Utah Admin. Code R414-302-6 - Residents of Institutions
(1)
For purposes of institutions, the definitions in
42 CFR
435.1010 apply.
(2) An individual who resides in a halfway
house may receive Medicaid coverage if the halfway house meets the following
criteria:
(a) the halfway house allows the
individual to work outside the facility;
(b) the halfway house allows the individual
to use community facilities at will, such as libraries, grocery stores,
recreation areas, or schools; and
(c) the halfway house allows the individual
to seek health care treatment in the community to the same extent as other
Medicaid members.
(3) The
department does not consider an individual who resides in a temporary shelter
for a limited period as a resident of an institution.
(4)
(a) An
individual who is an inmate of a public institution is not eligible for
Medicaid coverage.
(b) As described
in Section R414-308-10, the department
neither denies eligibility of incarcerated individuals nor closes their cases,
but places their cases in a suspended status.
(5) Individuals who reside in an institution
for mental disease (IMD) are not eligible for Medicaid coverage except for:
(a) individuals who are 65 years of age or
older;
(b) individuals who are
under 22 years of age who receive inpatient psychiatric services as described
in 42 CFR
440.160;
(c) individuals who reside in an IMD that is
licensed as a Substance Use Disorder (SUD) residential treatment program and
are receiving treatment for an SUD;
(d) individuals 21 through 64 years of age,
who reside for a stay of up to 60 days, in an IMD that is licensed as a mental
health residential treatment program and has the required certification in
accordance with the department's 1115 Demonstration Waiver, and are receiving
treatment for a mental health disorder; and
(e) individuals 21 through 64 years of age
who are in a licensed psychiatric hospital for a stay of up to 60 days. This
exception does not apply to individuals residing in the Utah State
Hospital.
Notes
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