Family and Children's Medicaid MA-3360 LIVING ARRANGEMENT

04/01/02

I. OVERVIEW OF LIVING ARRANGEMENT

A. Introduction

The type of living arrangement that an applicant/recipient (a/r) has affects whether the individual is potentially eligible for Medicaid and whether he is budgeted as private living arrangement (pla) or as long term care (ltc). How an individual is budgeted affects county of residence, reserve, and spousal/parental financial responsibility.

Use the DMA-5121, Determining Potential Medicaid Eligibility and Budgeting, as a reference.

B. Types of Living Arrangements

For Medicaid purposes there are two types of living arrangements, private living arrangement (pla) or long term care (ltc) living arrangement.

1. Private Living Arrangement (pla)

A private living arrangement is usually thought of as a private residence. However, in the Medicaid program individuals who live in many types of group living arrangements or institutional settings are also budgeted pla. All of the following types of living arrangements are considered to be pla:

a. Home or apartment

b. Commercial boarding house or rooming houses

c. Adult Care Home (formerly domiciliary care facility)

d. Residential treatment facility

e. Educational or vocational facility

f. Hotel and motel

g. Group living arrangement or supervised independent living licensed by Mental Health

h. Homeless or emergency homeless shelter

(I.B.)

i. A general/acute care hospital, psychiatric unit of a state mental hospital or psychiatric residential treatment facility (PRTF), when the expected length of stay is 12 months or less

2. Long Term Care Living Arrangement (ltc)

In the Medicaid program, only those individuals who live in a medical facility as defined in MA-3325, Long Term Care Budgeting, are considered to be in a long-term care living arrangement. This includes:

a. A nursing facility for SNF, ICF, ICF-MR, SNF Rehab, hospice, or

b. Nursing level of care in a hospital (usually called a swing bed or inappropriate level of care bed), or

c. A general/acute care hospital, psychiatric unit of a state mental hospital, or psychiatric residential treatment facility (PRTF) when the length of stay is expected to exceed 12 months or ends with a direct transfer to a nursing facility.

NOTE: Always refers to MA-3260, Community Alternatives Program, for budgeting rules when an a/r requests services under a Community Alternative Program (CAP).







For questions or clarification on any of the policy contained in these manuals, please contact your local county office.