How Incarceration Affects Medicare and Medicaid
If you or any of your family members are currently incarcerated, or if someone close to you is in jail awaiting sentencing, you may want to know how a jail or prison sentence affects Medicare and Medicaid benefits. While federal law prohibits inmates getting Medicare benefits while incarcerated, you can take steps to make sure coverage is reinstated without a long delay or expense upon release. Like Medicare, Medicaid does not pay health care benefits for the incarcerated. It can be important to know what to expect on release.
Medicare and the Incarcerated
Federal law, specifically 42 CFR 411.4, states that Medicare cannot pay for health care services if the beneficiary has no legal obligation to pay for those services. When someone is incarcerated in a federal facility, the prison or institution is generally responsible to pay for necessary medical care and prescriptions. Most state and local governments also assume responsibility for prisoner healthcare costs. Medicare will not pay for services provided by any government entity. The individual remains Medicare eligible, but services are suspended until the date of release from custody.
For the purpose of enforcing the Medicare regulation, incarceration is defined to include all of the individuals who meet one of the following criteria: (a) under arrest, (b) incarcerated, (c) imprisoned, (d) escaped from prison or jail, (e) under supervised release, (f) on medical furlough, (g) required to live in a mental health facility, (h) required to live in a halfway house, (i) under home detention, and (j) confined completely or partially in any way under a penal statute or rule.
There are exceptions to the suspension of benefits rule. If state or local law requires incarcerated persons to repay the state for the cost of medical care they receive while in custody, and if the state actively and aggressively pursues collection efforts against the inmate, Medicare may provide coverage. The Medicare rules are very strict on this. If the state routinely takes vigorous action to collect such medical debt, Medicare may provide coverage to the incarcerated person. If the state or locals are half-hearted in collection efforts, Medicare won’t pay.
Arizona does not sue inmates or send their medical bills to collection agencies. However, Arizona prisons do charge prisoners a $5 co-pay for doctor visits as a deterrent against frivolous doctor visits.
Medicare Strategies for Incarcerated People
Part A
While Medicare will not cover an incarcerated person, it is important to plan for the resumption of coverage upon release with as little delay and extra cost as possible. You may want to keep Medicare Part A in place during incarceration. Most people do not pay a premium for Part A, so keeping it in place will not be a financial burden and will guarantee that coverage will resume without delay on release from prison.
Part B
You do pay premiums for Medicare Part B coverage. When you are on Social Security, Medicare Part B premiums are usually deducted from monthly benefits. That way, you never have to worry about paying them. However, once you are convicted of a crime and incarcerated for 30 days or more, Social Security suspends your benefits. That means if you want to keep Medicare Part B, you will have to pay the monthly premiums by setting up a direct pay account with Medicare at 1-800-633-4227.
If you cannot afford to pay the Part B premiums while in prison, you may want to promptly withdraw from Part B. Otherwise, you will end up owing money when you are released. If you do not withdraw from Part B, several months premiums will accrue until Medicare unenrolls you for lack of payment. When released from prison, you will still owe those back premiums, and they will be deducted from your Social Security benefits. If you rely on Social Security as a large portion of your income, that can be a real hardship. Withdrawing as soon as you are incarcerated and starting fresh with no outstanding premiums upon your release may be a favorable option.
Medicaid and the Incarcerated
Title 19 of the U.S. Code prohibits states from using Medicaid funds to pay for medical services to incarcerated persons. Once a person goes to jail, his or her Medicaid account changes to a no-pay status. Some states suspend Medicaid eligibility and reinstate it on release. Others may suspend or terminate eligibility and leave the inmate responsible to get it reinstated on release.
Arizona has its own version of Medicaid, The Arizona Health Care Cost Containment System (AHCCCS). AHCCCS has a statewide “enrollment suspension and reinstatement” process intended to prevent prisoners from having their AHCCCS eligibility terminated and having to go through the whole application process again when released. AHCCCS coordinates with the Arizona Department of Corrections (ADOC) and most Arizona counties (including Pima and Maricopa counties) to make sure there is a system to facilitate reinstatement.
Arizona Department of Corrections and the county jails send a daily report to AHCCCS listing AHCCCS recipients who are currently incarcerated, those who have been released, and those scheduled for release. ADOC and the counties submit prerelease applications for those inmates who are scheduled for release in the coming days. The prison system submitting prerelease applications is a real benefit for inmates. It means the inmate does not have to worry about the paperwork and application process. This cooperative system gets newly released prisoners back into the healthcare system and on AHCCCS coverage without undue delays.
AHCCCS also has intergovernmental agreements with most of the counties (including Pima and Maricopa) to provide funding for short-term inmate hospital stays. These interagency agreements are intended to prevent people from falling through the cracks and ending up uninsured.
