8113 Long Term vs. Temporary Care (Planned Brief Stay)

Individuals whose stay in a Medicaid approved institution will not exceed the month of entrance and the following two months are considered to be in temporary care and eligibility is to be determined under independent living methodologies. The person would be treated as though he or she were still living in the community and be included in either an individual or family group assistance plan as appropriate. However, this provision would not be applicable to the extent that it conflicts with the requirements of 8143 regarding separate budgeting for institutionalized spouses and 8144.2 regarding application of the spousal impoverishment income provisions.

NOTE : A stay shall be defined as any continuous period of institutionalization, whether in a hospital, nursing facility, other institution, or a combination of one or more.

On the other hand, long term care shall be generally defined as a stay which will exceed the month of entrance and the following two months except when spousal impoverishment provisions apply as indicated below. Long term care policies would be applicable beginning with the month of entrance for children under the age of 18 entering an institutional arrangement or the month following the month of entrance for adults, except that financial eligibility methodologies will vary for individuals in adult care homes based on whether or not the individual meets the monthly liability amount as specified in 8172 .

For institutionalized spouses for whom the spousal impoverishment provisions of 8144 and subsections are applicable and for children under the age of 18 as described in 2666 and 8183 , long term care shall be defined as a stay which will last at least 30 consecutive days.

If the stay does not exceed this time period, independent living methodologies (including HCBS or PACE) would be applicable as noted above. If the stay is determined to exceed this time period, long term care policies would be applicable beginning with the month following the month of entrance except for those persons in which application of the spousal impoverishment provisions of 8144.2 are more beneficial. In addition, financial eligibility methodologies will vary for individuals in adult care homes based on whether or not the individual meets the monthly liability amount as specified in 8172 .

If the individual enters the institution from an HCBS arrangement, the requirements of 8173 apply.

NOTE : If an individual is initially processed as being in temporary care and the stay exceeds those time lines, long term care policies shall then be applied beginning in the third month following the month of entrance.