2.5.4 Program for People Living in Institutions for Mental Diseases

Minnesota provides health care for people who meet Medical Assistance (MA) eligibility criteria while living in an Institution for Mental Diseases (IMD). This health care may be federally or state-funded. State-funded MA for people living in an IMD is also known as Program IM.

An IMD is a hospital, nursing facility, or other institution of 17 beds or more that primarily provides diagnosis and treatment for people with mental illness or chemical dependency. See Appendix E Institutions for Mental Diseases for more information.

People must have an MA basis of eligibility and meet all of the MA eligibility requirements associated with their basis. People are in one of the following eligibility groups:

• MA for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability (MA-ABD)

• MA for Employed Persons with Disabilities (MA-EPD)

• MA for Families With Children and Adults (MA-FCA)

When an MA enrollee moves into an IMD, they do not need to file a new application for health care.

The following people continue to be eligible for federally funded MA while living in an IMD:

• People age 65 or older

• Children younger than age 21 in an accredited, licensed inpatient psychiatric hospital

• People residing in an IMD that is an accredited, licensed inpatient psychiatric hospital who received MA covered services prior to their 21st birthday. Enrollees who continue to receive these services in the same facility after age 21 are covered by MA until they turn age 22.

• People residing in an IMD facility approved to participate in the 1115 Substance Use Disorder (SUD) System Reform Demonstration

• People enrolled in Refugee Medical Assistance (RMA)

• People ages 21 up to 65 enrolled in a managed care plan with a length of stay of no more than 15 days during the calendar month

This subchapter includes policies that apply to Program IM and links to policies that apply to all MA and all Minnesota Health Care Programs (MHCP) programs.

1. IMD General Requirements

   1. MA-ABD General Requirements

   2. MA-EPD General Requirements

   3. MA-FCA General Requirements

2. Program IM Non-Financial Eligibility

   1. MA-ABD Bases of Eligibility

   2. MA-ABD Certification of Disability

   3. MA-FCA Bases of Eligibility

   4. MA Citizenship and Immigration Status

   5. MA County Residency

   6. MA Social Security Number

   7. MHCP State Residency

3. Program IM Financial Eligibility

   1. MA-ABD Financial Eligibility

   2. MA-EPD Financial Eligibility

   3. MA-FCA Financial Eligibility

4. Program IM Post-Eligibility

   1. MA Begin and End Dates

   2. MA Benefit Recovery

   3. MHCP Change in Circumstances

   4. MA Cooperation

   5. Program IM Medicare

   6. MA Cost Sharing

   7. MHCP Fraud

   8. Program IM Health Care Delivery

   9. MHCP Inconsistent Information

   10. Program IM Leave Days

   11. MA-EPD Premiums and Cost Sharing

   12. MA Qualifying Health Coverage

   13. MA Referral for Other Benefits

   14. MA-ABD Renewals

   15. MA-FCA Renewals

 

Legal Citations

Code of Federal Regulations, title 42, section 435.1009

Code of Federal Regulations, title 42, section 438.6

Code of Federal Regulations, title 42, section 441.151

Minnesota Statues, section 256.055, subdivision 13

Published: October 1, 2021

Previous VersionsPrevious Versions

© 2019 Minnesota Department of Human Services

Minnesota.gov is led by MN.IT Services