Family and Children's Medicaid MA-3215 Processing the Application
IV. pROCEDURES FOR APPLICATIONS RECEIVED FROM PRISONERS WITH INPATIENT HOSPITALIZATIONS
NC Department of Public Safety, Division of Prisons (DOP) will take applications from inmates who have inpatient hospitalizations but who will remain incarcerated after release from the hospital. Automated suspension for incarcerated individuals will allow the IMC approve cases in suspension status. See MA-2510, Living Arrangement.
A. DOP will forward the applications and signed authorizations to each prisoner’s last county of residence for processing.
B. Follow procedures in MA-2307/3207, Mail in Applications. The application date is the date the application is received by the county DSS. If incomplete, return the application, including the cover letter to the Medicaid Coordinator at DOP to 831 W. Morgan Street, Raleigh, NC 27603.
REISSUED 03/01/14 – CHANGE NO. 01-14
C. Key “P” source code in the HOW APP RECEIVED field on the 8124 screen.
D. If a disability determination is required, DOP will complete the DMA-5009, Social History, provide a signed DMA-5028, Authorization to Disclose Information, for each for each medical source, and forward these documents along with up to 12 months of medical records in DOP possession. Refer the case to DDS following procedure in MA-2525.
E. DOP is the Authorized Representative for all prisoner a/bs. If additional information is needed, send a 5097, Request for Information, to: “Medicaid Coordinator”, 831 W. Morgan Street, Raleigh, NC 27603. The Medicaid Coordinator can be reached at (919) 838-4000.
F. Key the beneficiary address in EIS as the Medicaid Coordinator.
G. If an incarcerated individual is eligible but for his status as a prisoner, enter a living arrangement code of 16 and a CCNC exempt code of 990058. This will put his Medicaid eligibility in suspension. Coverage is limited to medical services received during an inpatient stay.