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UPDATED: JANUARY 2012

549.3

OTHER ELIGIBILITY REQUIREMENTS

MAINTAINING MEDICAID ELIGIBILITY FOR INDIVIDUALS ADMITTED TO A PSYCHIATRIC CENTER

5. Case Type 20 (MA) recipients with Coverage Code 09 who are participating in the spenddown program must have their case suspended and their premium payment discontinued. Recipients who have been authorized for MSP-only must have their MSP Buy-in span end-dated in eMedNY.

Re-Instatement of Medicaid

Upon notification from DOH/OMH that an individual whose Medicaid or FHPlus authorization had been placed in suspend status is being discharged from the psychiatric center such individual must have their Medicaid coverage reinstated with the coverage they had immediately prior to their admission to the psychiatric center. Medicaid coverage must be reinstated for five months (the month of discharge, plus four months) with appropriate notice at the individual’s current address.

In situations where the releasee is residing with family members who are not in receipt of Medicaid or FHPlus, his/her ongoing eligibility shall be redetermined at renewal as a member of the household, after the five month reinstatement period. If the releasee is a member of a currently eligible Medicaid/FHP household, eligibility for the other household member(s) must be reviewed at renewal.

Exceptions to Re-Instatement

1. Medicaid eligibility must be redetermined for individuals who are being discharged to an SNF. While a new application is not required, Supplement A to the DOH-4220 is required if resource information must be captured.

2. Coverage for individuals who are being discharged to the custody of the United States Immigration and Customs Enforcement (ICE) must be discontinued.

3. Individuals who are being discharged to a NYS or local correctional facility will continue to have their coverage suspended.

4. Coverage must be discontinued for individuals who are being discharged to another state’s law enforcement.

5. Coverage for individuals who are being discharged to the Federal Bureau of Prisons must have their coverage discontinued. (MRG)