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State of Maryland Medical Assistance Manual Revised April 2014

An individual must meet technical eligibility, living arrangement and financial eligibility, before he or she may be determined eligible to receive Medical Assistance benefits. A person’s living arrangement essentially refers to his or her residency in the community, as opposed to residency in an institution, which includes IMDs. Different financial criteria are applied based on a person’s status as a community resident or as institutionalized. There are several eligibility factors which determine when a person is considered institutionalized. The applicable policy is based upon the person’s age, i.e., persons under 21 years old, persons who are 21 through 64 years old, and persons 65 or older. Once a person is considered institutionalized, the person retains that status until discharged from the facility. The rules are as follows: 1) Persons under 21 years old. Children are considered institutionalized as of the first day of the first full calendar month of admission to an IMD. 2) Persons 21-64 years old. Non-aged adults are considered institutionalized as of the 30th consecutive day of residency in an IMD, or as of the 60th cumulative day of residency in an IMD during a calendar year. 3) Persons 65 or more years old. An aged person is considered institutionalized as of the first day of admission to the IMD if the admission last for 30 days or more. For children (under 21 years old) and elderly adults (65 or more years old), being considered institutionalized has the same effect. On the date the person is considered institutionalized, the following applies: • MA eligibility is re-determined based on long-term care rules. • If enrolled in Health Choice, the person must be disenrolled from the MCO as of the date that the institutionalization status is considered to begin. • If an individual enters an IMD before age 21, he or she may remain MA eligible as an institutionalized person in the IMD up to his or her 22nd birthday or until care in the IMD is no longer required. If a recipient is discharged from an IMD and then is readmitted and institutionalized at age 21 or older, the recipient loses MA eligibility and MA does not cover the IMD services. Therefore, MA covers a recipient’s IMD services until the earlier of the date that the recipient: • No longer requires the services • Is unconditionally discharged; or • Reaches age 22. For adults between the ages of 21 and 64, admission to the IMD for a continuous period of institutionalization causes the person to become ineligible for MA. When a non-aged adult is considered institutionalized in an IMD, the following applies: • If enrolled in Health Choice, the person must be disenrolled from the MCO effective the date that the institutionalized status is considered to begin. • For recipients of Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA), their MA eligibility is not terminated unless their eligibility for the cash program ends. However, MA is prohibited from paying for the cost of their IMD services.