Page 94

UPDATED: AUGUST 1999

535

OTHER ELIGIBILITY REQUIREMENTS

LIVING ARRANGEMENTS

Description: This section describes where Medicaid may be provided. A recipient may reside in his/her own home or a medical institution/facility. Medicaid may also be given to residents of certain public institutions/facilities. Federal reimbursement is not always available, however.

Policy: Care and services under Medicaid may be provided to an otherwise eligible A/R residing in: his/her own home; a general or chronic disease hospital; or an institution used primarily for the care of the mentally ill, when the A/R is under age 21, under age 22 if the A/R turned age 21 while residing in the institution, or is age 65 or over. Generally a person residing in a public institution may not receive Medicaid unless the public institution is: a medical facility; a community residence, not on the grounds of a major institution, serving 16 or fewer residents; a child care institution for 25 or fewer children; an emergency shelter for the homeless; a home for adults operated by a local social services district; or an OMH residential care center for adults (RCCA).

References: SSL Sect.

365 366

Family Court Act 454

Dept. Reg.

360-3.4 360-6.6

ADMs

OMM/ADM 97-1

90 ADM-18 89 ADM-2 88 ADM-50 86 ADM-23

Interpretation: The term his/her own home is broad in scope. Such living arrangement may include the person's own house or apartment, a private home for adults, an approved home for the aged or blind, a residential facility not located on the grounds of a major institution, a child care institution; and congregate care living arrangements. Persons in family care or foster care are living in their own home for Medicaid purposes. See OTHER ELIGIBILITY REQUIREMENTS LIVING IN OWN HOME for a discussion of the A/R living in his/her home. (MRG)