Effective Date: March 1, 2026

Previous Policy

Definition

Non-medical institutions include jails, prisons, juvenile correctional facilities and community residence facilities. Other institutions may also be non-medical. Medicaid policy differs for residents of public or private non-medical institutions.

Residents of Private Non-Medical Institutions

Residents of private non-medical institutions can receive Medicaid if they meet all other factors of eligibility.

Residents of Public Non-Medical Institutions

A public non-medical institution is an institution that is the responsibility of a governmental unit or that is under the administrative control of a governmental unit. Residents of some public, non-medical institutions are not eligible for Medicaid. Individuals living in the following institutions may be eligible for Medicaid coverage, if all other factors of eligibility are met. See 604 for suspending benefits for incarcerated individuals. Residents of a public non-medical institution who are within 90 days of release may be eligible for pre-release services with Medicaid.

A community residence facility. An eligible community residence facility must meet the following requirements:

Designed for and actually serving 16 or fewer individuals;

Cannot be located on the grounds of or adjacent to an ineligible institution.

Must operate primarily as a facility that provides other services the residents need, such as:

social services;

help with personal living activities;

training in socialization and life skills; or

occasional or incidental medical or remedial care.

A halfway house. An eligible halfway house ( Table XVI ) must meet following the requirements:

Residents of the facility must have freedom of movement and association as outlined according to the following tenets:

Residents are not precluded from working outside the facility;

Residents can use community facilities ‘at will’, such as libraries, grocery stores, recreation areas, or schools; and

Residents can seek health care treatment in the community to the same extent as other Medicaid enrollees in the state.

‘At will’ includes facility operational rules or “house rules”. For example, the facility may be locked or closed during certain hours of the day, residents may be required to report in during certain times, or sign in and out, etc.

Home Confinement, also known as "house arrest" “ankle monitor,” or “electronic monitoring.” If the conditions of home confinement fit the definition of freedom of movement described in 2.a. and b., the individual is eligible for Medicaid.

Residency When Entering or Leaving a Non-Medical Institution

Anyone who moves from a household to a private, non-medical institution, or a public, non-medical institution that meets one of the exceptions in C. above, is still a resident of a household for the month they are admitted to the institution.

An individual who moves from a household to a jail or prison may continue to be a resident of a household. See 401-4 for MAGI Programs and 408-2 and 408-6 for ABD Programs.

If the individual enters a public institution that does not meet one of the exceptions in C. above, Medicaid eligibility is available for the portion of the month during which the individual was not in the public institution.

When a person leaves to receive inpatient services in a hospital, an IMD, the State Developmental Center, or a long-term care facility, the individual is not a resident of a public non-medical institution from the date of admission to the date of discharge from the hospital, IMD, State Developmental Center or long-term care facility. Medicaid eligibility is available for the portion of the month during which the individual is inpatient in the hospital, IMD, State Developmental Center or long-term care facility if the individual meets all other factors of eligibility.

If the individual is not a member of the community household during the inpatient stay in a hospital, IMD, State Developmental Center, or long-term care facility. Base eligibility on the individual's circumstances while the individual is an inpatient, not on the circumstances of the household in which the individual lived before entering the public, non-medical institution such as a jail or prison.

If the individual is disabled, or claiming to be disabled see 303 .

When a child residing in a public, non-medical institution is admitted for an inpatient stay in a medical hospital, IMD, State Developmental Center or long-term care facility, determine eligibility based on the child's income and assets ( 215-3 ).

Anyone who moves from a non-medical institution to a household becomes a resident of a household for the remainder of the month during which they move into the household.

See 703-7 for policy on applying for medical assistance before the person has left the institution, when a person is about to leave the Utah State Hospital, jail or prison, and when an incarcerated individual is admitted for an inpatient stay in a hospital, IMD, State Developmental Center, or long-term care facility.

Disability Decision When Leaving a Public Institution

If the individual was determined disabled before entering the public institution, or while living in a public institution, see 303-10 to determine their eligibility for Disability Medicaid.