ProviderOne
enhancement: 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.
What was the previous policy?
Previous policy required eligibility to end during periods
of incarceration. Substitute Senate Bill 6430, which was signed into law in
2016, made this change.
How has ProviderOne changed to reflect the new policy?
In July, ProviderOne will display a new coverage category
for incarcerated individuals. The new category displays:
- Incarceration dates.
- A valid Apple Health eligibility segment.
These two categories together limit
the scope of coverage to inpatient
hospitalizations only.
What is the purpose of this change?
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.
Provider training
Senate Bill 6430 also requires HCA and the Department of
Social and Health Services (DSHS) to publish guidance and provide trainings to behavioral
health organizations (BHOs), managed care organizations (MCOs), and behavioral
health providers.
Training will cover:
- Outreach
- Assistance
- Transition planning
- Rehabilitation case management
For those who are:
- Incarcerated.
- Involuntarily hospitalized.
- In the process of transitioning out of one of
these settings.
How is this change being implemented?
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.
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