23 MAC Pt. 105, R. 1.4
Budgeting for Institutional Eligibility
Cite as 23 Miss. Admin. Code Pt. 105, R. 1.4
Budgeting for Institutional Eligibility
Eligibility while residing in an institutional or long term care program is based on all of the
following conditions:
A. The individual must reside in a medical facility or alternative placement for thirty (30)
consecutive days or longer. These include:
1. A licensed and certified Title XIX facility such as a skilled nursing facility or intermediate
care facility for individuals with intellectual disabilities.
2. A Home and Community Based Services (HCBS) waiver program.
3. An inpatient acute care hospital, including psychiatric residential treatment facilities
(PRTFs) for children under age twenty-one (21).
4. Suitable private living arrangements where cost-effective medical care is provided for a
disabled child living at home, per eligibility criteria for the Katie Beckett category of
eligibility.
B. The individual must be in need of a level of care appropriate for the placement and the
placement must be medically necessary. Level of care requirements are outlined in Miss.
Admin. Code, Title 23, Part 207.
C. The individual must meet all factors of eligibility, including all non-financial and financial
requirements for the institutional category of eligibility. Resource eligibility includes a
determination of transfers of assets and substantial home equity that would result in a penalty
period in which eligibility is prohibited for institutional and HCBS coverage. The transfer of
assets provision is outlined in Miss. Admin. Code, Title 23, Part 103, Chapter 7. The substantial
home equity provision is outlined in Miss. Admin. Code, Title 23, Part 103, Rule 4.22.
D. Institutional and HCBS waiver eligibility is subject to the Estate Recovery provision as
outlined in Miss. Admin. Code, Title 23, Part 306.
E. Prior to the final determination of eligibility, an in-person or telephone interview, as
appropriate, is required with the individual or their representative so that explanations of
required institutional policy provisions can be discussed.