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Aged, Blind and Disabled Manual; Section: Categories of Eligibility; Policy Manual Number: 115.015; Chapter: INSTITUTIONAL MEDICAID
Legal Authority: 42 CFR 435.236; 42 CFR 435.1005; 42 CFR 435.1009; 42 CFR 435.1010; 42 CFR 435.520; 42 CFR 435.540; 42 CFR 435.541; TennCare 1115 Medicaid Demonstration; Section 1902(a)(10) of the Social Security Act; Tenn. Comp. R. & Regs. 1200-13-20-.08(5); State Plan Amendment TN-21-0010
1. Policy Statement Medicaid benefits and potentially Long-Term Services and Supports (LTSS) payments are available to eligible individuals receiving care in a medical institution (regardless of age) provided they are not:
a. An inmate of a public institution; or b. A patient in an Institution for Mental Disease (IMD), unless she is:
i. Under age 22 and receiving inpatient psychiatric services; or ii. At least 65 years of age.
LTSS payments are available for individuals receiving Nursing Facility (NF) care and approved for CHOICES. Individuals approved for Institutional Medicaid based on 30-day continuous confinement will not receive LTSS payments unless they are admitted to a NF or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) with an approved PAE. Medicaid benefits and LTSS payments are also available for aged adults and physically disabled adults (age 21 and older) when approved for and receiving CHOICES Home and Community Based Services (HCBS), and individuals of all ages with Intellectual and Developmental Disabilities (IDD) who are eligible for and receiving Employment and Community First (ECF) CHOICES services.
2. Definitions a. Aged: Individuals age 65 or older.
b. Blind: Individuals who have been determined to be legally blind by the Social Security Administration (SSA).
c. Disabled: Individuals who have been determined to be disabled by the SSA or TennCare. Generally, an individual is considered disabled when he is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or to last for a continuous period of not less than 12 months.