8. Inmate of a Public Institution

Section 1902(xx)(9)(A)(ii)(VIII) of the Act provides an exclusion from the community engagement requirement for individuals who are inmates of a public institution. Medicaid has a long-standing definition of “inmate of a public institution” and “public institution” at § 435.1010, which we reference in new § 435.554(c)(9). We consider an individual to be an inmate of a public institution if the individual is in custody and held involuntarily through operation of law enforcement. [ 80 ] Public institutions do not include educational or vocational training institutions; child care institutions; or medical institutions, including institutions for mental diseases (IMDs). Inmates of public institutions include individuals in correctional institutions such as State or Federal prisons, local jails, detention facilities, or other penal settings. Recent legislative changes [ 81 ] and CMS guidance have required or provided flexibility to States to provide certain Medicaid-covered services to eligible individuals during periods of incarceration. Because States are required to suspend rather than terminate eligibility during periods of incarceration, [ 82 ] States should have systems and processes already in place to identify this population, including an individual's date of release. We believe that applying the existing Medicaid definitions to this exclusion ensures consistency and will promote administrative efficiency, as States will be able to use information from existing eligibility and data systems when effectuating this exclusion. We adopt the existing definition of “inmate of a public institution” at § 435.1010 for the community engagement exclusion at the new § 435.554(c)(9).