8218 Institutional Transitions

The intent of the Institutional Transition program is to transition eligible individuals from Medicaid approved institutional care settings into the community and onto HCBS waiver services (see 8112).  Individuals must be eligible for Medicaid and functionally eligible for one of the following HCBS waivers: Frail and Elderly (FE), Physical Disability (PD), Intellectual and Developmental Disability (I/DD), or Brain Injury (BI).

For HCBS waivers with waiting lists, the individual must be a current resident in an institutional care setting for a minimum of 90 consecutive days before being considered eligible to apply for an institutional transition.  In the event an individual is admitted to a facility for a temporary stay which becomes long term with no disruption of services, the temporary stay days shall count toward the 90 day stay requirement. 

The MCO or State Hospital Discharge Planner is responsible for initiating the referral process and shall send a request for institutional transition to the HCBS Transition Specialist.  The functional assessment will be conducted by the assessing entities that currently serve each of the HCBS waiver populations specified above.  The HCBS Transition Specialist will notify eligibility staff of eligible individuals via the ES-3160.

For individuals eligible for institutional transition, HCBS begins the date the individual transitions from an institutional living arrangement to community living, if approved by the HCBS Transition Specialist.  (See 8200.2). 

Ongoing case management will also be provided by the care coordinator.  Eligibility staff are responsible for informing the care coordinator concerning the Medicaid eligibility decision, the amount of any client obligation, and any changes in obligation or eligibility. The care coordinator is responsible for providing information to eligibility staff concerning the person-centered service plan, the cost of the care, and any changes in that care or in the client’s living arrangement. The ES-3160/ ES-3161 shall be used for these purposes.