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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 April 2021 Subchapter Subject Page ending with Page M0280 INSTITUTIONAL STATUS REQUIREMENTS M0280.200 3

• residential facilities located on the grounds of, or adjacent to, any large (more than 16 beds) institution; • correctional or holding facilities for individuals who are prisoners, who have been arrested or detained pending disposition of charges, or who are held under court order as material witnesses or juveniles

• educational or vocational training institutions that primarily provide an approved, accredited or recognized program to individuals residing there

• hospitals, nursing facilities, and intermediate care facilities for individuals with intellectual disabilities. NOTE: An individual residing in a public educational or vocational training institution for purposes of securing education or vocational training is NOT an inmate of a public institution, and therefore may be eligible for Medicaid, even though the educational or training facility is not a publicly operated community residence. I. Residential Institution An institution that does not meet the definition of a “medical facility.”

M0280.200 INSTITUTIONAL STATUS RULE

A. Introduction Federal regulations in 42 CFR 435.1008 prohibit federal financial participation (FFP) for individuals who are inmates of a public institution, with certain exceptions for patients in an IMD. Federal regulations limit FFP for individuals who are age 22 years or over but under age 65 years and who are patients in an institution for the treatment of mental diseases (IMD). An individual who is age 22 or over, but under age 65 and who is enrolled in Medicaid at the time of admission to an IMD may remain enrolled in Medicaid. The Department of Medical Assistance Services (DMAS) will coordinate with the Centers for Medicare and Medicaid Services (CMS) to ensure that no unauthorized FFP occurs. There is no prohibition on FFP for individuals under age 22 years if they are receiving inpatient psychiatric services.

NOTE: an ICF-ID is not an IMD.