GIS 14 MA/030: Medicaid Applications for Individuals Incarcerated in Local Correctional Facilities

The purpose of this General Information System (GIS) message is to inform local departments of social services (LDSS) of a change in procedure for processing applications for Modified Adjusted Gross Income (MAGI) category individuals who are incarcerated in a local correctional facility (jail).

New York State of Health (NYSoH) recently revised the online application to include an incarceration question for individuals who do not appear as incarcerated on a data match, e.g., against the electronic Prisoner Update Processing System (PUPS). Individuals who affirm incarceration and are determined Medicaid eligible will receive coverage limited to inpatient hospital only (Coverage Code 26). This change will allow Navigators and Certified Application Counselors to process MAGI applications for local jail incarcerees who do not appear as incarcerated on PUPS through New York State of Health.

Effective immediately, Upstate LDSS's will no longer be processing Access New York Health Care applications (DOH-4220) for MAGI-category incarcerated individuals. Any Access New York Health Care applications received by the Upstate LDSS's should be registered in WMS and sent to NYSoH with the MAGI screening tool. Upstate LDSS's should use Upstate CNS Reason Code DD2, "Application Received After 1/1/2014 for Categorically MAGI Individuals", as appropriate, to notify the MAGI-category jail incarceree that his or her application has been sent to NYSoH.

For an interim period, New York City (NYC) will continue to process applications from inmates in the NYC Department of Correction. HRA should use NYC CNS Reason Code HH8, "Application Received After 1/1/2014 for Categorically MAGI Individuals", as appropriate, to notify the MAGI-category jail incarceree that their application has been sent to NYSoH.