Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 11 - LIVING ARRANGEMENTS
Section 477-11-003 - LIVING ARRANGEMENTS

Universal Citation: 477 NE Admin Rules and Regs ch 11 ยง 003

Current through September 17, 2024

003.01 ELIGIBLE LIVING ARRANGEMENTS. An applicant or client is eligible regardless of his or her living arrangement.

003.01(A) INSTITUTIONALIZED INDIVIDUALS. An inmate of a public institution, as defined by 42 Code of Federal Regulations (CFR) 435.1009, who meets inpatient status in a medical institution, as defined by 42 CFR 435.1010, and who is otherwise eligible may only receive payment for services received during his or her inpatient stay over 24 hours.
003.01(A)(i) EXCEPTION. This does not apply to infants or young children who reside with their mother at the Nebraska Correctional Center for Women.

003.01(B) INSTITUTES OF MENTAL DISEASE (IMD). Psychiatric care is only covered by Medicaid to individuals in an institute for mental disease who are age 21 or younger or age 65 or older. If an individual is receiving treatment in a facility on the individual's twenty-first birthday, eligibility continues until either release or the month of the twenty-second birthday, whichever is sooner.

003.02 DETERMINING THE NATURE OF AN INSTITUTION. The Department is responsible for determining the public or private nature of an institution, and whether a public institution is one in which otherwise eligible individuals may receive Medicaid.

003.03 CRITERIA FOR DETERMINING PUBLIC NATURE OF INSTITUTIONS. Governmental participation in financial support of an institution, in policy formulation, or in the application of policy to specific situations, is evidence of the public nature control which makes it a public institution. Payment from public funds to, or in support of, individuals in a private institution is not considered governmental participation in support of the institution.

003.04 PRIVATE INSTITUTION AND HOME. The private institution in which a Medicaid applicant or recipient chooses to reside may be a fraternal, benevolent, or charitable institution, or an individual may make plans for living in a home which is privately owned and operated which furnishes shelter, board, and care according to the person's needs.

003.04(A) ELIGIBILITY IN A PRIVATE INSTITUTION OR HOME. In determining the Medicaid eligibility of a person living in a private institution or home, it is necessary to determine if the person has entered into any agreement with the institution to receive shelter and care in return for a transfer of property, insurance, or other assets. It is also necessary to determine what the institution is able to furnish its residents from its own resources. The individual may be eligible to receive Medicaid if residing in a facility if the terms of the individual's stay do not in any way restrict the use of personal assets or income and if the individual has a medical need.

003.05 PATIENTS IN A MEDICAL INSTITUTION. Medicaid may be provided for a person who is a patient in a medical institution if all other eligibility factors are met. Psychiatric wards of medical hospitals are considered part of the medical institution and are not subject to the restriction on psychiatric care for individuals in an institute for mental disease (IMD).

003.06 MEDICAID APPROVED PROVIDERS. In order to receive Medicaid payment, an institution, whether public or private, must be a Medicaid approved provider and have signed a Medicaid provider agreement in accordance with 471 of the Nebraska Administrative Code (NAC).

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