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Effective: December 1, 2006 |
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14.10.10 - Institutions for Mental Diseases (IMDs) |
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People who live in an Institution for Mental Diseases (IMD) may be eligible for Minnesota Health Care Programs (MHCP). See Institutions for Mental Diseases (IMDs) for specific health care program eligibility criteria for residents of IMDs.
Exception: People who meet all other eligibility requirements for Refugee Medical Assistance (RMA) are eligible for RMA regardless of their living arrangement. The Refugee Medical Assistance program, which is 100% federally funded, is not subject to living arrangement requirements.
An IMD is a hospital, nursing facility, or other institution of 17 beds or more which may provide treatment for chemical dependency (CD) or mental illness (MI) or both. The system codes for IMDs are:
l 49 State Sex Offender and Forensic Programs - IMD.
l 50 Regional Treatment Center (RTC) - MI Psychiatric Inpatient Hospital - IMD.
l 51 Rule 31 IMD - CD.
l 52 Rule 36 IMD - MI.
l 53 Privately Owned Psychiatric Inpatient Hospital - IMD.
l 58 RTC - CD Psychiatric Inpatient Hospital - IMD.
l 59 Out-of-State SED (severe emotional disturbance) Residential Treatment Facility for Children - IMD (more than 16 beds).
Adults who are admitted to an IMD and were not placed by a health plan (or whom the health plan was not court-ordered to cover) are generally not eligible for federally funded health care program coverage. See Institutions for Mental Diseases for the groups that may still qualify for federally funded Medical Assistance (MA) in an IMD.
l If an adult MinnesotaCare enrollee is admitted to an IMD (and was not placed by the health plan), close MinnesotaCare at the next renewal. If the enrollee is eligible for a MinnesotaCare major program that is federally funded, change the enrollee to state-funded MinnesotaCare starting the month after admission (unless that is the renewal month).
l If an adult MA enrollee is admitted to an IMD (and was not placed by the health plan), close federally funded MA the day prior to admission (unless the enrollee meets one of the exceptions in IMDs). Open state-funded program IM for the day of admission.
l If an adult GAMC enrollee is admitted to an IMD, GAMC eligibility continues, for payment to outside providers only.
Example:
Max, age 36, is eligible for federally funded MinnesotaCare. His household's renewal month is December. He is admitted to an IMD on September 5. He was not placed by the health plan.
Action:
Change Max to state-funded MinnesotaCare effective October 1. Close MinnesotaCare for December 1; determine potential eligibility for other MHCP coverage.
Example:
Irene is eligible for federally funded MA. She is admitted to an IMD on September 5. She was not placed by the health plan, and does not meet one of the exceptions for continuing on federally funded MA in an IMD.
Action:
Close federally funded MA September 4; open program IM effective September 5.
For more information, see: