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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 May 2015 Subchapter Subject Page ending with Page M0280 INSTITUTIONAL STATUS REQUIREMENTS M0280.202 5
E. Cross Reference If the individual has been, or is expected to be, in the medical facility or medical section of the facility for 30 or more consecutive days, the individual is receiving long-term care. Chapter 14 contains additional eligibility policy for individual in long term care.
M0280.202 INDIVIDUALS IN RESIDENTIAL FACILITIES
A. Institutions With Medical and Residential Sections Some institutions have both medical and residential sections. An individual in the medical certified section (or beds) of the institution is a patient in a medical facility. If the individual has been, or is expected to be, in the medical facility for 30 or more consecutive days, the individual is receiving long-term care. Go to chapter M14 to determine the individual's eligibility. An individual in the residential portion (or beds) of the institution is a resident of a residential facility. Use this subchapter to determine the resident's institutional status. B. Private Residence or Group Home An individual who lives in a private residence in the community that is not an institution (it is an establishment that provides food, shelter and some services to three or less persons unrelated to the proprietor) is not living in an institution. A group home that has a capacity of no more than three residents is not an institution. C. Private Residential Facility A resident of any age in a private residential facility meets the institutional status requirement for Medicaid UNLESS the individual is incarcerated, as defined below. D. Public Residential Facility A resident of any age in a PUBLIC residential facility meets the institutional status requirement for Medicaid UNLESS: • the public residential facility has more than 16 beds, or • the individual is an inmate - an incarcerated adult or a juvenile in detention - as described in section M0280.300 below, and is not an individual listed in M0280.301 below.