1015.010.15 Individuals Residing in an Institution

IM-32 March 28, 2012

When determining residence for applicant/participants admitted to or residing in an institution that is:

organized to provide medical care, including nursing and convalescent care
has personnel, equipment and facilities to meet the health needs of patients on a continuing basis, within accepted standards
is authorized under State law to provide medical care
is staffed by professional personnel who provide adequate and continued medical and nursing services sufficient to meet nursing care needs

If the applicant/participant is admitted to or residing in an institution, the criteria of age and the ability to declare intent must be considered in determining whether the individual meets the residence eligibility requirement.

For individuals living in an institution:

- Who are 21 years of age or older, and capable of declaring intent
  - The State of residence is the State where the applicant or participant is living and intends to remain permanently, or for an indefinite period of time, except when another State made the placement
- Who became incapable of declaring intent when they were 21 years of age or older
  - The State of residence is the State where the applicant/participant is physically present, except when another State made the placement
- Who are 20 years of age or younger and who are blind or disabled
  - The State of residence is the parent’s or legal guardian’s State of residence at the time of placement except when another State made the placement
  - The State of residence of the individual’s parent, instead of the legal guardian’s State of residence, if there has been no termination of parental rights
  - The State of residence of the guardian, if a legal guardian has been appointed and parental rights have been terminated
  - In cases where there is no living parent and no appointed legal guardian, the applicant/participant’s State of residence is the State in which the applicant/participant is institutionalized
- Who became incapable of declaring intent before they were 21 years of age
  - The State of residence is the parent’s or legal guardian’s State of residence at the time of placement except when another State made the placement
  - The State of residence of the individual’s parent, instead of the legal guardian’s State of residence, if there has been no termination of parental rights
  - The State of residence of the guardian, if a legal guardian has been appointed and parental rights have been terminated
  - In cases where there is no living parent and no appointed legal guardian, the applicant/participant’s State of residence is the State in which the applicant/participant is institutionalized
  EXAMPLE: Mike C. is 22 years old. He has been institutionalized at a rehabilitation hospital in Illinois for two years for treatment of serious physical injuries and severe brain damage as a result of an automobile accident. Mike did not have a permanent address before he was injured when he was 20 years old. Mike’s parents live in Missouri and want to have him institutionalized in the State so he can be near them. Mike meets the residence eligibility requirement based on his parents’ residence and the fact that he became mentally incapable before he was 21.

For ANY OTHER INSTITUTIONALIZED individual, the State of residence is the State where the applicant/participant lives and intends to remain permanently or for an indefinite period of time.

If FSD is unable to determine the State of residence for an institutionalized applicant/participant who is incapable of declaring intent, the State of residence for the institutionalized applicant/participant is the State in which the institution is located. An applicant/participant may not be excluded from MO HealthNet coverage because FSD cannot determine the applicant/participant’s State of residence.

EXAMPLE: Mary P., age 87, is confined in a nursing facility in Missouri. She has no legal guardian. She is unable to communicate and it is not possible to learn when and where she became incapable of declaring intent. Her State of residence is the State in which the institution is located, in this instance, Missouri.