Eligibility Online Manual
M1001B INPAT-PSYCH (Geriatric Hall at the State Hospital in Evanston)
Purpose: This section will assist in determining eligibility for INPAT-PSYCH (Geriatric Hall at the State Hospital in Evanston).
Current Policy Effective Date: November 1, 2015
Date Last Reviewed: November 12, 2015
Previous Policy: April 1, 2012
POL M1001B: DETERMINING ELIGIBILITY FOR INPAT-PSYCH (GERIATRIC HALL AT THE STATE HOSPITAL IN EVANSTON)
1. Applicants Must Meet Basic Eligibility
Refer to Section M600 for a description of all basic eligibility factors.
2. Applicants Must Be Age 65 Or Older
3. SSI Eligibles Do Not Need To Submit Application
If SSI is lost, an application will be required to redetermine eligibility.
4. Applicants Must Meet Income Requirements
Use only the applicant’s income when determining if income requirements are met.
5. Applicants Must Meet Resource Requirements
6. Clients Must Be Reviewed
Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.
A review is not required for SSI clients.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
7. Clients May Lose Benefits
The case will close on the first day of the next month when any of the following occur:
Client does not complete review.
Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.
Client determined no longer eligible.
Defining Group: Social Security Act § 1902(a)(10)(A)(ii)(xv)
Income: 42 CFR 435 Subpart K
Resources: 42 CFR 435 Subpart L
Applicants Do Not Have to Meet Medical Necessity.
Applicants Do Not Have to Meet 30 Consecutive Days of Institutionalization Requirement.
Applicants Do Not Have to Make Patient Contributions.
1. Finalize eligibility and close benefits in WES when the the applicant is no longer eligible.
2. Allow 15-day closure notice when an adverse action has occurred