Title 16
15000 AFDC-TANF Related Programs
Medicaid coverage is available to individuals in acute care hospitals who would be eligible for Medicaid under Section 1931 if they were not hospitalized. These individuals will be determined eligible only after the patient has been in the hospital for 30 consecutive days. For example, if an individual enters the hospital on April 24, DSS need not consider eligibility under this program unless the individual is still hospitalized on May 23 (and has been continuously hospitalized since April 24).
15160.1 Eligibility Determination
Eligibility will be determined using Medicaid under Section 1931 technical and financial criteria. There is no medical eligibility criterion. (See DSSM 15120)
If the applicant is eligible, the Medicaid may be opened retroactive to the date of admission to the hospital. In no case can coverage be effective more than 3 months prior to the application date.
EXCEPTION: There is no 3 month retroactive coverage from the application filing date, if in the month of application, the individual is eligible for enrollment in the Diamond State Health Plan or Diamond State Partners.
15160.2 Patient Pay Calculation
There is a patient pay requirement for these individuals. The patient pay amount is determined according to the post eligibility determination described in the Long Term section. A family allowance is given for maintenance needs of a needy spouse and/or dependents in accordance with Section 1931 standards. The spousal impoverishment post eligibility calculation does not apply.
15160.3 Redetermination of Eligibility
Redeterminations of eligibility must be completed at six month intervals, but bi- weekly contacts must be made with the hospital to determine that the recipient is still institutionalized.
