27.4 Definitions

27.4.1 Institutionalized Person

27.4.2 Community Spouse

27.4.3 SSI Recipient and Institutional Medicaid Application

27.4.1 Institutionalized Person

 "Institutionalized person" means someone who:

1. Participates in Community Waivers, or

2. Has resided in a medical institution for 30 or more consecutive days, or

3. Is likely to reside in a medical institution for 30 or more consecutive days, as attested to by the medical institution.

An exception to the 30-day period is that a resident of an IMD is considered an institutionalized person until he or she is discharged.

The 30-day period includes situations in which the person resides in more than one medical institution during 30 or more consecutive days. However, an individual is not considered “institutionalized” if he or she meets this 30-day test but is in a medical institution solely for the purpose of receiving residential substance use disorder treatment.

27.4.2 Community Spouse

See community spouse Someone who is 1) Married to an institutionalized person and 2) Not living in a nursing home or other medical institution for 30 or more consecutive days. in Glossary.

27.4.3 SSI Recipient and Institutional Medicaid Application

An SSI Supplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind, or disabled. recipient who has resided or is likely to reside in a medical institution for 30 days or more may apply and be non-financially eligible for institutional Medicaid if the SSA Social Security Administration. A federal agency which administers the SSI, OASDI, and Medicare programs. will discontinue the person's SSI because of the financial effect of his or her residence in the medical institution.

An SSI recipient who has not resided or is not likely to reside in a medical institution for 30 days or more is non-financially ineligible for institutional Medicaid.  The person remains Medicaid eligible through SSI.