A-6000, Persons in Institutions for Mental Diseases

Revision 12-3; Effective September 1, 2012

Coverage for persons age 65 and older in IMDs is part of the Medicaid program. These persons must meet all eligibility criteria for institutional care. The medical necessity determination is met by a letter from the institution stating that in-patient care is necessary. The personal needs allowance is $60 for a person and $120 for a couple. There is no protected earned income allowance.

For TIERS, persons in IMDs (ME-State Hospital or ME-Non-State Group Home) receive a Your Texas Benefits Medicaid card. Although these cases are Title XIX community-based ICF/IID facilities and state hospitals, the co-payment is calculated as appropriate for institutional cases.