Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Kev Pab Cuam Rau Cov Neeg Raug Kaw Hauv Xeev Medi-Cal thiab Kev Pab Cuam Rau Cov Neeg Raug Kaw Hauv Nroog Medi-Cal

Medi-Cal State Inmate Program thiab Medi-Cal County Inmate Program

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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.

Federal Authority

Section 1905(a)(29)(A) of the Social Security Act
- Kev pab kho mob tsis suav nrog kev saib xyuas lossis kev pabcuam rau tus neeg raug kaw hauv lub tsev kho mob pej xeem, tshwj tsis yog tus neeg mob hauv lub tsev kho mob.

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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

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Qhov Kev Pabcuam Medi-Cal Inmate Program tshwm sim ntawm ib lub Xeev thiab Lub Nroog thiab tso cai rau Medi-Cal cov kev pabcuam hauv tsev khomob uas tso cai rau tus neeg mob hauv tsev khomob, suav nrog cov kev pabcuam puas hlwb hauv tus neeg mob, thiab cov kev pabcuam kws khomob muab rau lub sijhawm tus neeg mob nyob hauv tsev khomob ntawm cov neeg raug kaw hauv tsev khomob uas tau txiav txim siab tsim nyog rau 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.