New Medi-Cal County Inmate Program Policy
Effective for dates of service on or after October 24, 2016, providers may submit claims for the Medi-Cal County Inmate Program (MCIP). MCIP is a fee-for-service program that provides Medi-Cal services to MCIP-eligible inmates. The term “MCIP-eligible inmate” refers to an individual who is eligible to receive MCIP services under the Adult County Inmate Program (ACIP), the Juvenile County Ward Program (JCWP), the County Compassionate Release Program (CCRP) and the County Medical Probation Program (CMPP).
MCIP consists of the following three programs:
- ACIP, authorized by Welfare and Institutions Code (W&I Code), Section 14053.7, provides Medi-Cal coverage to eligible adult county inmates. ACIP covers Medi-Cal allowable inpatient hospital services, including inpatient psychiatric services and physician services, provided during the inpatient hospital service stay of adult inmates in county correctional facilities.
- JCWP, authorized by W&I Code, Section 14053.8, provides Medi-Cal coverage to eligible juvenile inmates (for example, county wards). JCWP covers Medi-Cal allowable inpatient hospital services, including inpatient psychiatric services and physician services, of juvenile inmates in county correctional facilities.
- CCRP and CMPP, authorized by California Government Code sections 26605.6, 26605.7 and 26605.8, allows county sheriffs to grant medical release or medical probation in lieu of jail time if certain conditions are met. CCRP and CMPP provide full-scope Medi-Cal coverage.
Pursuant to W&I Code, Sections 14053.7(k) and 14053.8(l), a Medi-Cal provider may submit claims to the Department of Health Care Services (DHCS) directly for MCIP services provided to MCIP-eligible inmates once the county responsible for the inmate receiving MCIP services has signed the Medi-Cal County Inmate Program Agreement. The agreement is valid from the effective date of the agreement until or unless the MCIP is discontinued.
Only MCIP inmate aid codes may be used for provider claims. More information will be released regarding inmate aid codes in a future Medi-Cal Update.
Providers must comply with Treatment Authorization Request (TAR) or utilization review requirements for their particular provider type and the fee-for-service MCIP service type.
To be covered under MCIP, the service must be a covered Medi-Cal service under ACIP, JCWP, CRPP or CMPP and provided to an MCIP-eligible inmate while off the grounds of the county correctional facility with an expected stay of more than 24 hours. The expected stay of 24 hours must be determined pursuant to California Code of Regulations (CCR), Title 22, Section 51108, and the billing instructions in the provider manual.
Medi-Cal providers may be reimbursed at the applicable Medi-Cal fee-for-service rate/methodology using the same claims process as standard fee-for-service Medi-Cal claims. For example:
- If a Medi-Cal provider receives fee-for-service reimbursement for non-inmate Medi-Cal inpatient hospital services under the All Patient Refined Diagnosis-Related Groups (APR-DRG) methodology (authorized by W&I Code, Section 14105.28) or the certified public expenditure (CPE) methodology, then fee-for-service MCIP services may be reimbursed by DHCS under the Medi-Cal provider’s existing fee-for-service claiming rate/methodology for MCIP services.
- If the Medi-Cal provider is a designated public hospital receiving inpatient hospital service reimbursement under the CPE methodology, but not all MCIP services are reimbursable under the CPE methodology, then the provider’s applicable fee-for-service Medi-Cal reimbursement methodology will apply for those MCIP services.
- If a Medi-Cal provider receives fee-for-service reimbursement for rendering Medi-Cal physician services associated with non-inmate Medi-Cal inpatient hospital services, then physician services for MCIP-eligible inmates will also be reimbursed by DHCS at the corresponding fee-for-service Medi-Cal rate/methodology if the physician services are provided during the inpatient hospital service stay.
- If a Medi-Cal provider receives fee-for-service reimbursement for Medi-Cal services that are also provided in CCRP or CMPP, then the provider may receive the reimbursement at the corresponding Medi-Cal fee-for-service rate/methodology.
The CPE methodology is established in the Inpatient Hospital State Plan (Attachment 4.19-A) and in W&I Code, Section 14166.4. The CPE methodology is authorized under the successor demonstration project as defined in W&I Code, Section 14166.1(m), and the subsequent demonstration project defined in W&I Code, Section 17612.2(x).
The county may reimburse a Medi-Cal provider to the extent required by or otherwise permitted by state and federal law to arrange for services for the MCIP-eligible inmate. Additional amounts shall be paid entirely with county funds, and shall not be matched with federal financial participation.
For additional information, providers can submit questions via email to DHCSIMCU@dhcs.ca.gov.
For eligibility related questions regarding ACIP, JCWP, CCRP or CMPP, providers can contact the Medi-Cal Eligibility Division at MCIEP@dhcs.ca.gov.
For all mental health and psychiatric service related questions regarding ACIP, JCWP, CCRP or CMPP, providers can contact the County Customer Services Section at MedCCC@dhcs.ca.gov.