Continuously Eligible Individuals Moving Out of the Medicaid Unit 510-05-53-20

(Revised 1/1/13 ML #3358)

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When an individual who is continuously eligible for Medicaid moves out of the Medicaid unit, that individual’s eligibility continues.

When a continuously eligible child leaves the Medicaid unit and enters foster care, a new application is processed to determine the child’s ongoing eligibility. If the child meets all eligibility criteria, the child begins a new continuous eligibility period. If the child does not meet the eligibility criteria, or would be eligible as medically needy, the child must be approved and remains continuously eligible only until the end of their current continuous eligibility period. A new review of eligibility is required at that time to establish any further eligibility.

When a continuously eligible individual enters a long term care facility, the individual is still considered part of the Medicaid unit; however, the post eligibility treatment of income ( 05-85-25 ) applies. Even though the individual is continuously eligible and remains eligible as other than medically needy, the individual’s income must be considered toward the cost of care, and he or she may have a client share (recipient liability). Once the individual’s continuous eligibility period ends, and a review is completed, the individual may become medically needy.

When a continuously eligible individual enters a specialized facility other than foster care, the individual is still considered part of the Medicaid unit. The individual remains eligible as other than medically needy. Once the individual’s continuous eligibility period ends, and a review is completed, the individual may become medically needy.

When a continuously eligible individual elects to receive HCBS, the individual is still considered part of the Medicaid unit. The individual remains eligible as other than medically needy. Once the individual’s continuous eligibility period ends, and a review is completed, the individual may become medically needy.

When a continuously eligible individual is away at school or training; is living outside the home to secure medical treatment; or is a child living outside of the parental home and is not living independently, the individual is still considered part of the Medicaid unit.

A continuously eligible individual may move from one case to another case. If the individual, through an application or review, meets all eligibility criteria to be continuously eligible in the new case, the individual begins a new continuous eligibility period. If the individual does not meet the eligibility criteria, or would be eligible as medically needy, the individual must be approved and remains eligible only until the end of their current continuous eligibility period. A new review of eligibility is required at that time to establish any further eligibility in the new case.

When a continuously eligible individual moves out of a household on other than a temporary basis, and is not being added to another case, the individual remains eligible in the case, but is no longer considered part of the Medicaid unit. Accordingly, the individual’s income will no longer affect other members of the Medicaid unit, nor can income be deemed from the Medicaid unit to the individual. Likewise, any caretaker relative remaining in the Medicaid unit can no longer remain eligible if their eligibility is based on being a caretaker relative for the child that left the household. If the caretaker relative remains eligible because of other children still in the case, or because the caretaker relative is eligible in their own right, the caretaker relative is no longer required to cooperate with Child Support for the child that left the household. Once the child’s continuous eligibility period ends, the child’s eligibility ends in the case.

When a continuously eligible individual leaves the household to enter a public institution or IMD, the child remains continuously eligible through the end of their continuous eligibility period. Refer to 510-05-35-95 “Public Institutions and IMD’s” for information regarding whether a medical service will be covered by Medicaid.