Medicaid Policy                                                                 

215-4 Residents of Medical Institutions

Effective Date: September 1, 2011

Previous Policy

 

This section describes how to decide if someone is a resident of a medical institution.

 

 Definition of a Medical Institution

A medical institution is a facility designed primarily to provide medical care.  Medical institutions include, but are not limited to:

 

1. Hospitals
2. Skilled nursing facilities
3. Intermediate care facilities
4. The Utah State Developemental Center
5. Institutions for Mental Disease (including the Utah State Hospital)

 

Who is Eligible When Living in a Medical Institution?

 

Residents of most medical institutions may be eligible for Medicaid if they meet all other eligibility factors.  (See D. below on specialized institutions.)  A person is a "resident of a medical institution" if the stay lasts or is expected to last more than 30 consecutive days.  Persons are not residents of medical institutions if their stay is 30 consecutive days or less.  See C.3. for an exception that applies to disabled infants.

 

Who is a Resident of a Medical Institution?

 

1. Unmarried People or People Married to Residents of Medical Institutions.

1. The person is a resident of a household the month he or she enters the institution.
2. The person becomes a resident of an institution beginning the month after entering if the stay is expected to or does last more than 30 days.
3. The person remains a resident of the institution during each full calendar month until the month he leaves the institution and returns home.  The month he returns home he is a resident of a household.
4. The person remains a resident of a household if he leaves the medical institution before the end of the month immediately after the month of entry.
5. If the person dies in the institution, he or she is a resident of an institution in the month of death, UNLESS death occurs in the month of entry.

 

2. Married person whose spouse is NOT a resident of a medical institution.

1. The person becomes a resident of the medical institution the month of entry when the stay is expected to or does last over 30 days.  
2. He remains a resident of an institution throughout the month of discharge.
3. He becomes a resident of the household the month after he leaves the institution and returns home.

 

3. A baby born in a hospital who meets disability criteria.

1. The baby is a resident of the hospital from the month of birth through the month of discharge.  The stay does not have to exceed 30 days.
2. The baby stops being a resident of an institution the month AFTER the baby leaves the institution.
3. The baby is a resident of a household beginning the month after the month of discharge.  
4. A baby born at home is a resident of the household in the month of birth.  

 

See Section 303-2, #1 on how to decide disability.  See Nursing Home Policy, Section 463-1 for income counting policy.

 

4. Moving from one medical institution to another medical institution without returning to the home does not change how residency is determined.
5. A person who is in a non-Medicaid medical facility may be eligible for Medicaid coverage of Ancillary Services only. There is an exception if the facility is an IMD. See Section 215-5.

 

NOTE on treatment of a home:  An individual who enters a medical institution may state an intent to return home.  See section 521-1 if the person owns a home to decide if the home is an excluded resource.

 

Specialized Institutions

 

1. Residents of medical institutions primarily engaged in providing diagnosis, treatment or care to persons with tuberculosis are not eligible for Medicaid.   [Note: Utah does not have any tuberculosis institutions, but some neighboring states do.]
2. Special eligibility rules apply to persons living in an Institution for Mental Disease.  These eligibility rules are described in Sec. 215-5.