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DMA ADMINISTRATIVE LETTER NO: 09-08, medicaid suspension

DATE: August 27, 2008

SUBJECT: Medicaid Suspension for Incarcerated Recipients and Recipients who enter an Institution for Mental Diseases.

DISTRIBUTION: County Directors of Social Services

All Medicaid Eligibility Staff

I. Background

II. MEDICAID Principles

III. MEDICAID Policy

IV. EIS PROCEDURE

Change Codes

9I

Your Medicaid benefits will be suspended because you are incarcerated. Your Medicaid coverage is limited to payment of medical services related to an inpatient hospital stay. No card will be issued.

9L

Your Medicaid benefits will be suspended because you are in an Institution for Mental Diseases. You will not have any Medicaid coverage during the suspension. No card will be issued.

9P

Your Medicaid benefits will remain in suspension because you are now in an Institution for Mental Diseases. You will not have any Medicaid coverage during the suspension. No card will be issued.

9S

Your Medicaid benefits will remain in suspension because you are now incarcerated. Your Medicaid coverage is limited to payment of medical services related to an inpatient hospital stay. No card will be issued.

9U

Your Medicaid benefits were suspended while you were incarcerated. Your Medicaid benefits have now been released from suspension.

9V

Your Medicaid benefits were suspended while you were in an Institution for Mental Diseases. Your Medicaid benefits have now been released from suspension.

Transfer Codes

78

Your Medicaid will be suspended because you are incarcerated. Your Medicaid coverage is limited to payment of medical services related to an inpatient hospital stay. No card will be issued.

98

Your Medicaid will be suspended because you are in an Institution for Mental Diseases. You will not have any Medicaid coverage during the suspension. No card will be issued.

WFFA Deletion Codes

8N

You cannot receive WFFA because you are incarcerated. You are being evaluated for Medicaid and will receive a separate notice.

8O

You cannot receive WFFA because you are in an Institution for Mental Diseases. You are being evaluated for Medicaid and will receive a separate notice.

Transitional Medicaid Deletion Codes

8W

You cannot receive Transitional Medicaid because you are incarcerated. You are being evaluated for Medicaid and will receive a separate notice.

8X

You cannot receive Transitional Medicaid because you are in an Institution for Mental Diseases. You are being evaluated for other Medicaid and will receive a separate notice.

If you have any questions, please contact your Medicaid Program Representative. For any issues that are not able to be handled through that venue, Mrs. Angela Floyd, Assistant Director for Recipient and Provider Services will be your point of contact and can be reached at (919) 855-4000.

(This material was researched and written by Mary Spivey, EIS Policy Consultant and Linda Faulkner, Projects Coordinator, Medicaid Eligibility Unit.)

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