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Chapter: 1400 Technical Requirements Program: MSSI, SFP 43 For the OSS and HCDA Programs, the individual must be 18 or older. Refer to passage 1440.0008 for specific HCBS age requirements.

All individuals must also meet the aged, blind or disabled criteria to be determined eligible for Medicaid under SSI-Related Programs, which are discussed in passages 1440.1200 - 1440.1206. 1440.0508 Verification of Age (MSSI, SFP) The same verification sources used as proof that an individual is "aged" may be used to prove any individual's age. Refer to passage 1440.1202. 1440.1100 LIVING ARRANGEMENTS (MSSI, SFP) This section describes policies relating to eligibility and living arrangements. 1440.1103 Residents of Public Institutions/IMDs (MSSI) Individuals residing in public institutions or institutions for mental diseases (IMDs) throughout an entire calendar month are eligible to receive Medicaid, however, their coverage will be suspended. This includes inmates, prisoners, detainees, or convicts under detention or custody of a Federal, State, or local penal, correctional, or other detention facility or institution.

An institution is an establishment that furnishes food, shelter, and some treatment or services to four or more persons unrelated to the proprietor. A public institution is administrated by a governmental unit. Public institutions exist at all levels: federal, state, and local.

An IMD is an institution that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services.

Medical institutions (for example, hospitals, nursing homes and intermediate care facilities), or a publicly operated community residence that serves no more than 16 residents or certain child care institutions are not considered public institutions.

Residents of a state mental hospital who are age 65 or older may be eligible for Medicaid.

Exception: Children who are under 18 years of age and are placed in an IMD under the Statewide Inpatient Psychiatric Waiver Program (SIPP) remain eligible for Medicaid and their coverage must not be suspended. 1440.1104 Reduced SSI - Patients in Medical Institutions (MSSI, SFP) SSI individuals who enter a medical institution are not entitled to receive a full SSI payment, but receive a reduced payment of $30.00. This limited Federal Benefit Rate (FBR) applies if the individual is an inpatient throughout a full month and Medicaid will pay a substantial part (over 50 percent) of the cost of care. The individual is entitled to the full FBR for the month he first enters the nursing home.

If the individual has other income over $30.00, his SSI will stop and his patient responsibility will be determined using only the other income. 1440.1105 Full FBR for Temporary Institutionalization (MSSI, SFP) One exception to the reduced FBR applies to individuals who enter a nursing home for a temporary stay. If he has expenses at home and his doctor expects he will stay for less than 91 days, he can receive the full FBR for three months. The individual must provide proof of these conditions to SSA by the 10th day of the month after the month of admission. The SSI payment is for the individual's personal needs and home expenses and is not used to pay the facility or to determine patient responsibility. A supplement to the personal needs allowance is not authorized in these cases because the individual’s income exceeds the personal needs allowance.