305.01 Individuals in Designated Receiving Facilities (MAM)

SR 13-36 Dated 11/13

Previous Policy

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Individuals in designated receiving facilities (DRF) may be eligible for Children’s Medicaid, FANF, or adult category medical assistance if they are under the age of 22 or age 65 or older and meet all the following criteria:

• The individual meets all the eligibility requirements for FANF, Children’s Medicaid, or OAA, APTD, or ANB.

Exception: Dependent children need not meet FANF categorical requirements to be eligible.

• The individual is hospitalized in a DRF.

• Countable income and resources (if required by policy) do not exceed the FANF, FANF-related medical assistance, Children’s Medicaid, OAA, APTD, or ANB limits in Chapter 600.

Exception: Eligibility is determined differently depending on the actual or anticipated length of hospitalization.

If the Length of Hospitalization in a Designated Receiving Facility is:

Under 30 Days

1.  Determine eligibility based on the living arrangement that existed prior to hospitalization.

2. Consider the individual temporarily out of the home for medical treatment.

3.  Continue medical assistance at the time of hospitalization, as long as the individual remains eligible and there is intent to return home.

30 Days or More

1.  Consider the individual to be residing at the DRF. Determine medical assistance-only eligibility using the income and resource limits for an assistance group of 1. Do not deem spouse or parental income or resources.

2.  If the individual is open for assistance with other group members, terminate assistance for that individual. No Advance Notice Period is required. If otherwise eligible, open a separate medical assistance or Children’s Medicaid case.

References: He-W 624.01, 42 CFR 435.1009 - 435.1010