1. (1) For purposes of institutions, the definitions in 42 CFR 435.1010 apply.

2. (2) An individual who resides in a halfway house may receive Medicaid coverage if the halfway house meets the following criteria:

   1. (a) the halfway house allows the individual to work outside the facility;
   2. (b) the halfway house allows the individual to use community facilities at will, such as libraries, grocery stores, recreation areas, or schools; and
   3. (c) the halfway house allows the individual to seek health care treatment in the community to the same extent as other Medicaid members.
3. (3) The department does not consider an individual who resides in a temporary shelter for a limited period as a resident of an institution.

4. (4)(a) An ndividual who is an inmate of a public institution is not eligible for Medicaid coverage.

   1. (b) As described in Section R414-308-10, the department neither denies eligibility of incarcerated individuals nor closes their cases, but places their cases in a suspended status.

5. (5) Individuals who reside in an institution for mental disease (IMD) are not eligible for Medicaid coverage except for:

   1. (a) individuals who are 65 years of age or older;
   2. (b) individuals who are under 22 years of age who receive inpatient psychiatric services as described in 42 CFR 440.160;
   3. (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;
   4. (d) individuals 21 through 64 years of age, who reside for a stay of up to 60 days, in an IMD that is licensed as a mental health residential treatment program and has the required certification in accordance with the department's 1115 Demonstration Waiver, and are receiving treatment for a mental health disorder; and
   5. (e) individuals 21 through 64 years of age who are in a licensed psychiatric hospital for a stay of up to 60 days. This exception does not apply to individuals residing in the Utah State Hospital.

KEY: state residency, citizenship, third-party liability, Medicaid

Date of Last Change: January 22, 2024

Notice of Continuation: January 6, 2023

Authorizing, and Implemented or Interpreted Law: 26B-3-108; 26B-1-213