Inpatient Services

If a child is receiving inpatient services when the age limit for an income level is reached or when the child turns 19 years of age, eligibility continues if all of the following requirements are met:

reaching age 19 or the age limit for an income level is the sole reason for ineligibility;

inpatient services are received in a Medicaid participating hospital or nursing facility on the last day of the month in which the age or income limit is reached and the first day of the next month;

the child remains eligible under all Children Under 19 Years of Age criteria except for age or income limit through the month in which the inpatient stay terminates.

If the child is transferred directly from one medical facility to another, the extended eligibility can continue if all other requirements are met.

Upon discharge or if there is a break in stay in a medical facility, the lower income level must be used if the child is under 19 years of age. If the child has reached 19 years of age, s/he is ineligible upon discharge or if there is a break in stay in a medical facility. Complete and document the results of a CMD prior to termination of Children Under 19 Years of Age.

This coverage can be established in the three months prior to an application, even if the child reaches the age limit in one of the prior months, provided the above criteria are met.

Step 1 Verify the inpatient stay that continues beyond the date the child would become Children Under 19 Years of Age ineligible. Continue Children Under 19 Years of Age eligibility through the month following the date of ineligibility and for each month until the child is discharged. Step 2 Complete and document results of a CMD on the child upon discharge from the medical facility and discontinue Children Under 19 Years of Age.

If Children Under 19 Years of Age is terminated before the agency is notified of the inpatient services, verify that the inpatient services were received and reopen the Children Under 19 Years of Age case. Continue Children Under 19 Years of Age until the patient is discharged. Complete and document the results of a CMD prior to terminating Children Under 19 Years of Age when the child is discharged from the medical facility.