Medicaid Policy
Medicaid Policy
Link to e-Forms. Search for State Hospital Cover Sheet.
Individuals Leaving a Public Institution
A person who has been determined disabled remains disabled until there is a finding that the person is not disabled.
Leaving for a community setting. When a person leaving the State Hospital or a public institution applies for Medicaid, consider the person disabled without doing a disability review if:
The individual had been determined disabled before the individual entered the institution, or while the individual was there, and
There has not been a period of over 30 days when the individual was not a resident in an institution.
Approve the individual for disability Medicaid if a. and b. are true and all other factors of eligibility are met without requesting a new disability determination. See B. for policy on when to request a new disability determination.
Leaving for an inpatient hospital stay. An individual determined disabled before entering a public institution such as a jail or prison is still considered disabled when they leave the public institution and are admitted to a medical hospital for an inpatient stay.
Do not request a new disability review during an inpatient hospital stay when the individual will return to the public institution once the medical need ends.
The individual may be eligible for Medicaid only during the inpatient stay unless they are within 90 days of release from the public institution (see 600).
If a individual was not determined disabled before entering the public institution or was denied disability before or after entering the public institution, request a disability decision if he claims a disability.
Disability Redeterminations
When a disabled individual meeting criteria in A.1. above moves from an institution into the community, and is approved for Medicaid, request a disability re-determination at the following times:
When the Medical Review date on the Form 121 from the most recent SMDO disability determination has already past; or
When the Medical Review date on the Form 121 from the most recent SMDO disability determination is within 30 days of the date the individual applies; or
SSA/SSI payments ended for a reason other than ‘not disabled’ over 12 months ago.
Do not close the case while the SMDO re-determines disability unless the individual is not qualified because of other eligibility factors.
Do not ask for a new disability determination or re-determination when:
The individual is still receiving SSDI benefits (individuals in the State Hospital continue to receive SSDI), or
The individual begins receiving SSI or SSDI benefits before you have made an eligibility decision.
If you have sent a referral to the SMDO, and SSI or SSDI benefits resume before the SMDO makes a redetermination decision, contact the SMDO and tell them disability benefits have resumed so they stop processing the decision.