When a claimant (receiving vendor based on OAA, PTD, or AB criteria) leaves a vendor facility for a non-vendor living arrangements, the action taken will depend on the new living arrangements and whether or not the claimant has a spouse. The eligibility specialist must establish the new living arrangement.
When a single individual leaves a vendor facility the individual will remain eligible for Medicaid either on a non-spend down or spend down basis. A married claimant may be ineligible based on assets of the spouse, unless:
- the claimant returns to the spouse’s home and is receiving HCB waiver services; OR
- the spouse is receiving Medicaid.
For a married claimant (not receiving HCB waiver services) whose spouse is not on Medicaid, complete a reinvestigation to determine if the claimant remains eligible based on the couples’ assets. Continue the claimant’s eligibility as MA non-spend down until the reinvestigation is complete. If the claimant remains eligible on available resources, follow the steps below based on the living arrangement.
NOTE: If the claimant leaves the vendor facility and goes to a hospital (other than an institution in which Medicaid may not be continued), record the information and take no further action for 30 days. If, after 30 days, the claimant remains in the hospital, determine if the claimant would continue to be eligible for MA non-spend down or spend down basis.