A-6000, People in Institutions for Mental Diseases

Revision 23-4; Effective Dec. 1, 2023

People 65 and older who live in an institution for mental diseases (IMD) may be eligible for Medicaid coverage. IMDs are commonly referred to as state hospitals.

A person living in an IMD must meet all eligibility criteria for institutional care to receive Medicaid. A letter from the IMD indicating that in-patient care is necessary fulfills the medical necessity requirement. The co-payment calculation for a Medicaid recipient residing in an IMD follows the same policy as the co-payment calculation for a Medicaid recipient living in a nursing facility, including the personal needs allowance. 

Note: There is no protected earned income allowance for Medicaid recipients residing in an IMD.
Medicaid recipients living in IMDs receive a Your Texas Benefits Medicaid card.

Automated System Program Identifier

TIERS – ME-State Hospital

Related Policy 

Application for Institutional Care, B-7400
Co-Payment, Chapter H