Medicaid Policy
Medicaid Policy
Link to e-Forms. Search for State Hospital Cover Sheet.
A. Definition
An IMD (Institution for Mental Disease) is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases or for the treatment of Substance Use Disorder (SUD). Services provided may include medical attention, nursing care, and related services. The Utah State Hospital in Provo is an example of an IMD. A psychiatric care unit within a regular medical hospital is not an IMD.
To decide which month a person first becomes a resident, see 215-4 about married or unmarried persons. Certain residents of an IMD can qualify for Medicaid or Medicare Cost Sharing.
B. Requirements for Residents of IMDs
1. To qualify for Medicaid or Medicare Cost Sharing, residents of an IMD must be:
a. 65 years old and older; or
b. Individuals 21-64 years old who reside in an IMD, other than the Utah State Hospital, licensed to provide treatment for serious mental illness. (Table XIX) ; or
c. Children admitted to the Utah State Hospital by the end of the month in which they turn 21 years old. If they are a resident of the Utah State Hospital when they turn 21, they may receive Medicaid through the month they turn 22. Eligibility ends the month after turning 22; or
d. Individuals receiving Substance Use Disorder (SUD) treatment as a resident in a residential treatment center (Table XVIII).
2. Residents of an IMD who cannot be eligible for Medicaid or Medicare Cost-Sharing programs are:
a. Children under age 21 who reside in an IMD, other than the Utah State Hospital, licensed to provide treatment for serious mental illness (Table XIX).
b. A resident of the Utah State Hospital who was not a resident when they turned 21.
c. Individuals 22-64 years old who reside in the Utah State Hospital. 21 year olds in the Utah State Hospital must meet the criteria in B.1.c. to qualify for Medicaid coverage.
Note: Residents preparing for discharge who are not eligible for Medicaid, may apply for Medicaid prior to their discharge date (703-7).
C. Residency in an IMD
1. A person who meets the IMD residency requirements and has become a resident of an IMD remains a resident until unconditionally released. This applies even if the person moves to a different residential setting, but has not been released by the IMD.
2. Residents of an IMD who do not meet the Medicaid eligibility requirements for IMD residents, as defined in B of this section, may qualify for Medicaid when placed on conditional or convalescent leave.
a. Convalescent leave is when the resident is sent home from the institution for a trial visit.
b. Conditional leave is when the resident is released from the institution on the condition that the resident receives outpatient treatment, or some other condition of release. If an IMD temporarily releases a patient from the IMD to receive medical treatment, the patient is not on a conditional release. The resident is still considered a resident of the IMD while getting the medical treatment, even if the medical treatment involves an inpatient stay at a hospital.
3. To decide if a person meets disability criteria when the person is leaving the State Hospital, see 303-10.