Date: July 22, 2020
To: All Medical Assistance Program Providers
Re: Illinois Department of Corrections (IDOC) Incarcerated Individuals: Restricting and Restoring Medical Benefits
Federal and State laws require that medical benefits be restricted for an individual identified as being incarcerated in an IDOC facility. If the individual’s eligibility is current upon release from the correctional facility, there is an automated process to restore full medical benefits. Community providers can request that the restriction be lifted in cases where the automated process has not yet occurred.
Restriction Upon Incarceration:
· The State has established an automated process that restricts the medical benefits by updating the Medicaid Management Information System (MMIS) on a weekly basis using an electronic file from IDOC.
· The restriction disenrolls the client from managed care retroactively to the last day of the month prior to incarceration. Any services already billed to the MCO for the month of incarceration would need to be rebilled to HFS under the traditional fee-for-service Medicaid program.
· Restricted medical benefits start on the date after the individual is admitted to IDOC. The individual must comply with all required activity to maintain medical eligibility (e.g. redeterminations).
· Providers will see “IDOC Hospital Benefit Package” in the Medical Electronic Data Interchange (MEDI). Medicaid eligibility for incarcerated individuals will be limited to inpatient hospitalization and professional medical services related to the hospital stay. All services provided by an enrolled hospital provider, those reimbursed as institutional services and those reimbursed as fee for service, must be billed directly to HFS. Individual practitioners who submit claims for professional services rendered in the hospital inpatient, outpatient, and emergency room settings must also submit inmates’ claims directly to HFS under the practitioner’s name and NPI.
Restoration upon Release
· IDOC releases an individual from the correctional facility with a 2-week supply of their maintenance medication.
· IDOC sends an automated data update to MEDI that ends the medical restriction and authorizes full medical benefits within a week after the individual’s release, if eligibility is current. If eligibility is not current, the individual must reapply for benefits.
· The last day of the restriction is the day before the release date, regardless of the date the restriction is lifted. Individuals will be covered under the traditional fee-for-service Medicaid program until they are enrolled in a Medicaid Managed Care Organization (MCO).
· Until the individual is enrolled in an MCO, providers should bill HFS for covered services provided.
· In the instance where the individual has been released from the correctional facility, is in need of immediate medical coverage and their benefits are still restricted, providers should send a secure email to HFS.IESAccess@Illinois.gov and include the individual’s name and recipient identification number (RIN). The HFS Central Office will review the IDOC records to verify the individual has been released and will manually end the restriction, restoring full medical coverage. Coverage cannot be restored until the individual has been released.
Interim Medicaid Administrator