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 enrollees.

  (3) The Department does not consider an individual who resides in a temporary shelter for a limited period of time as a resident of an institution.

  (4) Individuals who are inmates of public institutions are not eligible for Medicaid coverage.

  (5) Individuals who reside in an institution for mental disease (IMD) are not eligible for Medicaid coverage with the following exceptions:

  (a) Individuals 65 years of age or older;

  (b) Individuals under 22 years of age who receive inpatient psychiatric services as described in 42 CFR 440.160; and

  (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.