Effective Date: October 1, 2021
Previous Policy
A nursing home resident must meet the categorical and non-financial criteria for one of the Medicaid programs such as Aged, Blind, Disabled, Child under 19, Medically Needy Child, Adults receiving traditional Medicaid benefits, or Pregnant Woman. See the program rules for these Medicaid programs.
A customer receiving community Medicaid who enters a nursing home is eligible for nursing home Medicaid for a minimum of 30 days beginning the month after they are admitted to an institution. Additional time will be allowed if requested. This will allow coverage while the worker requests any additional verification needed to establish and approve continued eligibility for the nursing home program.
If it is determined that the recipient is not eligible for the nursing home program, close the nursing home coverage and consider ancillary coverage. There is no overpayment unless the customer willfully withheld information.
10 day notice rules apply to all changes.