8000 - Institutional and Home and Community Based Services Living Arrangements
8100 Institutional Living/Long Term Care
This section sets forth the guidelines regarding individuals who reside in an establishment where food and shelter are furnished to four or more persons unrelated to the proprietor and, in addition, some treatment or services are provided which meet some need beyond the basic provision of food and shelter. The type of institution (public or private), the purpose of being in the institution (medical or nonmedical), the length of stay, and whether Medicaid makes substantial payments on behalf of the individual are factors that determine whether the individual will establish, retain, or lose eligibility for assistance and the amount of income protected to meet maintenance needs. Institutional living arrangements include but are not limited to adult care homes, hospitals, psychiatric facilities, assisted living/residential health care facilities, and other facilities (such as certain elderly high rises) which meet the above definition. In some instances, the determination of whether a living arrangement meets the definition of institution will need to be made on a case by case basis. What is important is that the arrangement meet all of the previously mentioned criteria (i.e., food, shelter, and some service provided to 4 or more persons).
Medical eligibility may be determined for an institutionalized person. However, there is no eligibility for an individual age 21 through 64 who resides in an IMD except as noted in 8112.4 and no eligibility for an individual in a penal institution, except as noted in 8111.1(2).
This section will primarily focus on the issue of long term institutional care. This refers to persons who are in need of medical services in an institutional setting over an extended period of time as defined in 8113 below.