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UPDATED: JANUARY 2012
549.2
OTHER ELIGIBILITY REQUIREMENTS
MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIDUALS ADMITTED TO A PSYCHIATRIC CENTER
be suspended for Case Type 24 (FHPlus) recipients who at the time of admission have Coverage Code 06 (Provisional, not yet enrolled, Upstate only), Coverage Code 20 (Community Coverage Without Long-Term Care) or 34 (FHPlus).
In situations where the individual was part of a multi-person household, a determination of the remaining household’s ongoing eligibility must be performed. The psychiatric center resident shall remain in the household count unless the district receives notification from OMH that the resident’s stay is other than temporary.
Medicare Part A and /or B premium payments and payments for third- party health insurance coverage must be discontinued and the Buy-In closed. If the individual is enrolled in a managed care plan, he/she must be dis-enrolled. NOTE: It may not be appropriate to discontinue payment of third-party health insurance premiums which cover other Medicaid/FHPlus household recipients.
Medicaid coverage will not be suspended for Temporary Assistance (TA)/Medicaid recipients if the individual continues to receive TA benefits based on the individual’s temporary admission to a psychiatric center. For these individuals, Medicaid coverage will continue. Also, Supplemental Security Income (SSI) beneficiaries will continue to receive Medicaid coverage based on the receipt of SSI.
Exceptions to Suspension:
1. Medicaid Coverage must be discontinued for recipients with Coverage Code 07 (Emergency Services Only). 2. Individuals with Coverage Code 31 or 36 (Active for Guarantee Coverage Only) must have their managed care guarantee coverage discontinued with appropriate notice. 3. Individuals authorized for Medicare Savings Program (coverage code 09) must have their coverage discontinued. 4. Individuals with coverage code 17, Health Insurance Continuation Only- COBRA, AHIP must have their coverage discontinued. NOTE: If the COBRA/AHIP policy covers other eligible household members, it may not be appropriate to discontinue payment of health insurance premiums.
(MRG)