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All Medicaid Programs |
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Obsolete Policy |
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Definition
Non-medical institutions include jails, prisons, 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 all other factors of eligibility are met. See sec. 215-2 to decide if the person is temporarily absent from the household.
Residents of Public Non-Medical Institutions.
A public 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 most public, non-medical institutions are not eligible for Medicaid. There are exceptions listed below.
A person who lives in a public non-medical institution for the primary purpose of getting education or training can receive Medicaid if all other factors of eligibility are met.
Residents of Community Residence Facilities can receive Medicaid if all other factors of eligibility are met.
A community residence facility must be designed for and actually serve 16 or fewer people.
It must operate primarily as a residence that provides additional services to help the people who live there.
A community residence facility does not include correctional or holding facilities, half-way houses, community residences designed to serve more than 16 people, community residences serving more than 16 people, and community residences on the grounds of or adjacent to an ineligible institution.
To be a community residence, a facility must provide food and shelter. In addition, it must provide or arrange for other services the residents need. For example, the other services may include:
social services;
help with personal living activities;
training in socialization and life skills;
occasional or incidental medical or remedial care.
Residency for the Month of Entry and the Month of Discharge from a Non-Medical Institution.
Anyone who moves from a household to a non-medical institution is still a resident of a household for the month he is admitted to the institution.
Once a person becomes a resident of a public non-medical institution, he must continue 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.
If a person leaves, 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 non-medical institution during the absence. For example, a person leaving to receive inpatient hospital services is still considered a resident of a public non-medical institution while in the hospital.
Anyone who moves from a non-medical institution to a household becomes a resident of a household for the month he moves into the household. See Sec. 611 to decide when eligibility can begin.
See Sec. 209-1 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.
Example #1
Example #2
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 Sec. 303-10 to decide eligibility as a disabled individual when the person returns to the community.