Section 120.318 Institutional Status

Section 120

Section 120.318

Institutional Status

a)         Individuals residing in public institutions (see 42 CFR

435.1009) are ineligible for medical assistance, except as provided in

subsections (b) and (c) of this Section.

b)         For individuals confined or detained in any local or State

penal or correctional institution who are otherwise eligible for, and enrolled

in, medical assistance authorized under Article V of the Illinois Public Aid

Code

[305 ILCS 5], benefits shall be limited to those services

reimbursed by the Department as described in 89 Ill. Adm. Code 140.10.  The limitation

shall be lifted upon timely notice to the Department that the individual has

been released.  The notice must confirm that the individual is residing in

Illinois and shall include an address through which the individual may be

contacted.  This change shall take effect upon adoption of this amended rule

for persons who are eligible for medical assistance because they have attained

the age of 65, are blind or have a disability.  For all other individuals, this

change shall take effect no later than January 1, 2012.

c)         Nothing in subsection (b) shall affect the eligibility of

pregnant women whose medical care during pregnancy is eligible for federal reimbursement

of the cost of care provided to an unborn child.

d)         Individuals who are confined or detained by a federal law

enforcement agency are ineligible for medical assistance.

e)         A resident of a private institution who has a contract with

the institution providing total needs throughout life is ineligible, as no

needs remain to be met.

f)         Residents of private institutions (other than those who have

purchased life care contracts) are ineligible for public assistance when they

have purchased care and maintenance to provide for all their needs in the

institution and the amount paid has not been wholly consumed for care

th

the institution providing total needs throughout life is ineligible, as no

needs remain to be met.

f)         Residents of private institutions (other than those who have

purchased life care contracts) are ineligible for public assistance when they

have purchased care and maintenance to provide for all their needs in the

institution and the amount paid has not been wholly consumed for care.

g)         Individuals, living in a public or a private facility that has

official policies and administrative procedures that are not in conformance or

are in conflict with the Illinois Public Aid Code provision or Department rules

governing eligibility for medical assistance, are ineligible for medical

assistance.