This rule establishes Medicaid (medical assistance) eligibility criteria for residents of institutions for the treatment of mental diseases (IMDs), limiting coverage to individuals under age 21, those aged 21 turning 22 who have been continuously admitted since their 21st birthday, or those aged 65 and older receiving inpatient psychiatric care in a Joint Commission-accredited psychiatric facility. Adults aged 22–64 in IMDs are only eligible for medical assistance for services rendered before admission or after discharge. Facility operators must ensure billing and eligibility determinations align with these age-based restrictions.
View official source9505.0045 RESIDENTS OF INSTITUTIONS FOR TREATMENT OF MENTAL DISEASES. A resident of an institution for the treatment of mental diseases is eligible for medical assistance only if the resident is receiving inpatient psychiatric care in a psychiatric facility accredited by the joint commission on accreditation of hospitals, and meets one of the following conditions: is a person under 21 years of age; or a person 21 years of age but less than 22 years of age who has been receiving inpatient psychiatric care continuously since the resident's 21st birthday; or is a person at least 65 years of age. Notwithstanding the other provisions of parts 9505.0010 to 9505.0140 , a person in an institution for the treatment of mental diseases who is over 21 years of age but less than 65 years of age is only eligible for health services before the date of admittance and after the date of discharge from an institution for the treatment of mental diseases. For purposes of this part, "institution for the treatment of mental diseases" means those facilities defined in Code of Federal Regulations, title 42, section 435.1009.