot determine the jurisdiction of residence based on the above rules, the residence is where the individual is physically located at present.
T Note:For purposes of State residency - an institution is a Title XIX Long Term Care Facility and an individual is considered to be incapable of indicating intent to reside in the State if:
MS Manual 01/01/14
Determinations specifically prohibited for State Residency are as follows:
MS Manual 01/01/14
Medicaid regulations provide for written agreements between States to resolve cases of disputed residency. These agreements may specify criteria for residency other than the aforementioned determinations provided:
As the State of Arkansas enters into written agreement with other States to resolve cases of disputed residency, the County Office will be notified. The notification will identify the State(s) and the criteria of the agreement(s).
The County Office will contact the Medicaid Eligibility Unit when either of the following situations occurs:
MS Manual 01/01/14
Public Law 99-509, the Omnibus Reconciliation Act of 1986, prohibits a State from denying any individual Medicaid benefits who does not have a fixed or permanent address, but who resides in the state and is otherwise eligible. If the applicant is considered an Arkansas resident and meets the other requirements for eligibility, the case may be approved using the address of choice for the applicant.
MS Manual 01/01/14
Juveniles committed to the custody of the Division of Youth Services may be detained in secure facilities or be placed for treatment in inpatient psychiatric facilities, inpatient medical facilities, residential treatment facilities, emergency shelters, therapeutic group homes or therapeutic foster care.
When juveniles in the custody of the Division of Youth Services are placed in juvenile detention centers and other facilities operated primarily for the detention of children who are determined to be delinquent, they are not eligible for a Medicaid payment.
When juveniles in the custody of the Division of Youth Services are placed for treatment in inpatient psychiatric facilities, inpatient medical facilities, residential treatment facilities, emergency shelters, therapeutic group homes or therapeutic foster care, they are eligible for a Medicaid payment.
The Division of Youth Services (DYS) and the Division of County Operations have entered into an inter-agency agreement which permits DYS to process and approve Medicaid eligibility for ARKids A and B for DYS juveniles who have entered treatment facilities.
MS Manual 01/01/14
Arkansas Code Ann. § 9-27-332(b) and 9-27-334(c) state that a facility cannot be specified by name when a juvenile is court ordered to an inpatient psychiatric facility. Therefore, a case will not be closed solely because the court ordered ARKids participant moves from one facility to another.
If the child transfers to another county, the case will remain open and will be transferred to the county where the facility is located. If the child is transferred to an out-of-state facility, the case record will be transferred, if necessary, to the child's home county office.
MS Manual 08/01/15
An inmate of a public institution is not eligible for Medicaid payment. See exception at D-372.
Public institution means an institution that is the responsibility of a government unit or over which a governmental unit exercises administrative control.
"Public Institutions" include:
If an individual in a public institution must be temporarily transferred to a medical treatment or evaluation facility, or if he/she is given temporary furlough, the individual is still considered to be under custody of the penal system and is not eligible for a Medicaid payment. See exception at D-372.
An individual will be considered in a public institution until the indictment against the individual is dismissed, or until he/she is released from custody either as "not guilty" or for some other reason (bail, parole, pardon, suspended sentence, home release program, probation, etc.).
"Public institutions" do not include:
MS Manual 08/01/15
Individuals in the custody of the Arkansas Department of Correction (ADC), Arkansas Department of Community Correction (ADCC), county jail, city jail, juvenile detention facility or Division of Youth Services (DYS) will be allowed to submit an application for Medicaid up to 45 days prior to the individual's scheduled release date. Applications will be submitted online at www.access.arkansas.gov, or by paper application, DCO-151, Application for Health Coverage Single Adults, which will be submitted to the local DHS county office.
If eligible, Medicaid will not start until the individual is released from custody. The authorized representative from the facility will notify DHS of the actual release date.
MS Manual 08/01/15
An individual in the custody of ADC, ADCC, or a local correctional facility who has been admitted and received treatment at an inpatient facility may be eligible for Medicaid payment provided all eligibility requirements are met. Eligibility will be determined in accordance with MS Sections D, E and F. Only the inmate will be included in the Medicaid household. The coverage period will begin on the hospital admission date and end on the hospital discharge date.
MS Manual 08/01/15
The appropriate correctional facility will notify DHS when a Medicaid or Health Care Independence Program recipient enters the ADC, ADCC, the county jail, city jail, or a juvenile detention facility. When this notification is received, DHS will place that individual's Medicaid coverage in suspended status for up to twelve (12) months from the initial approval or most recent renewal.
When an individual with suspended Medicaid eligibility receives eligible medical treatment off the grounds of the detention facility or is released from custody, the individual's case will be reinstated if the reinstatement date is within the twelve (12) month period from the individual's initial approval or most recent renewal. For those individuals receiving eligible treatment while off the correctional facility grounds, Medicaid will be re-instated for a fixed eligibility period from the date of hospitalization to the date of hospital discharge. The case will be re-suspended following the fixed eligibility period.
If the individual is in the correctional facility when a redetermination comes due, the case will be closed due to the individual's incarceration status. If the same individual with a closed case requires overnight medical treatment off the correctional facility grounds, the correctional facility will submit a new application for the individual and once approved, the treatment stay will be approved for a fixed eligibility period and the case will be placed in suspended status for a new 12-month period.
Those individuals with suspended coverage that are being released from custody while their case is in suspended status will have their coverage reinstated on the date of their release from the correctional facility.
MS Manual 01/30/15
When a child enters the custody of DYS, an automated notice will be sent via DHS Share to the designated staff in the county office. The notification will contain the county residence code, county name, the child's social security number, name, date of birth and the date the child entered custody. The information will be retrieved from DHS SHARE by the designated worker who will take appropriate case action (i.e. case closure or dropping a child).
MS Manual 01/30/15
When a child leaves the custody of DYS, an automated notice will be sent via DHS Share to the designated staff in the county office. The notification will contain the county residence code, the county name, the child's social security number, name, date of birth, the date the child is released from custody, and the DYS staff who has been assigned to this child. The information will be retrieved from DHS SHARE by the designated worker who will take appropriate case action.
Upon receipt of the date of discharge for a child, if it is time for a reevaluation, the county will send a reevaluation application to the parent or guardian to complete and return within 10 days. If the reevaluation packet is not received within the 10 days, another 10-day notice will be sent for completion of the reevaluation application. If the application is not received within the additional 10 days, an adequate notice will be sent stating the case has been closed. Before closing the case, the DCO eligibility worker should notify the DYS Service Manager and request his or her assistance in getting the requested information.
If a reevaluation application is needed to process continued eligibility, the eligibility worker will also notify the DYS Service Manager that an application is needed. Therefore, the DYS Service Manager can assist the family in getting the application completed and returned to DCO for processing.
Upon receipt of the permanent date of discharge, the following procedures will be followed by the county.
* If the child is returned to the same home that he or she left prior to entering DYS custody and the Medicaid case is still open with other children, the child will be added to the case. This case action will be treated as a change and a new application will not be required.
* If the child is returned to the same home that he or she left prior to entering DYS custody and was the only Medicaid eligible child in the home, the case will be reopened. If it is within the reevaluation period, a new application will not be required.
* If the child is returned to the same home that he or she left prior to entering DYS custody and it is time for the reevaluation, add the child to the case. Then complete the reevaluation including the child released from DYS custody in the standard of need.
* If the child is returned to a different home, an application will be needed to determine eligibility.
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
When citizenship cannot be verified through the Federal Data Services Hub (FDSH) or the SSA match, the worker must access Vital Records through ARFinds for verification of birth. If citizenship documentation cannot be obtained through Vital Records, specific forms of documentation may be acceptable evidence of citizenship. If an individual presents evidence from the listing of Primary Documentation, no other information is required.
To establish U.S. citizenship, the document must show a U.S. place of birth and that the person is a U.S. citizen. The documents must be original or certified copies. Copies of documents already obtained will be accepted as assumed made from the original unless questionable (e.g. stamped "copy", or unreadable).
In general, the caseworker should obtain primary evidence of citizenship before using the secondary documentation or tertiary list. The following forms of documentation may be accepted:
Primary documentation- The highest reliability that conclusively establishes identification and citizenship.
* A U.S. Passport.
* A Certificate of Naturalization (Department of Homeland Security (DHS) Forms N-550 or N-570).
* A Certificate of U.S. Citizenship (DHS Forms N-560 or N-561).
Secondary documentation- Secondary evidence of citizenship is documentary evidence of satisfactory reliability that is used when primary evidence of citizenship is not available.
* A U.S. birth certificate.
* A Certification of birth issued by the Department of State (Form DS-1350).
* A Report of Birth Abroad of a U.S. Citizen (Form FS-240).
* A Certification of Birth Abroad (FS-545).
* An American Indian Card issued by the Department of Homeland Security with the classification code "KIC". (Issued by DHS to identify U.S. citizen members of the Texas Band of Kickapoos living near the U.S./Mexican border).
* Final adoption decree.
* Evidence of civil service employment by the U.S. government before June 1976.
Revised (08/15)
* An official military record of service showing a U.S. place of birth.
* A Northern Mariana Identification Card (issued by the INS to a collectively naturalized citizen of the United States who was born in the Northern Mariana Islands before November 4, 1986.
Third level documentation- Third level evidence of U.S. citizenship is documentary evidence of satisfactory reliability that is used when neither primary nor secondary evidence of citizenship is available. This documentation includes:
* Extract of U.S. hospital record of birth established at the time of the person's birth, created at least 5 years before the initial application date and indicating a U.S. place of birth.
* Life or health or other insurance record created at least 5 years before the initial application date showing a U.S. place of birth.
* Religious records recorded in the U.S. within 3 months after the birth which show that the birth occurred in the U.S. showing the date of the birth of the individual or the individual's age at the time the record was made. These must be official records recorded with the religious organization (e.g., baptismal certificates). Entries in a family bible are not considered recorded religious records.
* Early school records which show the name of the child, the date of admission to the school, the date of birth (or age at the time the record was made), a U. S. place of birth, and the name(s) and place(s) of birth of the applicant's parents.
Fourth level documentation- Fourth level evidence of U.S. citizenship is documentary evidence of the lowest reliability. This level should only be used in the rarest of circumstances. This level of evidence is used only when primary evidence is not available, both secondary and third level evidence do not exist or cannot be obtained within the reasonable opportunity period, and the applicant alleges a U.S. place of birth. This documentation includes:
* Federal or State census record showing U.S. citizenship or a U.S. place of birth, as well as the applicant's age.
* Birth records that were recorded with vital statistics 5 years after a birth (a delayed birth record).
* Institutional admission papers from a nursing home, skilled nursing care facility or other institution created at least 5 years before the initial application date and which indicate a U.S. place of birth.
Revised (08/15)
* Medical (clinic, doctor, or hospital) record which was created at least 5 years before the initial application date and indicates a U.S. place of birth unless the application is for a child under 5.
* Other document that was created at least five years before application for Medicaid. These documents are Seneca Indian tribal census record, Bureau of Indian Affairs tribal census records of the Navaho Indians, U.S. State Vital Statistics official notification of birth registration, an amended U.S. public birth record that is amended more than 5 years after the person's birth or a statement signed by the physician or midwife who was in attendance at the time of birth.
* The Roll of Alaska Natives maintained by the Bureau of Indian Affairs.
* Written affidavit. This should be in rare circumstances when the applicant or recipient cannot provide evidence from another listing.
Written affidavits may be used in circumstances when the state is unable to secure evidence of citizenship from another listing. The affidavits must be supplied by at least two individuals, one of whom is not related to the recipient. Each must attest to having a personal knowledge of the event(s) establishing the recipient's claim of citizenship. Those making affidavits will be subject to prosecution for perjury. If the persons claiming knowledge of another's citizenship has information, which explains why documentary evidence establishing the claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well.
A second affidavit from the recipient or other knowledgeable individual explaining why documentary evidence does not exist or cannot be readily obtained must also be requested.
If citizenship is verified with a document on the secondary or lower level listed above, providing proof of identity will be required. Acceptable forms of identity are:
NOTE: If the expiration date has expired, the ID is still acceptable.
When an individual's INS documentation appears valid but does not have the necessary coding to show the alien's status, or the entry or admission date is missing, verification of the alien's status can be obtained through SAVE's automated database, the Alien Status Verification Index (ASVI).
To access the ASVI:
* Using a touch-tone phone, dial the toll-free system number, 1-800-365 -7620.
* Enter the access code, then press the pound (#) sign when instructed by the recorded message.
* Enter the alien registration number when instructed by the recorded message. The alien registration number is a series of digits preceded by the letter "A." Do not enter the "A." If the number is less than nine digits, use zeros at the beginning of the number to make it nine digits. (E.g., if the number is "A12345" enter it as "000012345.")
If a record for the alien is found, the ASVI system will give the alien's:
* Registration number.
* Verification number.
* Last and first name, spelled out.
* Date of birth.
Revised (08/15)
* Status code.
* Country of birth code.
* Social Security number.
* Date of entry.
If no record is found for the alien, the ASVI system will instruct you to "institute secondary verification." When this message is received, use form G-845, Document Verification Request, to request information from INS.
Secondary Documentation of Alien Status
Secondary documentation is the process for obtaining status information from the INS when using form G-845, Document Verification Request, and its supplement.
Obtain secondary documentation only when:
* SAVE instructs you to do so.
* The documentation the individual provided shows an eligible status, but the document itself is expired or appears questionable or not genuine.
* The documentation is a receipt showing that the alien has an eligible status but has applied to INS for a replacement card.
* The INS documentation appears to be genuine and the alien claims to have an eligible status, but necessary codes or dates are missing from the card.
Until verification is received from the INS indicating the individual is a qualified alien, the individual should be treated as a nonqualified alien.
The chart below shows the types of documentation that can be used to verify alien status, and additional verification that certain aliens must provide to verify that they are eligible for Medicaid (e.g., the date they were admitted to the U.S., or the date a particular alien status was granted or adjusted).
Revised (08/15)
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
Alien Status | Acceptable Documentation of Alien Status | Medicaid Status |
Amerasian Immigrant | * INS Form I-551, Permanent Resident Card, annotated AM6, AM7 or AM8. * Unexpired temporary I-551 stamp in a foreign passport annotated AM1, AM2 or AM3. * INS Form I-94, Arrival/Departure Record, annotated AM1, AM2 or AM3. | Eligible Regardless of U.S. entry date |
Asylee | * INS Form I-94, Arrival/Departure Record, noting admittance under section 208 of the INA. * INS Form I-94, Arrival/Departure Record, annotated AS-1, AS-2 or AS-3. * INS Form I-94, Arrival/Departure Record, with Visa 92 or V-92. * Order of an immigration judge granting asylum. * Written decision letter from the Board of Immigration Appeals. * INS Form I-688B, Employment Authorization Card, annotated "274a.12(a)(5)." * INS Form I-730, Approval Letter. * INS Form I-766, Employment Authorization Document, annotated "A5." | Eligible as of date asylum is granted. |
Battered Alien | Proof of admission of entry date and one of the following documents: * I-360 or I-130 petition with proof of filing (a file-stamped copy of the petition, an I-797 or I-797VC, or another document demonstrating filing, such as a signed certified return receipt or cash register or computer-generated receipt). * INS Form I-797 or I-797C indicating approval or prima facie validity of an I-360 petition. * INS Form I-797 or I-797C indicating filing or approval of an I-130 petition. * Order or document from the Immigration Court or Board of Immigration Appeals granting suspension of deportation under INA section 244(a)(3), or cancellation or removal under INA section 204A(b)(2). * Application for cancellation of removal (Form EOIR 42B) or suspension of deportation (Form EOIR 40) with proof of filing (a file-stamped copy of the application or another document demonstrating filing, such as a signed certified return receipt or cash register or computer-generated receipt). * A document from the Immigration Court or Board of Immigration Appeals indicating that the applicant has established a prima facie case for suspension of deportation under INA section 244(a)(3), or cancellation of removal under INA section 204A(b)(2). | Barred for five (5) years if entered U.S. on or after 8/22/96. Eligible if entered U.S. before 8/22/96. |
Canadian-born American Indian | * INS Form I-551, Alien Registration Receipt Card, coded S13. * I-551 stamp in a Canadian passport coded S13. * INS Form I-94, Arrival/Departure Record, coded S13. * Proof of tribal membership or a tribal document showing the individual has at least 50% American Indian blood. Proof of membership can be a tribal membership card, other tribal documents showing membership, or collateral contact with the tribe's government. | Eligible Regardless of U.S. entry date |
Conditional Entrant | Proof of admission or entry date and one of the following documents: * INS Form I-94, Arrival/Departure Record, with stamp showing admission under section 203(a)(7) of the INA. * INS Form I-688B, Employment Authorization Card, annotated "274a.12(a)(3)." * INS Form I-766, Employment Authorization Document, annotated "A3." | Barred for five years if entered U.S. on or after 8/22/96. Eligible if entered U.S. before 8/22/96 |
Cuban or Haitian Entrant | * INS Form I-551, Permanent Resident Card, annotated CU6, CU7 or CH6. * Unexpired temporary I-551 stamp in a foreign passport annotated AM1, AM2 or AM3. * INS Form I-94, Arrival/Departure Record, annotated CU6 or CU7, or with a stamp showing parole as "Cuban/Haitian Entrant" under section 212(d)(5) of the INA. | Eligible regardless of U.S. entry date |
Deportation or removal withheld | * INS Form I-688B, Employment Authorization Card, annotated "274a.12(a)(10)." * INS Form I-766, Employment Authorization Document, annotated "A10." * Order of an immigration judge showing deportation withheld under section 243(h) or removal withheld under section 241(b)(3) of the INA and date of grant. | Eligible Regardless of U.S. entry date |
Lawfully admitted for permanent residence | * INS Form I-551, Permanent Resident Card. * Unexpired "Temporary I-551" stamp in a foreign passport. * INS Form I-94, Arrival/Departure Record, with a temporary I-551 stamp. | With proof of 40 qualifying quarters, eligible regardless of U.S. entry date. Without 40 qualifying quarters: * Barred for five years if entered U.S. on or after 8/22/96. * Eligible if entered U.S. before 8/22/96. |
Paroled into U.S. for at least one year | Proof of admission or entry date and INS Form I-94, Arrival/Departure Record, showing admission for at least one year under section 212(d)(5) of the INA. Note:The applicant cannot use admission periods for less than one year to meet the one-year requirement. | Barred for five years if entered U.S. on or after 8/22/96 Eligible if entered U.S. before 8/22/96 |
Refugee | * INS Form I-94, Arrival/Departure Record, showing entry under section 207 of the INA. * INS Form I-688B, Employment Authorization Card, annotated "274a.12(a)(3)." * INS Form I-766, Employment Authorization Document, annotated "A3." * INS Form I-571, Refugee Travel Document. Note:Refugees who have adjusted to lawful permanent resident status are still considered refugees for Medicaid eligibility. If a refugee has a Form I-551, Permanent Resident Card*, it will be annotated RE-6, RE-7, RE-8, RE-9 or R8-6. | Eligible regardless of U.S. entry date |
Veteran or active duty military personnel lawfully admitted for permanent residence (and families) | To verify alien status: * INS Form I-551, Permanent Resident Card. * Unexpired "Temporary I-551" stamp in a foreign passport. * INS Form I-94, Arrival/Departure Record, with a "Temporary I-55I" stamp. To verify military status: * Honorably discharged veteran: Original or notarized copy of form DD214 (discharge papers). Note:This verification is sufficient when the veteran is a U.S. citizen, and the spouse or unmarried dependent children (or surviving spouse and unmarried dependent children of a deceased veteran) are aliens. * Active duty: Original or notarized copy of the current orders showing the person is on full-time duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard, or a DD form 2 military ID card (active duty papers). | Eligible regardless of U.S. entry date |
Other (legal or illegal) | Documents that indicate the person's alien status is one other than those specifically listed under Aliens Subject to Five-Year Bar (MS D-223) or under Aliens Exempt from Five-Year Bar (MS D-224). | Ineligible regardless of U.S. entry date |
*In 1998, the INS changed the name of Form I-551 from "Alien Registration Receipt Card" to "Permanent Resident Card" because the new name more appropriately identifies the individual as having permanent resident status.
If the documentation provided does not contain all the information needed to establish the alien's eligibility, additional verification can be obtained from the INS by contacting them in writing, using form G-845, or by contacting SAVE by phone.
If the documentation provided appears questionable, contact INS in writing using form G-845 to attempt verification of the document, rather than using SAVE.
Revised (08/15)
SSNs that have mismatched through the electronic verification process will be submitted to the queue with a message that the SSN could not be verified.
To resolve the mismatch, first check for obvious mismatches, (e.g., errors in keying the SSN, sex, name or date of birth). Next check SOLQ to determine if a correction can be made in the system from the SSA data on SOLQ.
Other methods of resolving a mismatch include:
* Viewing the social security card. The name in the system must match the name on the social security card; and
* Viewing a copy of the birth certificate or other proof of age or date of birth mismatch.
Household Cooperation in Clearing the Mismatch
When declared SSNs are returned by SSA as unverified, it is often necessary for the household to furnish the information necessary to resolve the mismatch.
A request for contact must be issued by the caseworker to advise the recipient of the mismatch, what caused the problem (e.g., name is incorrect) and what information must be provided to resolve the problem. The recipient will be given 10 days to furnish the information. If the household does not furnish the needed information by the end of the designated 10-day period an advance notice of adverse action will be issued.
The notice will specify that:
If the recipient claims that the information needed to clear the mismatch report cannot be furnished, the caseworker must substantiate the inability to provide the needed information. For example, a household may claim it cannot verify a name change because official records were destroyed in a fire. The case worker would attempt to verify the occurrence of the fire because SSA records cannot be corrected without the missing documentation. If the
Revised (08/15)
caseworker verifies that the recipient cannot provide the information needed to verify the SSN, the individual may continue to participate if otherwise eligible.
All actions taken to clear SSN mismatches must be fully documented in the system.
Monitoring
The DCO Supervisor, or designee in the absence of the supervisor, will be responsible for monitoring the mismatch notifications.
Revised (08/15)
016.20.15 Ark. Code R. 002