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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 October 2025 Subchapter Subject Page ending with Page M0280 INSTITUTIONAL STATUS REQUIREMENTS M0280.600 10

M0280.500 INDIVIDUALS MOVING TO OR FROM PUBLIC INSTITUTIONS

A. Moves To Public Institution If a currently eligible individual enters a public institution, a partial review must be completed to determine if he continues to meet institutional status requirements for continued coverage, as well as all other Medicaid eligibility requirements. Outstanding bills for covered medical services incurred prior to his admission and during his Medicaid coverage period will be paid. B. Moving From Public Institution Although a person may not be eligible for Medicaid while living in a specified public institution or part thereof, he may apply for such assistance as a part of prerelease planning. If he is found eligible (except for institutional status), do not enroll until he leaves the institution to live elsewhere. C. Resident Admitted to Medical Facility A resident of an ineligible public institution may be eligible for Medicaid coverage limited to inpatient hospitalization when admitted to a medical institution (general hospital) for inpatient care.

M0280.600 DEPARTMENTAL RESPONSIBILITY

A. Incarcerated Individuals The Cover Virginia Incarcerated Unit (CVIU) is responsible for case management of incarcerated individuals with active Medicaid coverage enrolled in aid categories 108 and 109, regardless of the facility where the offender resides. See M0140 for additional information. B. All Other Institutions Local social services departments are responsible for the Medicaid eligibility determination and enrollment of individuals in institutions EXCEPT for incarcerated individuals in aid category 108 or 109. The local DSS agency in the Virginia locality where the individual last resided outside of an institution is the responsible DSS agency. If the individual resided outside of Virginia immediately before admission to the institution, the responsible local DSS is the DSS agency serving the locality where the institution is located. When a local department carries responsibility for eligibility determination and enrollment of an individual living in an institution, the department is also responsible for: • advising the institution of the individual's eligibility for Medicaid and enrollment in the program;

• submitting a DMAS-225 form to the institution to indicate the patient’s eligibility and availability of current patient pay information in the Medicaid Management Information System (MMIS), if applicable; and

• seeing that the Medicaid card is forwarded to the institution for the enrollee’s use.