Ability to suspend Medicaid for incarcerated individuals

Beginning July 5, 2017, the Health Care Authority’s (HCA) ProviderOne payment system will allow Washington Apple Health (Medicaid) enrollment to be suspended while an eligible client is in jail or prison. Previous policy required eligibility to end during periods of incarceration. Substitute Senate Bill 6430, which was signed into law in 2016, made this change. In July, ProviderOne will display a new coverage category for incarcerated individuals. The new category displays: Incarceration dates and a valid Apple Health eligibility segment. These two categories together limit the scope of coverage to inpatient hospitalizations only. This enhancement increases access to coverage, which facilitates better care coordination and health outcomes, while increasing payment accuracy and reducing administrative burden. Incarcerated individuals can apply for Apple Health, and upon enrollment, their coverage is suspended. When the individual is released from the facility, their case automatically changes to Apple Health coverage. Medicaid suspension is being implemented in a phased approach. In the future, state hospitals and other facilities will be incorporated into the suspension process. Currently, the agency is developing training materials that will be available this fall.

INDUSTRY NEWS TAGS: Medicaid Washington

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