Page 1

LONG TERM CARE SERVICES F-100 PERSONS INSTITUTIONALIZED AT LEAST 30 CONSECUTIVE DAYS The term “institutionalized” refers to a person who is receiving long-term care services in a medical or nursing facility or has been screened and approved to receive Medicaid-covered Long-Term Care (LTC) services in the person’s home or community setting. The individual must be in the institution at least 30 consecutive days. In determining the number of days in a medical institution for eligibility purposes, include the date of admission, but not the date of discharge/death. Applications can be processed under this category prior to the 30th day based on a licensed physician’s statement the customer is likely to be in the institution at least 30 consecutive days. The customer must be an inpatient in a skilled nursing facility (SNF), intermediate care facility (ICF) or intermediate care facility for individuals with intellectual disabilities (ICF/IID), or hospital. Time spent in an institution for mental disease (IMD) is considered when determining institutionalization for 30 consecutive days when going to or from the IMD. If, when going from the IMD to a SNF, ICF or hospital, the customer was only temporarily transferred and not actually discharged, the time in the IMD cannot be counted toward length of time institutionalized. An "outpatient" stay is less than a 24–hour period regardless of the hour of admission, whether or not a bed is used or whether or not the patient remains in the facility past midnight. Before determining a person’s financial eligibility for a long-term care coverage category, first determine that the person resides in an institution and that all non-financial requirements have been met. Institutionalized persons must meet the same non-financial requirements as non-institutionalized persons. Special Medicaid eligibility rules, including a higher income limit, apply to institutionalized individuals. Specific provisions, known as spousal impoverishment, are used to evaluate the income and resources of institutionalized persons who are married. Eligibility begins the first day of the month in which the customer entered the medical facility, provided an application is received, and all other eligibility requirements met. F-100.1 Eligibility Exceptions • Individuals under age 65 who are inpatients in an institution for mental diseases (IMD) i.e., freestanding psychiatric hospital, are not eligible for Institutional Medicaid. • An IMD is a hospital, nursing facility or other institution of more than 16 beds primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. Individuals are considered severely psychotic, emotionally ill, suicidal and a danger to themselves, others or property. In Nevada, IMDs are commonly referred to as "psychiatric hospitals." An institution for persons with intellectual disabilities IS NOT an institution for mental diseases F-100 LONG TERM CARE SERVICES Division of Social Services Medical Assistance Manual 08 Aug MTL 08/25 PERSONS INSTITUTIONALIZED AT LEAST 30 CONSECUTIVE DAYS