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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 M0280.301 8

3. Type of Facility The type of facility, whether it is residential or medical and whether it is public or private must be determined. A juvenile is not eligible for full- benefit Medicaid if he/she is a resident of an ineligible public residential facility. He can be eligible for Medicaid coverage limited to inpatient hospitalization if he is admitted to a medical facility for inpatient services. EXAMPLE #1: A juvenile is detained for criminal activity. He is placed on probation with specific conditions of release, including a stay of 30 days or longer at a detention facility. The facility is identified as a juvenile detention center, not a treatment center. Upon release from the detention center, he will be placed on probation and will live with his mother. Because of the nature of his custody (criminal activity) and the nature of the facility (a detention center is a public institution) he is not eligible for full-benefit Medicaid/FAMIS during the period of incarceration, but can be eligible for Medicaid coverage for inpatient hospitalization. After he is released from the detention center and while he is on probation, he is NOT an inmate of a public institution and may be eligible for full benefit Medicaid/FAMIS.

M0280.301 WHO IS NOT AN INMATE OF A PUBLIC INSTITUTION

A. Who Is NOT An Inmate of a Public Institution An individual is NOT an inmate of a public institution if: • he is in a public educational or vocational training institution for purposes of securing education or vocational training OR • he is in a public institution for a temporary period pending other arrangements appropriate to his needs.

B. Educational or Vocational Institution 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. C. Temporary Stay An individual residing in a public institution for a temporary period pending other arrangements appropriate to his needs is NOT an inmate of a public institution, and therefore may be eligible for Medicaid. D. Admitted Under TDO An individual over age 18 who was arrested or detained, but did not reside overnight in a prison or jail before being admitted to a public institution under a temporary detention order (TDO) is NOT an inmate of a public institution because he did not reside in the jail or prison immediately before admission to the treatment facility. E. Arrested Then Admitted to Medical Facility An individual who, after arrest but before booking, is escorted by police to a hospital for medical treatment and held under guard is NOT an inmate of a public institution and may be eligible for Medicaid. He is not an inmate of a public institution because he did not reside in a jail, prison or secure detention facility immediately prior to admission to the medical facility. F. Inmate Out On Bail An inmate in a prison or jail prior to arraignment, conviction, or sentencing is not eligible for Medicaid unless he/she is out on bail or released on his/her own recognizance.