Revision 21-4; Effective December 1, 2021

A person confined in a public institution, including a jail, prison, reformatory or other correctional or holding facility, is not eligible for Medicaid.;

Permanent Release

A person who enters a Medicaid certified long-term care facility, skilled nursing facility, nursing facility or intermediate care facility for people with an intellectual disability or related condition after a permanent release from a correctional facility is not considered to be in a public institution.

Related Policy

People Confined in a County Jail in Texas, D-3810

D-3810 People Confined in a County Jail in Texas

Revision 22-2; Effective June 1, 2022

When a Texas county jail reports a Medicaid recipient is confined for more than 30 days, suspend or terminate benefits.

If notified of the person’s confinement from a source other than a county jail in Texas, terminate the person’s Medicaid.

Suspension

Suspend Medicaid within two business days of receiving a report of confinement from a county jail for the following types of assistance (TOAs):

  • TA 10, ME – Waivers
  • TA 88, ME – Medicaid Buy-In for Children
  • TP 03, ME – Pickle
  • TP 14, ME – Community Attendant Services
  • TP 18, ME – Disabled Adult Child
  • TP 21, ME – Disabled Widow(er)
  • TP 22, ME – Early Aged Widow(er)
  • TP 23, MC – SLMB
  • TP 24, MC – QMB
  • TP 26, MC – QI-1

The suspension is effective the day after the report of confinement is received.

Provide a new reasonable opportunity period to submit documentation of citizenship or alien status if a person’s original reasonable opportunity period expires during the suspension period. The new reasonable opportunity period is the earlier of:

  • 95 days from the date the reinstatement is disposed; or
  • the last day of their current certification period.

Keep the original reasonable opportunity period if the person’s Medicaid coverage is reinstated before the reasonable opportunity period end date.

The TF0001, Notice of Case Action, generated at reinstatement will include the reasonable opportunity information to remind the person to submit documentation of citizenship or alien status.

Note: For couple cases, suspend Medicaid for the incarcerated person only. The spouse may continue to receive benefits, if eligible.

Reinstatement

Reinstate Medicaid that was suspended due to incarceration in a county jail within two business days of receiving notification from any source that a person has been released from a Texas county jail. To reinstate Medicaid:

  • Perform individual inquiry. Determine if the person has suspended Medicaid.
  • If Medicaid is suspended, perform a County Jail Release - Search. Determine if:
    • the person’s Medicaid was suspended due to confinement; and
    • there are months remaining in their original certification period.
  • If yes, create a Process a County Jail Confinement/Release task for all active cases where the person was included before suspension. Enter the release information into TIERS on the County Jail Release - Details page.

Medicaid coverage is reinstated effective the date of the person’s release from the county jail for the remaining months of the original certification period. Form TF0001 is generated to notify the person of the reinstatement.

Consider the report of release as a change report for all other types of assistance. Determine if the person needs to be added to the other types of assistance.

If the person’s health care coverage terminated at confinement or the original certification period has ended, the person is not eligible for reinstatement. Send a Medicaid application to the person’s last known address.

Termination

Terminate Medicaid within two business days of receiving a report of confinement for the following TOAs:

  • TA 12, ME – State Group Home
  • TP 10, ME – State Supported Living Center
  • TP 15, ME – Non-State Group Home
  • TP 16, ME – State Hospital
  • TP 17, ME – Nursing Facility
  • TP 25, MC – QDWI
  • TP 87, ME – Medicaid Buy In

Medicaid is terminated effective the day after HHSC receives the notification.

Related Policy

People confined in a Public Institution, D-3800
Reasonable Opportunity to Provide Verification of Alien Immigration Status, D-8841