Due to state employee furloughs, call center and staff response time may be delayed. Thank you for your understanding.
Due to COVID-19, HCA’s lobby is closed. Learn more about your customer service options.
Obtain the determination of whether the person is likely to remain institutionalized for 30 consecutive days from the department-designated social service worker or case manager.
For nursing facility cases, the HCS social service worker notifies financial of the date of request for assessment, whether the person is projected to be in a nursing facility 30 days or more and if the person meets NFLOC.
For those people who meet both 30 day or more institutionalization and NFLOC, institutional Medicaid is considered.
For individual persons who don't meet the 30 day or more institutionalization, institutional Medicaid can't be considered. Eligibility for Medicaid is determined as if the person were in their own home. If the person is eligible for another Medical program, the admission into the medical institution is considered a short stay (29 days or less). See Short Stays.
For active Apple Health clients who lose institutional medicaid status due to discharge from a medical institution or no longer receiving a HCB Waiver service, redetermine eligibility under a noninstitutional medical program.