Institutions for Mental Diseases

Institutions for Mental Diseases An Institution for Mental Diseases (IMD’s) are hospitals, nursing facilities or other institutions of more than sixteen (16) beds that are primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services. A. Individuals under age twenty-one (21) may receive Medicaid while in an institution for mental diseases if they are receiving psychiatric services and are otherwise eligible. If the individual is receiving inpatient psychiatric services at the time the individual turns age twenty-one (21), the individual may receive Medicaid until age twenty-two (22). B. Individuals between the ages of twenty-one (21) and sixty-five (65) are not eligible to receive any Medicaid benefits while residing in an institution for mental diseases, with the following exception: 1. A Medicaid eligible pregnant woman who is receiving treatment for a substance use disorder is eligible to receive Medicaid covered services provided outside the IMD facility. 2. Pregnancy-related Medicaid may be determined prior to or after entering the IMD. Medicaid will continue through the twelve (12) month postpartum period. 3. Eligibility for pregnancy-related Medicaid may be determined for the retroactive period but not prior to October 1, 2019, which is the effective date of the IMD exception provision. C. Individuals age sixty-five (65) or older may not receive Medicaid benefits while in an IMD unless they reside in a long-term care facility or receive inpatient hospital services and are otherwise eligible for Medicaid in an allowed group.