B-6300, Institutional Living Arrangement

Revision 26-3; Effective Sept. 1, 2026

Determine the first day a person’s eligibility can be established under the special income limit. The following forms provide adequate verification of dates of admission to a Medicaid facility:

Form 3618, Resident Transaction Notice ;

Form 3619, Medicare/SNF Patient Transaction Notice ; and

Form H0090-I, Notice of Admission, Departure , Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution.

Eligibility staff may contact the administrator, bookkeeper, or office manager for the date of admission, in the absence of the above-listed forms.

Use the special income limit for the month of entry to a Medicaid-certified long-term care facility (Medicare-SNF, NF or ICF/IID). Do when anticipating that the person will stay in a Medicaid-certified facility for at least 30 consecutive days. Eligibility under the special income limit cannot be approved until the applicant has lived in an institutional setting for at least 30 consecutive days. Application processing may start on receipt, including pending for more information. Suspend the case or delay certification, as appropriate, until the requirement is met if the applicant meets all other eligibility factors before meeting the 30-day stay requirement. Refer to the MEPD Due Date Chart job aid on The LOOP to determine the 31st day.

The 30-day requirement begins with confinement to one or more Medicaid-certified facilities (Medicare- SNF , NF or ICF/IID ) for at least 30 consecutive days. The date of admittance to an institution is day zero.

Example 1: Mr. Smith entered the nursing facility on March 27. He stayed there for 30 consecutive days and did not go home, to the hospital or to another nursing facility during that time. The earliest staff can certify the case is the 31st day, which is April 27.

Example 2: Mr. Lopez entered the hospital on Feb. 10 and entered the nursing facility on Feb. 19. He stayed there for 30 consecutive days and did not go home, to the hospital or to another nursing facility during that time. The start of the 30 consecutive days started on Feb. 19, not Feb.10.The earliest staff can certify the case is the 31st day, which is March 22.

Example 3: Mr. Johnson entered the nursing facility on March 1. He went to the hospital on March 5. He returned to the nursing facility on March 10. The 30 consecutive days started on March 1 and was not interrupted by the hospital stay. The earliest staff can certify the case is the 31st day, which is April 1.

Example 4: Mr. Brown entered the nursing facility on May 10. The 31st day is June 10. He went home on June 1. He did not stay the required 30 consecutive days. Staff cannot certify the case.

Example 5: Mr. Leo entered the nursing facility on April 20. The 31st day is May 21. He died on May 10. He did not stay the required 30 consecutive days. Staff can certify the case if the person meets all other eligibility requirements, including medical necessity.

Example 6: Mr. Smith entered the hospital on Feb. 15 and then went directly to the nursing home on March 10. His wife continues to live in their home in the community. The 30 consecutive days starts on March 10, not Feb. 15. The earliest staff can certify the case is the 31st day, which is April 10th.

Note: The hospital stay in February is the start date for the continuous period in an institution for the spousal resource assessment. This is different than the 30-consecutive day requirement. Refer to Chapter J, Spousal Impoverishment , regarding the resource assessment and spousal protected resource amount (SPRA).

Consider both the days in a medical facility and the days in a Home and Community-Based Services waiver setting when determining the 30 consecutive day requirement.

It may be necessary to verify the living arrangement for prior months. Do this by contacting the applicant or authorized representative to make sure the appropriate income limit is used for determining eligibility for prior months. It may also be necessary to contact the facility, Home and Community-Based Services waiver provider or hospital, if an applicant was discharged to a hospital. This is to make sure that the 30 consecutive day requirement is met.

The case record must include the following documentation :

Date the applicant entered the Medicaid facility.

Date the applicant met the 30 consecutive day requirement or date of death.

Source of verification.

Refer to Appendix XXX, Medical Effective Dates (MEDs) . Use the information under the Institutional Based area to determine the appropriate income limit for the month of application and the prior months.

The 30 consecutive day requirement does not apply to a regular Medicaid recipient who:

is eligible for SSI; or

was eligible for SSI and continues regular Medicaid eligibility through one of the cost-of-living adjustment (COLA) disregard programs.

The COLA disregard programs are:

ME-Pickle

ME-Disabled Adult Child

ME-Disabled Widow(er)

ME-Early Aged Widow(er)