Tahanan Mga Tagapagbigay ng Serbisyo at Kasosyo Programa ng Bilanggo ng Estado ng Medi-Cal at Programa ng Bilanggo ng Medi-Cal County

Medi-Cal State Inmate Programa at Medi-Cal County Inmate Programa

Kasaysayan

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.

Pederal na Awtoridad

Section 1905(a)(29)(A) of the Social Security Act
- Hindi kasama sa tulong medikal ang pangangalaga o mga serbisyo para sa isang bilanggo ng isang pampublikong institusyon, maliban bilang isang pasyente sa isang institusyong medikal.

Awtoridad ng Estado

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

Pangkalahatang-ideya

Ang Medi-Cal Inmate Programa ay nangyayari sa parehong antas ng Estado at County at pinapayagan Medi-Cal na pinapahintulutang mga serbisyo sa ospital para sa inpatient, kabilang ang mga serbisyo ng inpatient na psychiatric, at mga serbisyo ng doktor na ibinibigay sa panahon ng pananatili sa ospital ng inpatient ng mga preso sa mga correctional facility na natukoy na karapat-dapat para sa 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.