10.09.24.05-5

.05-5 Nonfinancial Eligibility Requirements — Institutions.

A. Inmate of a Public Institution.

(1) To be eligible for Medical Assistance, an applicant or recipient may not be incarcerated as an inmate of a public institution.

(2) Inmate Status.

(a) An individual is considered incarcerated as an inmate of a public institution if the individual resides in a public institution involuntarily as a result of being accused or found guilty of a criminal offense, including the duration of time in which the individual is involuntarily residing in the public institution in a preadjudication or pretrial status awaiting criminal proceedings, penal dispositioning, or other involuntary detainment procedure.

(b) An individual may not be considered an inmate of a public institution if the individual resides in a public:

(i) Institution voluntarily and not as the result of a legal criminal process;

(ii) Educational or vocational training institution for the purpose of receiving educational or vocational training; or

(iii) Institution for the first partial month of residence or for a temporary period pending other arrangements appropriate to the individual's needs.

(c) Hospitalization as a Result of the Commission of a Crime. An individual who is hospitalized as a result of an injury sustained during the commission of a crime and has not yet been incarcerated because of the hospitalization may not be considered an inmate of a public institution.

(d) Retaining Inmate Status. Except as provided in §A(2)(f) of this regulation, an individual's inmate status continues until the criminal indictment against the individual is dismissed or the individual is released from the public institution.

(e) An individual who is not present at the correctional facility during the day, because the individual is attending a day treatment program or participating in day-time employment, but who resides in a correctional facility at night, shall be considered an inmate of a public institution.

(f) Inmate Admitted to Medical Institution. An inmate may be covered by Medical Assistance during the period when the inmate is admitted as an inpatient of a medical institution, such as a hospital, nursing facility, or juvenile psychiatric facility, and is receiving services covered by Medical Assistance.

(g) Individual Sent to an Institution for Mental Disease (IMD).

(i) Inmate status shall apply to an individual who is accused of a criminal offense and is sent directly to an IMD either for a mental examination or because the individual is determined mentally incompetent to stand trial.

(ii) An individual committed by a court to an IMD based on a verdict of not guilty by reason of insanity may not be considered an inmate of a public institution.

(3) Children Younger than 21 Years Old Committed to a Correctional Facility.

(a) A child committed by a court to a correctional institution due to a violation of the law shall be considered incarcerated as an inmate of a public institution.

(b) A child committed to the custody of the Maryland Department of Juvenile Services shall be considered incarcerated as an inmate of a public institution if the child is placed in a State-owned and State-operated facility, and that status shall continue until the child is released from the facility.

(c) A child committed to the custody of the Maryland Department of Juvenile Services may not be considered an inmate of a public institution if the child is living:

(i) With the child's parent, caretaker relative, or legal guardian;

(ii) In a group home serving no more than 16 residents; or

(iii) In a privately operated facility under the jurisdiction of the Maryland Department of Juvenile Services.

B. Institution for Mental Disease (IMD).

(1) An institutionalized individual younger than 65 years old who is admitted for residence in an institution for mental disease is not eligible for Medical Assistance, unless the applicant or recipient is:

(a) Younger than 22 years old; and

(b) Receiving inpatient psychiatric services for individuals younger than 21 years old.

(2) Inpatient psychiatric services for individuals younger than 21 years old may be provided:

(a) To individuals who are younger than 21 years old; or

(b) Until the earlier of the date that the individual:

(i) No longer requires the services; or

(ii) Is 22 years old, if the individual was receiving the services immediately before reaching 21 years old.

(3) Except as provided in §B(4) of this regulation, when an individual is on conditional release or convalescent leave from an IMD, the individual may not be considered institutionalized in the IMD.

(4) An individual who is receiving inpatient psychiatric services for individuals younger than 21 years old shall be considered an institutionalized individual until the earlier of the date that the individual:

(a) Is unconditionally released from the IMD; or

(b) Is 22 years old.