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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 M0280.201 4

B. Procedures The policy and procedures for determining whether an individual is in an IMD are contained in subchapter M1430. The policy and procedures for determining whether an individual is an inmate of a public institution are contained in the following sections: • M0280.201 Individuals in Medical Facilities • M0280.202 Individuals in Residential Facilities • M0280.300 Inmate of A Public Institution • M0280.301 Who Is NOT An Inmate of A Public Institution • M0280.400 Procedures For Determining Institutional Status • M0280.500 Individuals Moving To or From Public Institutions • M0280.600 Departmental Responsibility. See Appendix 1 to this subchapter for an Institutional Status Quick Reference Guide.

M0280.201 INDIVIDUALS IN MEDICAL FACILITIES

A. Public or Private The public or private ownership or administration of a medical facility is irrelevant because a medical facility is not a public institution as defined in this subchapter. B. Individuals in IMDs The following individuals in public or private IMDs are NOT eligible for enrollment into Medicaid because they do not meet the institutional status requirement: • an individual who is age 22 or over, but under age 65; • an individual who is under age 22 who is NOT receiving inpatient psychiatric services in the 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.

1. Patient Under Age 22 or 65 Years and Older in an IMD An individual is in an IMD when he/she is admitted to live there and receive treatment or services provided there that are appropriate to his/her requirements. A patient in an IMD is an individual who is receiving needed professional services that are directed by a licensed practitioner of the healing arts toward maintenance, improvement, or protection of health or lessening of illness, disability, or pain. An individual is considered to be in an IMD from the date of admission to the IMD until discharge from the IMD. An individual who is age 65 or older and who is a patient in a public or private IMD meets the institutional status requirement for Medicaid. An individual who is under age 22, who is a patient in a public or private IMD and who is receiving inpatient psychiatric services in the IMD meets the institutional status requirement for Medicaid.