Skip navigation
The Habeas Citebook: Prosecutorial Misconduct - Header

Nc Doc Audit Inmate Medicaid Eligibility 2010

Download original document:
Brief thumbnail
This text is machine-read, and may contain errors. Check the original document to verify accuracy.
STATE OF
NORTH CAROLINA

PERFORMANCE AUDIT
DEPARTMENT OF CORRECTION
INMATE MEDICAID ELIGIBILITY
AUGUST 2010

OFFICE OF THE STATE AUDITOR
BETH A. WOOD, CPA
STATE AUDITOR

PERFORMANCE AUDIT

DEPARTMENT OF CORRECTION
INMATE MEDICAID ELIGIBILITY

AUGUST 2010

STATE OF NORTH CAROLINA

Office of the State Auditor

Beth A. Wood, CPA
State Auditor

2 S. Salisbury Street
20601 Mail Service Center
Raleigh, NC 27699-0601
Telephone: (919) 807-7500
Fax: (919) 807-7647
Internet
http://www.ncauditor.net

August 18, 2010
The Honorable Beverly Eaves Perdue, Governor
Members of the North Carolina General Assembly
Mr. Alvin W. Keller, Jr., Secretary, Department of Correction
Ladies and Gentlemen:
We are pleased to submit this performance audit titled Inmate Medicaid Eligibility. The audit
objective was to determine if the Department of Correction could reduce inmate health care
costs by requiring hospitals and other medical service providers to bill Medicaid for eligible
inmate inpatient hospital and professional services. Mr. Keller reviewed a draft copy of this
report. His written comments are included in the appendix.
The Office of the State Auditor initiated this audit to identify opportunities for cost-savings.
We wish to express our appreciation to the staff of the Department of Correction for the
courtesy, cooperation, and assistance provided us during the audit.
Respectfully submitted,

Beth A. Wood, CPA
State Auditor

TABLE OF CONTENTS

PAGE
SUMMARY .................................................................................................................................1
INTRODUCTION
BACKGROUND ..................................................................................................................2
OBJECTIVES, SCOPE, AND METHODOLOGY ......................................................................2
FINDINGS AND RECOMMENDATIONS ..........................................................................................3
APPENDIX
DEPARTMENT RESPONSE .................................................................................................8
LETTER FROM STATE AUDITOR TO CMS ......................................................................10
LETTER FROM CMS TO STATE AUDITOR ......................................................................12
1998 LETTER FROM HCFA............................................................................................14
1997 LETTER FROM HCFA............................................................................................18
ORDERING INFORMATION ........................................................................................................22

SUMMARY
PURPOSE
This audit report evaluates whether the Department of Correction (Department) could reduce
inmate health care costs by requiring hospitals and other medical service providers to bill
Medicaid for eligible inmate inpatient hospital and professional services and makes
recommendations so Department management can take appropriate corrective action.
RESULTS
The Department could save about $11.5 million a year by requiring hospitals and other
medical service providers to bill Medicaid for eligible inmate inpatient hospital and
professional services. Because the federal government reimburses the State approximately
$.65 for every $1.00 spent on Medicaid, billing Medicaid for eligible inmate health care
would reduce the Department’s costs by transferring those costs to the federal government.
The Department would also realize reduced costs because hospital and medical services for
eligible inmates would be paid at Medicaid rates that are lower than the rates currently paid
by the Department.
To realize these savings, the Department may need to obtain or train Medicaid eligibility
specialists and establish procedures to determine Medicaid eligibility for inmates and ensure
that Medicaid eligibility is not terminated when inmates return from medical institutions.
Federal reimbursement is available to offset some of the administrative costs that the
Department may incur.
Although not within the scope of this audit, local governments could also realize savings by
requiring medical providers to bill Medicaid for eligible inmate health care. Inquiry of
officials in two counties and an organization that manages inmate health care for 45 counties
indicates that local governments do not bill Medicaid for any inmate health care.
RECOMMENDATIONS
The Department should require hospitals and other medical providers to bill Medicaid for
eligible inmate inpatient health care costs. The Department should work with the Department
of Health and Human Services, County Directors of Social Services, and local governments to
establish the necessary policies and procedures.
AGENCY’S RESPONSE
The Agency’s response is included in the Appendix A.

1

INTRODUCTION
BACKGROUND
The Eighth Amendment of the United States Constitution requires states to provide inmates
with adequate medical treatment. In accordance with the Constitution, North Carolina
General Statute 148-19 requires the Department of Correction (Department) to provide health
services to prisoners.
The Department cooperates with 35 hospitals to provide medical services for over 40,000
inmates housed in 71 prison facilities across the State.
During the 2008 and 2009 calendar years, the Department paid about $159.8 million for
inmate health care.
OBJECTIVES, SCOPE, AND METHODOLOGY
The audit objective was to determine if the Department could reduce inmate health care cost
by requiring hospitals and other medical service providers to bill Medicaid for eligible inmate
inpatient hospital and professional services.
The Office of the State Auditor initiated this audit to identify opportunities for cost-savings.
The audit scope included the Department’s inmate medical costs and inmate medical
information for calendar years 2008 and 2009. We conducted the fieldwork from March to
June 2010.
To determine if the state could reduce inmate health care costs, we interviewed Department
staff and reviewed inmate medical claims data. We obtained the services of specialists to
identify inmates who were likely Medicaid eligible and to calculate potential savings. We
obtained a letter from the Centers for Medicare & Medicaid Services to clarify federal
regulations concerning inmate Medicaid eligibility. We interviewed Department of Health and
Human Services, Division of Medical Assistance staff. We interviewed personnel from states
that charge Medicaid for inmate health care costs.
Because of the test nature and other inherent limitations of an audit, together with limitations
of any system of internal and management controls, this audit would not necessarily disclose
all performance weaknesses or lack of compliance.
We conducted this performance audit in accordance with generally accepted government
auditing standards. Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions
based on our audit objectives. We believe that the evidence obtained provides a reasonable
basis for our findings and conclusions based on our audit objectives.
We conducted this audit under the authority vested in the State Auditor of North Carolina by
North Carolina General Statute 147.64.

2

FINDINGS AND RECOMMENDATIONS

$11.5 MILLION A YEAR IN INMATE HEALTH CARE COST SAVINGS IS AVAILABLE
The Department of Correction (Department) could save about $11.5 million a year by
requiring hospitals and other medical service providers to bill Medicaid for eligible
inmate inpatient hospital and professional services. 1 The amount of potential savings
will increase when health care reform expands Medicaid eligibility in 2014. To realize
these savings, the Department will need to determine Medicaid eligibility for inmates and
ensure that Medicaid eligibility is not terminated when inmates return from medical
institutions. Although not within the scope of this audit, it is also possible that local
governments could reduce costs by charging eligible inmate health care to Medicaid.
Bill Eligible Inmate Inpatient Health Care Costs to Medicaid
Currently, the Department does not require hospitals or other medical service providers to
bill Medicaid for any inmate health care costs. The Department pays for inmate health
care at rates significantly higher than Medicaid rates. A previous state audit concluded
that the Department pays an average of 467% (from 198% to as high as 879%) of
Medicaid rates for inmate health care costs. 2
The Department could reduce its inmate health care costs if medical providers billed
Medicaid for inpatient services provided to Medicaid-eligible inmates. Inmates could be
Medicaid eligible if they meet the Medicaid eligibility requirements, which include
income and resource limits, citizenship and alien status, state of residence, 20 years old or
younger, 65 years old or older, pregnant, blind, or disabled. Inmates could also be
Medicaid eligible if they are considered physically or mentally disabled under the federal
Supplemental Security Income (SSI) program. There are nine diagnostic categories of
mental disorders under SSI including personality disorders and substance addiction
disorders, which may establish disability.
Generally, the federal government will not reimburse states (called federal financial
participation or FFP) for inmate medical care under the Medicaid program. However, an
exception is allowed “during that part of the month in which the individual is not an
inmate of a public institution.” 3 For purposes of FFP, guidance from the Centers from
Medicare and Medicaid Services 4 (CMS) indicates that inmates lose their “inmate status”
and obtain “inpatient status” when treated in an inpatient hospital setting that is not under
the control of a state’s correction system. Consequently, FFP is available for an inmate’s
health care expenses if the inmate is Medicaid eligible and he or she is an inpatient of a
medical institution.

1

Medicaid is a health insurance program funded by a state and federal partnership for low-income parents, children, seniors,
and people with disabilities. The federal government provides a federal match to state government funding by reimbursing
states a percentage of their Medicaid expenditures.
2
Office of the State Auditor. Department of Correction Fiscal Control Audit. February 2010
3
42 CFR 435.1008
4
CMS is part of the US Department of Health and Human Services. CMS is the federal agency that administers Medicare,
Medicaid, and the Children's Health Insurance Program.

3

FINDINGS AND RECOMMENDATIONS

Correspondence from the CMS, formerly known as the Health Care Finance
Administration (HCFA), a letter from the North Carolina Department of Health and
Human Services (DHHS), and the experiences of five states confirm that FFP is available
for inmate inpatient health care. Specifically:


A May 4, 2010, CMS letter to the State Auditor says, “The North Carolina
Medicaid program potentially could have been billed by enrolled Medicaid
hospitals for services provided to inmates that are inpatients and are also
Medicaid beneficiaries. Charges for professional services that occurred during
the inpatient stays may also be billed on the Medicaid program.” 5



HCFA letters from 1997 and 1998 state, “An exception to the prohibition of FFP
is permitted when an inmate becomes a patient in a medical institution. This
occurs when the inmate is admitted as an inpatient in hospital, nursing facility,
juvenile psychiatric facility, or intermediate care facility. Accordingly, FFP is
available for any Medicaid covered services provided to an ‘inmate’ while an
inpatient in these facilities provided the services are included under a State’s
Medicaid plan and the ‘inmate’ is Medicaid eligible.” 6



An August 27, 2008, DHHS letter to County Directors of Social Services notes
that “medical services received during an inpatient hospital stay for an
incarcerated recipient” who is Medicaid eligible can be charged to Medicaid. 7



Five states (Louisiana, Mississippi, Nebraska, Oklahoma, and Washington) report
that they charge eligible inmate inpatient health care to their Medicaid programs.

Billing Medicaid for eligible inmate health care costs would reduce the Department’s
costs in two ways. First, the Department would realize reduced costs because hospital
and medical services for eligible inmates would be reimbursed at Medicaid rates that are
lower than the rates currently paid by the Department. Second, billing Medicaid for
eligible inmate health care would reduce the Department’s costs by transferring those
costs to the federal government because the federal government reimburses the State
about $.65 for every $1.00 spent on Medicaid.
For example, Chart 1 shows that the Department paid about $26.5 million in inpatient
medical care for inmates who were
Chart 1: Inpatient Costs for Medicaid-eligible Inmates
2008 - 2009
potentially Medicaid eligible during the
$26,492,533
2008 and 2009 calendar years.
At
Medicaid rates, those services would have
only cost the Department about $9.2
million, a $17.3 million savings.
Additionally, the federal government
$3,284,234
would have reimbursed the State about
$5.9 million. As a result, total cost to the
Without Medicaid

5

With Medicaid

S ource: Auditor analysis
See appendix
See appendix
7
Division of Medical Assistance. DMA Administrative Letter No: 09-08, Medicaid Suspension. August 27, 2008
6

4

FINDINGS AND RECOMMENDATIONS

State would have been about $3.3 million instead of $26.5 million, a two-year savings of
$23 million or $11.5 million a year.
Assuming that CMS does not change its current policy on inmate Medicaid eligibility, the
Department could realize additional savings from the new health care reform law.
Beginning January 1, 2014, the Patient Protection and Affordable Care Act “establishes a
new eligibility category for all non-pregnant, non-Medicare eligible childless adults
under age 65 who are not otherwise eligible for Medicaid and requires minimum
Medicaid coverage at 133% FPL [federal poverty level].” 8 Consequently, more inmates
will become Medicaid eligible in 2014. Furthermore, states will receive 100% federal
reimbursement for “newly eligible individuals” during the first three years: January 2014
through December 2016. 9
Determine Inmate Medicaid Eligibility and Prevent Eligibility Termination
The Department does not currently have procedures in place to determine if an inmate
who needs inpatient medical services is Medicaid eligible. Furthermore, the Department
does not have personnel assigned to determine Medicaid eligibility.
To realize the potential cost-savings described above, the Department may need to obtain
or train Medicaid eligibility specialists and will need to establish procedures to determine
if inmates who are sent to medical institutions for inpatient services are Medicaid
eligible. Medicaid eligibility for inmates can be determined at any time before, during, or
after incarceration. In a 2004 letter to State Medicaid Directors, 10 CMS said:
As a reminder, the payment exclusion under Medicaid that relates to
individuals residing in a public institution or an IMD [Institute for Mental
Disease] does not affect the eligibility of an individual for the Medicaid
program. Individuals who meet the requirements for eligibility for
Medicaid may be enrolled in the program before, during, and after the
time in which they are held involuntarily in secure custody of a public
institution or as a resident of an IMD.
Additionally, the State should be able to recover 50% of administrative costs the
Department incurs for staffing, training, and performing Medicaid eligibility
determinations. Federal regulations state FFP is available for salaries, fringe benefits,
travel, training, and necessary administrative costs incurred in determining Medicaid
eligibility. 11
Failure to timely determine Medicaid eligibility, however, can cost the Department
money. For example, the Department cannot recover about $23.2 million in potential
savings for calendar years 2008 and 2009. During that period, the Department paid
8

The Henry J. Kaiser Family Foundation. Medicaid and Children’s Health Insurance Program Provisions in the New Health
Reform Law. April 2010
9
Patient Protection and Affordable Care Act. Section 2001.(a)(3)
10
Letter from CMS to State Medicaid Directors dated May 25, 2004. Subject: Ending Chronic Homelessness.
11
42 CFR 432.50 and 42 CFR 435.1001

5

FINDINGS AND RECOMMENDATIONS

inpatient health care costs for 646 inmates who were potentially eligible for Medicaid.
Federal regulations allow states two years to file and recover reimbursement for Medicaid
claims if the individual was Medicaid eligible at the time of service. 12 But states can
only look back three months before the eligibility application was filed to obtain
retroactive reimbursement for Medicaid-eligible expenses.13
Consequently, the
Department cannot recover the potential savings identified for calendar years 2008 and
2009.
After determining eligibility, the Department will also need to ensure that Medicaid
eligibility is not terminated when inmates return from the hospital. CMS recommends,
“Once determined eligible, the inmates remain eligible and their cases should be placed
in a suspension status during their incarceration.” 14
It may also be advantageous for the Department to work with DHHS and local
governments to ensure that Medicaid-eligible inmates do not have their eligibility status
terminated when they are first incarcerated. In a September 2008 letter, DHHS directed
County Directors of Social Services to suspend the Medicaid benefits of newly
incarcerated individuals for the remainder of his or her “certification/payment review
period.” 15 However, the Department may want to work with the County Directors of
Social Services to ensure that the counties are aware of and follow the DHHS policy.
Savings Possible for Local Governments
Although not within the scope of this audit, local governments could also realize savings
by requiring medical providers to bill Medicaid for eligible inmate health care. Inquiry of
officials in two counties and an organization that manages inmate health care for 45
counties indicates that local governments do not bill Medicaid for any inmate health care.
The amount of savings that local governments will realize will depend on the number of
inmates that are Medicaid eligible and on the rates currently paid for inmate care. As
noted above, however, the amount of potential savings will increase in January 2014 when
the new health care reform law expands Medicaid eligibility.
Recommendation: The Department should charge Medicaid for eligible inmate inpatient
health care costs. The Department should work with DHHS, County Directors of Social
Services, and local governments to establish the necessary policies and procedures.

12

45 CFR 95.7
42 U.S.C. 1396a.(a)(34)
14
Letter from CMS to the State Auditor dated May 4, 2010.
15
Division of Medical Assistance. DMA Administrative Letter No: 09-08, Medicaid Suspension. August 27, 2008
13

6

[ This Page Left Blank Intentionally ]

7

APPENDIX

Auditee Response

8

APPENDIX

9

STATE OF NORTH CAROLINA

Office of the State Auditor
2 S. Salisbury Street
20601 Mail Service Center
Raleigh, NC 27699-0601
Telephone: (919) 807-7500
Fax: (919) 807-7647
Internet
http://www.ncauditor.net

Beth A. Wood, CPA
State Auditor

April 8, 2010
Ms. Jackie Glaze, Associate Regional Director
Center for Medicare and Medicaid Services
Office of the Regional Administrator
Atlanta Federal Center
61 Forsyth Street, SW, Suite 4T20
Atlanta, Georgia 30303-8909
RE: Medicaid Coverage Policy for Inmates of a Public Institution
Dear Ms. Glaze:
My Office is conducting a performance audit of the North Carolina Department of
Correction. Specifically, we are addressing the Department's expenditures attributable to
inpatient care for inmates.
As part of this audit we are addressing whether the State's Medicaid program could have
been billed by enrolled Medicaid hospitals for inpatient services provided to inmates that
otherwise met qualifications to be Medicaid beneficiaries. Similarly, we are assessing
whether professional service charges associated with these inpatient episodes would have
been Medicaid eligible.
The Social Security Act excludes Federal Financial Participation (FFP) for medical care
provided to inmates of a public institution. In reviewing all available guidance from
CMS and other applicable regulations, however, there appears to be clear, consistent
language supporting a process whereby inmates lose their "inmate status" and garner
"inpatient status" when being treated in a non-Correction, inpatient, hospital setting.
Specifically, a 1998 HCFA Program Issuance Transmittal Notice Region IV on the
subject “Clarification of Medicaid Coverage Policy for Inmates of a Public Institution”
reads in part:
An exception to the prohibition of FFP is permitted when an inmate
becomes a patient in a medical institution. This occurs when the inmate is
admitted as an inpatient in hospital, nursing facility, juvenile psychiatric
facility, or intermediate care facility. Accordingly, FFP is available for
any Medicaid covered services provided to an ‘inmate’ while an inpatient
in these facilities provided the services are included under a State’s
Medicaid plan and the ‘inmate’ is Medicaid-eligible.

10

APPENDIX
Ms. Jackie Glaze, Associate Regional Director
April 8, 2010
Page Two

Although North Carolina's State Plan, like many others we have reviewed, stipulates that
inmates are not Medicaid eligible, my staff views this as general guidance consistent with
the Social Security Act, CMS policy, and the Code of Federal Regulations. My staff does
not see this language as precluding inmates from accessing Medicaid if the inmates are
treated in an inpatient hospital (acute or psych) setting that is not part of the Department
of Correction.
Will you please assist me by clarifying that Medicaid inpatient hospital services and
associated professional services would be available to incarcerated individuals that
otherwise meet the State's Medicaid eligibility criteria?
Would the State need to revise its Medicaid State Plan in any manner in order to avail
itself of FFP for these inpatient hospital and professional services?
Lastly, would the State be able to retroactively claim FFP for these individuals for a
period of twenty-four months?
I very much appreciate your time and consideration in assisting me with these questions
and I look forward to your reply.

Sincerely,

BETH A. WOOD, CPA
STATE AUDITOR

11

APPENDIX

12

[ This Page Left Blank Intentionally ]

13

APPENDIX

14

APPENDIX

15

APPENDIX

16

APPENDIX

17

APPENDIX

4 V

O

~f~i12~2
j

10:44
I-CPA DSP’S
DEPJLRTMENT OF HEM-TB ~ liii M&N SERViCES

410 786 3262
~
Health ‘aiR rm.rnm.v

J
DALTR4OREMD 21244-18W
uco secuwrv souiiv.tw

DEC (2~ggy

~,

‘I-.

FROM:

Director
Disabled and Elderly Health Programs Group
Center for Medicaid and State Opetatiotis

SUBJECT:

Clarification of Medicaid Coverage Policy for inmates of a Public Institution

TO,

All Associate Re8ional Administrators
Division for Medicaid and State operations

-

The purpoSe of this memorandum is to clarifr current Medics coverage policy for inmates of a
public iIIStiWtibn Reccndy;cefltrat office staff have become aware of a number of inconsistencies
in vajious .rcgional office 4irqctives on this subject which have been ant to States.. .MaeOVCr..
the wowi~~s ip&* bf3nquiiied from the internet has prompted us to expand and~ih’some cases,
refine or ~O~age policy ~n this area. Therethre, in the interest of insuring consistent and
unitbnn appljcatlon ofM~dlcaid’pOhcy on inmates of a public instRuttition. we believe that this
cothI~1w~e is

Q

C...

(PFP)
medical care
provided
inmatesAct
of aspecifically
public iiistitutioti~
the inmate
is a
Sectionforl905(aXA)
of the
Social toSecurity
excludesexcept
Federalwhen
Financial
Participation
patient in a medical institution. The fl’s distinction that should be made is tbft the statute refers
only to FFP not being available. it does not spedt~. nor imply. that Medicaid eligibility 1
precluded for those h~lividuals who ar6’inmBtes ofa public institution.’ Accordlfl&S’4 iniatesofa”
public insdtut~on may be eligible for Medicaid if the appropriate eligibility criteria sit met,•.
The next significant distinction is that under current Medicaid coverage policy tot Inmates hre .is
no difference in the application ofthis policy to juveniles than the application to ~iht For’”
purposes of excluding FFP. for example, !juver1~le awaiting trial in a detention center is no
different than an adult In a inaidmum security prison. For application of the statUte, both are
considered inmates of a public institution.
Criteria for Prohibition of flP
When detennining whether FFP is prohibited u
the above noted statt two criteria must
met. First, the individual must be an inmatc and second, the facility in which the individual is
resadmg must be a public institution. An individual is an inmate when serving time kr a criminal
olbise or confined bwnhurnrily in State or Federal prisons, jails, detention ficilities, or other
penal fwlrhrs. An individual who is voluntarily residing in a public institution would not be

18

I4Jr~U14~d

iW”l4

ttI~H LWtU

4W ~(~b ~

APPENDIX

r.av05

—

considered an inmate, and the statuto(Y prohibition of FtP would not apply. Likewise, an
individuaL who is-voluntarily residing in a public educational or vocational training institution tbr
purposes of securing education or vocational training or who is vokmtarily residing in a public
institution while other living anangeflieMs appropriate to the individual’s needs arc being made,
would not be considered an inmate. It is impor~&)t to note that the exception to inmate status
based on ‘while other living anangerneflts apptopriate to the individual’s needs are being made’
does not apply when the individual is involuntarily residing in a public institution awaiting criminal
proceedings.
disposiLiOflS.~ or other involuntary detainment deteaninalioM. Moreover, itt
duration of time that an individual is residing in the public institution awaiting these ~ángemeitt5
does not determine inmate status.

0

—

—

Regarding the second criteria necessary .ibr detetinuiling whether PEP is prohi~Itqd, a JhcIlity.is a
public institution when itis under the responsibility of a governmei$al umi, or ov~ wiach a
governmental unit exercises administrative controL This contro’ can e3dSt when a facility is
actually an organizational par eta gOV!fflmeilt4 !~‘~ or when a goverciflental unit exercises final
administratIVC control, ,pdudfllfroWflCnhiP and to
scsi Thc’ht’n and !groun4s used
“houeiñrnatcs..
~~9iifrólânals0
iTh$af\aiifi5rW~nMlit
gove
and r.~!
‘

iuthontytoturc’
~

~ ~

fnvath4~tbOflàul’h15~

-

:~-‘~:.

~‘

:.:;~::4:.:.’.~~

;.:~

..

•

Some States have contracted WIIh.a pdvate health care entity to provide medical care in the public
institution to its inmates. We have detenninid that PEP would no1 be available tbr the medical
services provide4 In this situation. We believe that the imnates arc not receiving ser~ices as a
patient in a medical institutioa Rather, they arc continuing to receive medical care in a public
institution because govenimental control Continues to exiat when the private ~e~gjq~ isa contractual
agent of a venunental unit.
-:
Y
I
~4j.4l~~J1%i
—r ~

•

.

•

.

.

‘

Some St~tc$ are also considering the feasibih~t ofselling yr nnsfemn&ownec4tip 4ghcsof*e..
prison $ medical up’ ‘includinä the hpusang fadility and the ,mmedhtc groundS~ to flnvate health
care entity. thereby potenti
abligihetmit ~4 &ics’l in$tudoä ibi wia PEP
available an the greater groundstf the public’k~tiwtiofl.~ We do.not believe this artangen%ent is’
within the Intent otthe exccptionspecified:in tl* s~tüte. We adhea to~.~i~.~.~ Il
un~Vailawe for any medical care provlilid oi the grea(~ ~jenilb of the. prison g~4~
aecunty Is ultimately maintained by tl~e govdnmental ‘unit

‘~

~

~

Excentinn to Prohibition of FF1!

As noted in the above cited statute. an exception to the prohibition of PEP is permitted when an
inmate becomes a patient in a medical institution, This occurs wh~i the Inmate is admitted as an
j~patiet in a hospital, nursing facility, juvenile psychiatric facility; or intermediate care facility.
Accordingly. PEP is available for any M’~’~ covered services provided to an ‘inmate’ while an
inpatinit IA these facilities providt4 the smvices arc içcluded under a States Medicaid plan and

0
19

APPENDIX
as-01-2002

Q

HcFq

10:45

DEl-PG

410 786 3262

P. 04i’Bs

the
an inpatient
inmate’ of
is Medicaid-eligible.
a lonj-tenn care facility,
We would
othernote
criteria
that such
in those
as meeting
cases where
level of
an care
~mmatt’
and plan
becomes
of
care assessments would certainly have to be met in order for FE? to be availablt
FFP, however, is not available fbi services provided at any of the above noted medical institutions
including clinics and physician offices when provided to the inmate on an outpatient basis. Nor is
FFP. available for medical care provided to an inmate taken to a prison hospital or dispensary. In
these specific situations ~he inmate would not be considered a patient in a medical institution.
Policy Anolicatlon
a result of a signiflàant number of recent inquiries from the Internet and regional offices~ we
have provided policy guidance inválving’lssues where inmates receiving medical care in various
settings and under unique situations. The tbIIOWing examples will help hi detentdnirg whether
FFPt~iasriil$bltOr nok Pleaqe keEp in mind that thesc are broad and general enmples and
extenuating cii~ ~ exist which could effect this detemntation.

Exm~PF~P$%Vilkblt’
,4k,tr’i’ ~.J.t.

.. .

..

:7tW~8~” the inmate in the public mstitutioil

I’
4...

(3

~4.

~p;

t~

a..

rarciz*livi4uals

3.

Individuals, on probation

4.
5~a..

6.

.

•~.

Individuals on home release except d~ing those times when reporting to a prison
for overnight Stay
lndiy4iiai$11v4,gvolyqtaHly in a detention center, jail, or county. penal facility after
the ne ~
adj~kated and other livi~ a~ements are being made ~i
them (c.g4 trañsfbr’to a community residence)
InmateS who become inpatients of a hospital, nursing facility, juvenile psychiatric
facility or intentediate care facility for the mentally retarded (Note; subject to
met gtter requirements of the Medicaid program)

Exam$eswhenFFPistflavailabtC:
I.

Individuals (including juveniles) who are being held involuntarily in detention
centers awaiting trial

2.

lnuiates involuntarily residing at a wilderness camp under governmental control

3.

Inmates involuntanly residing in bait-way houses under governmental control

20

APPENDIX
el—2~~

10:45

P.~/B5

410 786 3262

a.

4.

lmMtCS ~gteiVing cRfl as an outpatient

5.

1~ates nceiving care on p~miseS of pñso~ jait detention center, or other p~
setting
~.

C

-

if there art any questions concern ng tilis cotnfflu
ion, please contact Thomas Shenk or Verna
Tyler on 410 786-3295 Ot 410 7864518. respectively.

(fl~~
Robert A. Streliner

0

TflT~

21

~

0

ORDERING INFORMATION

Audit reports issued by the Office of the State Auditor can be obtained from the web site at
www.ncauditor.net. Also, parties may register on the web site to receive automatic email
notification whenever reports of interest are issued. Otherwise, copies of audit reports may be
obtained by contacting the:
Office of the State Auditor
State of North Carolina
2 South Salisbury Street
20601 Mail Service Center
Raleigh, North Carolina 27699-0601
Telephone:

919/807-7500

Facsimile:

919/807-7647

22

 

 

CLN Subscribe Now Ad 450x600
Advertise Here 4th Ad
Prisoner Education Guide side