Inicio Proveedores y socios Medi-Cal Reclusos Estatales Program y Reclusos del Condado Medi-Cal Program

Medi-Cal Reclusos del Estado Program y Medi-Cal de Reclusos del Condado de Program

Historia

Federal law prohibits claiming Medicaid funds for healthcare services provided to inmates residing in correctional facilities. There is an exception to this federal prohibition when an inmate receives inpatient services at a medical facility located off the grounds of the correctional facility for an expected stay of more than 24 hours, and the inmate is found to be Medicaid eligible.

Autoridad Federal

Section 1905(a)(29)(A) of the Social Security Act
- La asistencia médica no incluye la atención o los servicios prestados a un recluso de una institución pública, excepto como paciente en una institución médica.

Autoridad Estatal

Assembly Bill (AB) 1628 (Chapter 729, Statutes of 2010) – Adults
- Welfare and Institution Code (WIC) §14053.7
Assembly Bill (AB) 396 (Chapter 394, Statutes of 2011) – Juveniles
Senate Bill (SB) 695 (Chapter 647, Statutes of 2011) – Juveniles
- Welfare and Institution Code (WIC) §14053.8
Senate Bill (SB) 1462 (Chapter 837, Statutes of 2012) – Compassionate Release and Medical Probation
- Government Code (GOV) §26605.6; GOV §26605.7 & GOV §26605.8

Visión general

La para reclusos Medi-Cal Program se lleva a cabo tanto a nivel estatal como del condado y permite Medi-Cal servicios hospitalarios permitidos para pacientes hospitalizados, incluidos los servicios psiquiátricos para pacientes hospitalizados y los servicios médicos proporcionados durante la estadía hospitalaria de los reclusos en instalaciones correccionales que se determine elegibles para Medi-Cal.

The Medi-Cal County Inmate Program (MCIP) is voluntary and counties have the option to participate in this program by entering into an agreement with the Department of Health Care Services (DHCS). Per legislation, there is to be no General Fund (GF) impact under MCIP. The purpose of the MCIP agreement is to establish the amounts needed to satisfy each county’s responsibility to reimburse DHCS for the nonfederal share of MCIP service costs incurred by DHCS. If a County does not participate in MCIP or does not abide by the terms of this Agreement, the County remains responsible for arranging for and paying for medical care for its inmates.

The Medi-Cal State Inmate Program (MSIP) is unique from standard Medi-Cal claiming because Medi-Cal providers do not directly bill the DHCS for MSIP services. Under the MSIP, the California Department of Corrections and Rehabilitation (CDCR) pays providers for healthcare services rendered to state inmates off the grounds of the correctional facility, and submits claims to the DHCS’ Fiscal Intermediary (FI) for Medi-Cal allowable services provided to MSIP eligible inmates. DHCS’ FI prices the claims and suspends without payment and forwards claims data to the Safety Net Financing Division (SNFD). SNFD generates an invoice for federal reimbursement paid to CDCR.