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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyMississippi Medicaid optional ABD coverage update …
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    CurrentMississippi Division of MedicaidPolicy N/A

    Optional Coverage of the Aged, Blind and Disabled Considered to be in an Institution

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    Defines optional Medicaid eligibility categories for individuals considered to be in an institution (nursing facility, hospital, HCBS waiver, or certain disabled children at home) and the eligibility tests they must meet for the Mississippi Division of Medicaid.

    Policy Summary
    PayerMississippi Division of Medicaid
    PolicyOptional Coverage of the Aged, Blind and Disabled Considered to be in an Institution
    Policy CodePolicy N/A
    Change TypeNo material changes
    Effective DateJul 1, 2025
    Last ReviewJul 1, 2025
    Next Review DateN/A
    Key ActionDetermine eligibility for optional ABD institutional-equivalent coverage by verifying institutional status, income, resources, and other non-financial eligibility factors.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    4distinct optional coverage groups described
    Katie Beckettnamed coverage group
    07/01/2025most recent revision

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    Optional ABD Institutional-Equivalent Coverage Criteria

    Optional ABD institutional-equivalent coverage criteria

    Optional Medicaid coverage is available for the following groups when income, resources, and other non‑financial eligibility factors are met as determined by the Division of Medicaid:

    ALL of the following

    • Individual must be in a Title XIX nursing facility or hospital.
    • Individual must meet income eligibility as determined by the Division of Medicaid.
    • Individual must meet resource eligibility as determined by the Division of Medicaid.
    • Individual must meet other non‑financial eligibility factors as determined by the Division of Medicaid.

    ALL of the following

    • Individual must be in a Title XIX nursing facility or hospital.
    • Individual must meet the special income test criteria.
    • Individual must meet resource and other non‑financial eligibility factors as determined by the Division of Medicaid.

    ALL of the following

    • Individual must be eligible under an approved waiver and be receiving waiver services.
    • Individual must meet income eligibility as determined by the Division of Medicaid.
    • Individual must meet resource and other non‑financial eligibility factors as determined by the Division of Medicaid.

    ALL of the following

    • Child is age 18 or under and living at home.
    • Child would be eligible for Medicaid if in a medical institution.
    • Division of Medicaid has made the required 1902(e)(3)(B) determination.
    • The cost‑effectiveness of care at home compared to care in a medical institution must be considered.

    Coding

    Eligibility Determination and Provider Actions

    Documentation Required

    Determine applicable institutional-equivalent eligibility pathway and verify eligibility

    Providers must determine Medicaid eligibility for individuals considered to be in an institution by confirming which optional ABD coverage pathway applies (cash-assistance-eligible if institutionalized; special income-test institutional eligibles; approved waiver recipients receiving HCBS; or Katie Beckett children living at home) and verifying the individual meets income, resource, and other non‑financial eligibility factors as determined by the Division of Medicaid.

    • Confirm the individual’s setting: Title XIX nursing facility or hospital, approved home-and-community-based waiver services, or a child living at home (Katie Beckett).
    • Verify income, resources, and other non‑financial eligibility factors per Division of Medicaid rules for the applicable pathway.
    • For Katie Beckett group, ensure the Division has made the required 1902(e)(3)(B) determination and that care at home is cost‑effective compared to institutional care.

    Definitions

    Katie Beckett group - definition and requirements
    DefinitionCertain disabled children age 18 or under living at home who would be eligible for Medicaid if they were in a medical institution and for whom the Division of Medicaid has made the required 1902(e)(3)(B) determination.
    Eligibility conditionChild must be living at home and be age 18 or under.
    Institutional equivalence requirementChild would be Medicaid-eligible if in a medical institution (institutional level of care).
    Division determinationDivision of Medicaid must make the determination required under section 1902(e)(3)(B) of the Social Security Act.
    Cost-effectiveness testThe cost-effectiveness of care at home compared to care provided in a medical institution must be considered.
    Institutional-equivalent individuals - who is 'in an institution'
    DefinitionIndividuals considered to be in an institution include persons who are in a Title XIX nursing facility or hospital, or those receiving home and community-based services under an approved waiver who would be Medicaid-eligible if institutionalized.
    Nursing facility/hospital residentsAn individual must be in a Title XIX nursing facility or hospital to qualify under institutional-equivalent coverage rules.
    HCBS waiver recipientsIndividuals receiving home and community-based services under an approved waiver who would be Medicaid-eligible if institutionalized may qualify when they receive waiver services.
    Special income test individualsIndividuals in institutions who are eligible under a special income test may qualify if they meet income, resource, and other non-financial eligibility factors as determined by the Division.
    Eligibility determinationsAll institutional-equivalent individuals must meet income, resource, and other non-financial factors of eligibility as determined by the Division of Medicaid.
    Policy Summary
    PayerMississippi Division of Medicaid
    PolicyOptional Coverage of the Aged, Blind and Disabled Considered to be in an Institution
    Policy CodePolicy N/A
    Change TypeNo material changes
    Effective DateJul 1, 2025
    Last ReviewJul 1, 2025
    Next Review DateN/A
    Key ActionDetermine eligibility for optional ABD institutional-equivalent coverage by verifying institutional status, income, resources, and other non-financial eligibility factors.
    SourceLink
    On This Page
    Optional ABD Institutional-Equivalent Coverage CriteriaCodingEligibility Determination and Provider ActionsDefinitions