Medicaid Policy
Medicaid Policy
Definition
Non-medical institutions include jails, prisons, juvenile correctional facilities and community residence facilities. Other institutions may also be non-medical. Medicaid policy differs for residents of public or private non-medical institutions.
Residents of Private Non-Medical Institutions
Residents of private non-medical institutions can receive Medicaid if they meet all other factors of eligibility.
Residents of Public Non-Medical Institutions
A public non-medical institution is an institution that is the responsibility of a governmental unit or that is under the administrative control of a governmental unit. Residents of some public, non-medical institutions are not eligible for Medicaid. Individuals living in the following institutions may be eligible for Medicaid coverage, if all other factors of eligibility are met. See 604 for suspending benefits for incarcerated individuals. Residents of a public non-medical institution who are with 90 days of release may be eligible for pre-release services with Medicaid.
A community residence facility. An eligible community residence facility must meet the following requirements:
Designed for and actually serving 16 or fewer individuals;
Cannot be located on the grounds of or adjacent to an ineligible institution.
Must operate primarily as a facility that provides other services the residents need, such as:
social services;
help with personal living activities;
training in socialization and life skills; or
occasional or incidental medical or remedial care.
A halfway house. An eligible halfway house (Table XVI) must meet following the requirements:
Residents of the facility must have freedom of movement and association as outlined according to the following tenets:
Residents are not precluded from working outside the facility;
Residents can use community facilities ‘at will’, such as libraries, grocery stores, recreation areas, or schools; and
Residents can seek health care treatment in the community to the same extent as other Medicaid enrollees in the state.
‘At will’ includes facility operational rules or “house rules”. For example, the facility may be locked or closed during certain hours of the day, residents may be required to report in during certain times, or sign in and out, etc.
Home Confinement, also known as "house arrest" “ankle monitor,” or “electronic monitoring.” If the conditions of home confinement fit the definition of freedom of movement described in 2.a. and b., the individual is eligible for Medicaid.
Residency When Entering or Leaving a Non-Medical Institution
Anyone who moves from a household to a private, non-medical institution, or a public, non-medical institution that meets one of the exceptions in C. above, is still a resident of a household for the month he is admitted to the institution.
If the individual enters a public institution that does not meet one of the exceptions in C. above, the individual is a resident of a household until he or she is admitted to the institution. Medicaid eligibility is available for the portion of the month during which the individual was not in the public institution.
Once a person becomes a resident of a public non-medical institution that does not meet one of the exceptions in C. above, he continues to be considered a resident of a public institution until released from the facility.
If a person leaves without being released, he continues to be considered a resident of a non-medical institution until he is released. For example, if the person “escapes” from the facility, he has not been released.
When a person leaves to receive inpatient services in a hospital, an IMD, the State Training School, or a long-term care facility, the individual is not a resident of a public non-medical institution from the date of admission to the date of discharge from the hospital, IMD, State Training School or long-term care facility. Medicaid eligibility is available for the portion of the month during which the individual is inpatient in the hospital, IMD, State Training School or long-term care facility if the individual meets all other factors of eligibility.
The individual is not a member of the community household during the inpatient stay in a hospital, IMD, State Training School, or long-term care facility. Base eligibility on the individual's circumstances while the individual is an inpatient, not on the circumstances of the household in which the individual lived before entering the public, non-medical institution such as a jail or prison.
If the individual is disabled, or claiming to be disabled see 303.
When a child residing in a public, non-medical institution is admitted for an inpatient stay in a medical hospital, IMD, State Training School or long-term care facility, determine eligibility based on the child's income and assets (215-3).
If a person leaves for any other reason, and is supposed to return to a public non-medical institution when the purpose for the absence ends, he continues to be considered a resident of a public non-medical institution during the absence. For example, a person is away from the public, non-medical institution on a work detail.
Anyone who moves from a non-medical institution to a household becomes a resident of a household for the remainder of the month during which he moves into the household.
See 703-7 for policy on applying for medical assistance before the person has left the institution, when a person is about to leave the Utah State Hospital, jail or prison, and when an incarcerated individual is admitted for an inpatient stay in a hospital, IMD, State Training School, or long-term care facility.
Disability Decision When Leaving a Public Institution
If the individual was determined disabled before entering the public institution, or while living in a public institution, see 303-10 to determine their eligibility for Disability Medicaid.