MR #17.07: Automation of Medical Benefit Restriction for Incarcerated Individuals

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  • The Healthcare and Family Services (HFS) restriction of medical benefits for recipients who become incarcerated is now automated.
  • The automated process updates MMIS with the new OBRA code "CI" to reflect the date of incarceration and the date of release.
  • Caseworkers may view the restriction of medical benefits in MMIS, and providers will see the restriction in the MEDI system.

  1. Central MMIS Updates
    1. Eligibility Dates
      1. Begin Date of the Automated Restriction
      2. End Date of the Automated Restriction
    2. New OBRA Code
      1. Viewing the Incarceration Restriction in MMIS

In a Healthcare and Family Services (HFS) agency initiative, HFS is now using an automated process to centrally restrict medical benefits for individuals who are incarcerated.

Effective 11/01/2016, an automated process centrally restricts medical benefits to inpatient hospitalization and professional medical services related to the hospital stay in MMIS for an individual who is identified as being incarcerated in an Illinois Department of Correction (IDOC) facility. Other correctional facilities (Department of Juvenile Justice (DJJ) and Illinois county facilities) may be included in this automated process at a later date.

The restriction process allows HFS to claim federal financial participation (FFP) for the cost of the hospital stay and the professional medical services related to the hospital stay.

This automated process restricts medical coverage for eligible incarcerated individuals who:

  • Are currently active on medical assistance; or
  • Apply for medical benefits in advance of their release dates from an Illinois correctional facility.

This release does not apply to federal prisoners. Individuals in federal prisons are not eligible for HFS medical benefits.

The restriction of medical benefits occurs in MMIS and is updated by HFS in an automated process.

Central MMIS Updates

The automated process updates MMIS on a weekly basis using an electronic file from IDOC. In addition to restricting medical coverage to inpatient hospital and professional medical services related to the hospital stay, it also ends payment for managed care, long term care coverage and primary case management fees to physicians and clinics during the period of incarceration.

Eligibility Dates

Begin Date of the Automated Restriction

Restricted medical benefits start on the date after the individual is admitted to the correctional facility. The individual must continue to comply with all required activity to maintain medical eligibility.

End Date of the Automated Restriction

IDOC releases individuals with a two week supply of their maintenance medications. The automated IDOC file will end the medical restriction within a week after the individual's release.  The last day of the restriction is the day before the release date.

In the instance where an individual has been released from a correctional facility and is in need of immediate medical coverage before the automatic weekly transaction updates the OBRA code, send an email to and include the individual's name, case number and RIN. HFS central office will review IDOC records to verify the individual has been released and will manually close the OBRA segment to restore full medical coverage.

New OBRA Code

A new OBRA code, 'CI', restricts medical coverage in MMIS to inpatient hospitalization and professional medical services related to the hospital stay for IDOC inmates.

Viewing the Incarceration Restriction in MMIS

To check the OBRA coding in MMIS, take the following steps:

  • Log into Bluezone/Seagull;
  • Access MMIS by selecting PF8 key from the inquiry screen;
  • Enter the Recipient Identification Number (RIN) and hit enter;
  • Shift F7 on your keyboard; then
  • Click on PA1 from the menu bar at the top of the screen.

The record will contain a begin and end dates and the Exc Cd (Exclusion Code) CI.

Note: Medical providers can see the restriction when they check medical eligibility in MEDI.


[signed copy on file]

James T. Dimas

Secretary, Illinois Department of Human Services

Felicia F. Norwood

Director, Illinois Department of HealthCare and Family Services