Suspension of Benefits for Incarcerated Members: Frequently Asked Questions

Starting on October 24, 2020, the Wisconsin Department of Health Services (DHS) and the Wisconsin Department of Corrections (DOC) implemented a suspension of health care benefits process for individuals participating in Medicaid or BadgerCare Plus who are incarcerated. This process will help ensure that individuals who qualify for BadgerCare Plus or Medicaid are able to access health care services immediately upon release from jail or prison, which benefits both the individual and their community. Below are frequently asked questions for partners.

Definitions

What does suspension mean?

When a person’s BadgerCare Plus or Wisconsin Medicaid enrollment is suspended during the time they are incarcerated, they are still enrolled as an active member of BadgerCare Plus or Wisconsin Medicaid. However, BadgerCare Plus and Wisconsin Medicaid will only cover services received when the person is hospitalized as an inpatient for more than 24 hours. Although the person only has limited coverage while incarcerated, being suspended makes it easier for them to get full benefits upon their release. Once a person leaves jail or prison, they just need to report this to the state so that their coverage can resume. They do not need to reapply.

What is the difference between "suspended" and "terminated?"

When a person’s BadgerCare Plus or Wisconsin Medicaid is suspended, they are still an active member, but BadgerCare Plus and Wisconsin Medicaid will only cover services received when the person is hospitalized as an inpatient for more than 24 hours. When a person’s BadgerCare Plus or Wisconsin Medicaid is terminated, it means that they are no longer enrolled in BadgerCare Plus or Wisconsin Medicaid at all. In this case, BadgerCare Plus and Wisconsin Medicaid will not cover any services.

Also, previously when a person's BadgerCare Plus or Wisconsin Medicaid was terminated, they had to complete the full application again to regain health care coverage. When someone's BadgerCare Plus or Wisconsin Medicaid coverage is suspended, their suspension can be lifted once they notify the state after leaving jail or prison and they can access important health care services without delay.

Eligibility and Enrollment

What happened to people who were incarcerated before the implementation of the suspension policy on October 24, 2020?

New applications received before October 24, 2020, from people who were already incarcerated were denied.

Prior to the implementation of COVID-19 temporary rules on March 18, 2020, if a BadgerCare Plus or Wisconsin Medicaid member was incarcerated, their BadgerCare Plus or Wisconsin Medicaid was terminated. If a person whose benefits were terminated wants to, they can reapply for BadgerCare Plus or Wisconsin Medicaid. If they are eligible, they will be enrolled and their benefits immediately suspended. The Wisconsin Department of Health Services (DHS) is not automatically re-enrolling people whose BadgerCare Plus or Wisconsin Medicaid was previously terminated.

If a BadgerCare Plus or Wisconsin Medicaid member was incarcerated on or after March 18, 2020, their membership initially remained active due to the COVID-19 temporary rules about maintaining enrollment. Members who are still incarcerated have now had their benefits suspended based on guidance from the federal Centers for Medicare & Medicaid Services (CMS).

How do the temporary BadgerCare Plus and Wisconsin Medicaid rules related to the COVID-19 public health emergency affect suspension?

Per guidance from CMS, BadgerCare Plus and Wisconsin Medicaid members should have their enrollment suspended when they are incarcerated, even during the COVID-19 public health emergency. The temporary rules do not override the federal law limiting BadgerCare Plus and Wisconsin Medicaid coverage to inpatient services for incarcerated members. When a suspended member is released, the suspension will be lifted and they will be enrolled in full BadgerCare Plus or Wisconsin Medicaid benefits.

What if the person is incarcerated under a different name than what is on their BadgerCare Plus or Wisconsin Medicaid case?

DHS’ data exchange with the Wisconsin Department of Corrections (DOC) includes alias information. Income maintenance workers will research to determine if the data exchange record is for the same person. For member-reported information or information from other sources, income maintenance workers will follow existing processes to ensure that they are applying the information to the correct case.

The webinar mentioned that DHS has a data exchange with DOC to send information about people incarcerated in DOC facilities, like state prisons, directly to DHS. Does this include address information or information for people who are on supervision, such as probation or parole?

The information DOC sends to DHS is for adults who are incarcerated in a DOC facility. This includes facility address information. Income maintenance workers will be notified when an existing BadgerCare Plus or Wisconsin Medicaid member moves to a different DOC facility so they can update the facility name and address on the member’s case.

DOC does not send DHS information on adults who are not residing in a DOC facility. Members who are residing in the community, including people on probation or parole, are not incarcerated so their BadgerCare Plus or Wisconsin Medicaid is not suspended. They are eligible for regular BadgerCare Plus or Wisconsin Medicaid. They are responsible for reporting changes to their income maintenance agency by phone, by mail, in person, or through the ACCESS website.

Where will mail or letters about the incarcerated person’s BadgerCare Plus and Wisconsin Medicaid benefits be sent?

Most notices and letters with information about the person’s benefits will be sent to the address that DHS and the income maintenance agency have on file for the case. If the person is on a case with family members who live in the community, these notices and letters will be sent to the address in the community. If the person who is incarcerated is the only one on the case, the notices and letters will be sent to the case address, which is usually the jail or prison address.

There are two informational letters about suspension that will always be sent to the incarcerated person at their jail or prison address if it is known:

  • One letter is sent when the person is first enrolled in suspended benefits, and it contains an explanation of suspension.
  • The other letter is sent if the person has their eligibility re-determined shortly before release, and it lets them know that they will have access to full benefits upon release. This letter also has information for the member on possible next steps, such as how to report additional changes to their agency like a new address or a new job, requesting a new ForwardHealth card if needed, enrolling in a health maintenance organization (HMO), and applying for other programs like FoodShare.

For people incarcerated in a DOC facility, DOC updates mailing address information regularly as part of the data exchange with DHS. This helps ensure that mail will be sent to the appropriate DOC facility.

Applicants and members who are incarcerated in jail or prison are asked to provide their DOC or jail number when they are a new applicant applying for BadgerCare Plus or Wisconsin Medicaid or when they are an existing member reporting that they are now incarcerated. If the DOC or jail number is known to the income maintenance agency, it will be included as part of the mailing address on correspondence sent to the incarcerated person. The DOC number for people incarcerated in DOC facilities is sent by DOC to DHS through the data exchange.

Jails and prisons will distribute mail to incarcerated people following their current mail processes.

How are incarcerated members notified when they need to complete a renewal?

When a member with suspended benefits has an upcoming renewal, DHS will first see if an administrative renewal is possible. An administrative renewal uses information available through data exchanges and other sources to complete the renewal without the member needing to take action. If DHS is able to do an administrative renewal, DHS will send a letter to the member at the mailing address on file for their case notifying them that their benefits have been renewed. If the person is on a case with family members who live in the community, the letter will be sent to the address in the community. If the person who is incarcerated is the only one on the case, the letter will be sent to the case address, which is usually the jail or prison address. The letter will also show the information used to complete the renewal and give instructions on how the member can contact their income maintenance agency to make any needed corrections. If the information is correct, the member does not need to take any further action for the renewal.

If an administrative renewal cannot be done, DHS will mail the member a pre-printed renewal form to the case’s mailing address on file. This form will be mailed out approximately 45 days prior to the renewal due date. The member can complete the renewal by:

  • Filling out the pre-printed renewal form and mailing it using the listed instructions.
  • Calling their income maintenance agency to complete the renewal by phone.
  • Completing the renewal using the ACCESS website, if the member has access to the internet.

Once the income maintenance agency processes the renewal, they will send the member a notice of decision showing if they remain eligible for suspended BadgerCare Plus or Wisconsin Medicaid.

Do jails and/or prisons need to inform income maintenance agencies when a person enrolled in suspended BadgerCare Plus or Wisconsin Medicaid is being released from jail or prison?

The release date for people incarcerated in DOC facilities will be sent to the income maintenance agency through a data exchange with DOC. However, DOC staff should still assist the soon-to-be-released person with contacting the income maintenance agency to report their new address and other household changes if necessary.

There is no statewide direct data exchange for income maintenance agencies to receive information about people in jail. If a jail already has a process in place with their local income maintenance agency to provide information about incarcerated people, they should continue this process. Members are ultimately responsible for reporting their release date to their income maintenance agency. However, jail staff should assist the soon-to-be-released person with contacting the income maintenance agency to report their release date, new address, and other household changes if necessary.

Income maintenance agency contact information is available online.

Some jails and prisons have an existing process where incarcerated people complete a phone application with their income maintenance agency about a month prior to release. Can these facilities continue to use this process?

Yes, jails and prisons can still assist incarcerated people with applying for BadgerCare Plus or Wisconsin Medicaid by phone. Prior to the implementation of the suspension policy in October 2020, incarcerated people could only apply within a certain amount of time prior to release. Now that incarcerated people can be eligible for suspended benefits throughout their incarceration, this time restriction no longer applies. People can apply at any time.

If an incarcerated person is already enrolled in suspended benefits, there is no need to complete a new application for BadgerCare Plus or Wisconsin Medicaid when the person is released. However, these facilities should still assist the person with contacting their income maintenance agency to report changes, such as the person’s new address after release and their release date.

Note: DOC is sending the release date through the data exchange for people incarcerated in DOC facilities. However, this data exchange release date may not be correct for people who have early release. DOC staff should assist the person with contacting their income maintenance agency to report their early release date.

Individuals participating in DOC Earned Release Programs (ERP) are often released prior to their scheduled extended supervision date. How does this change in policy impact individuals participating in ERP?

Since incarcerated members can apply for suspended BadgerCare Plus or Wisconsin Medicaid at any time, there is no longer a requirement to wait until the 20th of the month prior to the month of release to apply. Participants can apply at any time, be placed in a suspended status, and notify their income maintenance agency when the release date is known. This same approach can be used for individuals who are released due to an extraordinary health circumstance.

What happens if a member does not report that they are incarcerated?

If a member does not report that they are incarcerated and the information is not sent to the income maintenance agency through another resource such as a data exchange, the member will incorrectly remain a regular member of BadgerCare Plus and Wisconsin Medicaid, instead of having their benefits suspended. This means that the member may need to pay back any costs or fees that BadgerCare Plus or Wisconsin Medicaid pays for services that should not have been covered during the time they should have been suspended.

When someone is suspended and remains part of a household, does that person still count as a member of that household size for purposes of income eligibility?

Yes. People who remain part of a household while incarcerated will still be counted as part of the household size, based on regular program rules.

Pregnant Women and Newborns

If a pregnant women gives birth while incarcerated, is the baby eligible for BadgerCare Plus as a continuously eligible newborn (CEN)?

Pregnant women who are incarcerated will continue to be enrolled in the BadgerCare Plus Prenatal Program if they meet the eligibility criteria for that program. This has not changed with the implementation of suspension policy. The BadgerCare Plus Prenatal Program is a separate, full benefit program and will not be suspended. Babies born to incarcerated mothers who are enrolled in the BadgerCare Plus Prenatal Program are not eligible for BadgerCare Plus as a CEN. However, the baby may be eligible for BadgerCare Plus under the regular rules for children.

Health Maintenance Organizations

When an existing member who is enrolled in an HMO is incarcerated, what happens with the HMO enrollment?

Members who have suspended BadgerCare Plus or Wisconsin Medicaid are not enrolled in an HMO. If an existing member is in an HMO and is then incarcerated, the member will be disenrolled from the HMO on the first of the month in which the BadgerCare Plus or Wisconsin Medicaid suspension begins.

Example: Paula is enrolled in BadgerCare Plus and is in an HMO. On March 20, 2021, Paula is incarcerated. The income maintenance agency processes this change and moves Paula into suspended BadgerCare Plus starting April 1, 2021. Paula is no longer enrolled in an HMO as of April 1, 2021. Hospital inpatient services that Paula receives while in a suspension will be covered by BadgerCare Plus as fee-for-service.

When the member’s suspension is lifted and full benefits are reinstated the month of release, is the member re-enrolled in the previous HMO right away or are they fee-for-service?

When the member regains full benefits in a program with HMOs, one of the following will happen:

  • If the incarceration was for a short time, the member may be automatically re-enrolled in the HMO they had prior to incarceration.
  • If the member was not previously in an HMO or was not recently enrolled in an HMO, they will be sent information about HMO enrollment and be asked to choose a new HMO. The HMO enrollment information will be mailed to the mailing address on file for the case. If the person is on a case with family members who live in the community, this information will be sent to the address in the community. If the person who is incarcerated is the only one on the case, the information will be sent to the case address, which is usually the jail or prison address. If the member has a re-determination of eligibility done prior to release, the HMO enrollment information will be mailed to the person’s facility address if they are still incarcerated and that is their case’s mailing address on file. If the re-determination of eligibility is done after release, it is important that the member reports to the income maintenance agency their current address in the community (and mailing address if different) so the HMO enrollment information is mailed to the correct place.
  • If they are on a case with other members of their household who are already enrolled in an HMO, they will automatically be enrolled in their household’s HMO.

Members will have fee-for-service coverage if they qualify for an HMO enrollment exemption or if they are in an area where HMO enrollment is voluntary and they choose not enroll in an HMO.

When a member is moving back to full benefits, how will DHS inform the member about enrolling in an HMO and continuing medications and treatment?

When eligibility is redetermined and the suspension lifted, a notice of decision will be sent to the member letting them know if they will be enrolled in full benefit BadgerCare Plus or Wisconsin Medicaid. If the member is in a program that has HMO enrollment, they will be re-enrolled in their previous HMO or receive the HMO enrollment packet with information on choosing an HMO, depending on their situation.

Members can contact an HMO enrollment specialist at 800-291-2002 with questions about HMO enrollment. Members can contact Member Services at 800-362-3002 with questions about their benefits.

Will members be locked into their HMO plan or will they have the option to change it?

The regular rules for HMO enrollment apply. If a member is not happy with the HMO they joined, they can change their HMO during the first three months of enrollment. This is called “open enrollment.” When the open enrollment period is over, the member cannot change their HMO for nine months. This is called a “lock-in” period. The member will be sent a letter telling them when the lock-in period will end. When the lock-in period has ended, the member can change to a different HMO if available. Members should contact the HMO enrollment specialist at 800-291-2002 if they have questions about HMO enrollment.

Members leaving jail or prison need to report their new address to their income maintenance agency so that they are provided the appropriate HMO options in their area.

Additional Information for Elderly, Blind, or Disabled Medicaid

Is Supplemental Security Income (SSI) Medicaid suspended when the member is incarcerated?

People who receive SSI payments are automatically eligible for Wisconsin Medicaid based on their receipt of SSI. These people are referred to as being enrolled in SSI Medicaid. People generally do not receive SSI payments while they are incarcerated. Since SSI Medicaid eligibility is dependent on the receipt of SSI payments, if the person is no longer receiving SSI payments, they are not eligible for SSI Medicaid. They will be disenrolled from SSI Medicaid. However, they can submit a health care application to their local income maintenance agency to see if they are eligible for suspended BadgerCare Plus or Wisconsin Medicaid.

If a person’s SSI payment resumes after they are released from jail or prison, they will again be enrolled in SSI Medicaid.

Note: SSI Medicaid is not the same as SSI-related Medicaid. SSI-related Medicaid is the basic Medicaid program for people who are age 65 or older, blind, or disabled (but who are not receiving SSI payments). SSI-related Medicaid eligibility is determined by income maintenance agencies and can be suspended when the person is incarcerated.

What happens when a Family Care, PACE, Partnership, or IRIS member enrolled in a Managed Care Organization (MCO) is incarcerated? How can the member re-enroll in the long-term care program and the MCO upon release?

Family Care cannot be suspended while the member is incarcerated. The member would be disenrolled from their long-term care program. The income maintenance agency will look to see if the member is eligible for a BadgerCare Plus or Wisconsin Medicaid program that can be suspended during incarceration.

To enroll in Family Care, PACE, Partnership, or IRIS upon release, the member will need to follow the regular application process and meet the regular functional and financial eligibility requirements. Members should contact their local aging and disability resource center (ADRC). ADRC contact information can be found online.

Note: If the member’s functional screen is current (last updated within a year) and there is no change in condition since incarceration, a new Long-Term Care Functional Screen may not be required, but will be reviewed.

Does the aging and disability resource center (ADRC) get reimbursed by Wisconsin Medicaid for the functional screen if it is done prior to the person’s release from jail or prison while they are still in a suspension?

It is the ADRC’s responsibility to determine initial functional eligibility for Wisconsin residents who meet an eligible target group and are interested in enrolling in a long-term care program regardless of their living situation. Funding for ADRC services is included in the general ADRC grant contract. Determining functional eligibility is a core service of the ADRC and is included in the ADRC contract. The ADRC does not receive separate funding for the completion of the functional screen. The ADRC may request to complete the long-term care functional screen virtually for residents who are incarcerated.

Note: The MCO does not receive a capitated rate for a member until the date of enrollment, which cannot occur until the person is released. However, the MCO is expected to begin developing a plan for the member upon receipt of the pre-release enrollment agreement, which will be sent by the ADRC with the enrollment date pending release.

Comprehensive Community Services

Can Comprehensive Community Services get reimbursed by Wisconsin Medicaid for completing the functional screen prior to the person’s release from jail or prison while they are still in a suspension?

No. BadgerCare Plus and Wisconsin Medicaid will not cover services while the person’s enrollment is suspended except for services provided while the person was hospitalized as an inpatient.

Last Revised: May 7, 2021