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Details for Service LTC-ICF MRC
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Service Name
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LTC-ICF MRC
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Program Name
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Adult Out of Home Supports
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Goal
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Provide services and protection to individuals and families experiencing serious health and safety needs who are not, at least temporarily, able to assist themselves with the goal of helping them to return to independent, community living.
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Objective
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Assure that adults being served in out-of-home placements receive support services designed to assist them in their return to home and/or community living.
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Division
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Division of Health Benefits
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Service Description
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Intermediate care facilities for people with mental retardation (ICF/MR) are institutional settings which diagnose, treat and/or rehabilitate people with mental retardation. They provide, in a protected residential setting, 24-hour supervision, coordination, and integration of health or rehabilitative services to help each person function at his or her greatest ability. In NC there are two types of ICF/MR facilities that Medicaid reimburses, State operated and non-state operated.
Persons who receive care in these settings have to be prior approved.
| ICF/MR services are optional. Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) program requires that states offer these services, if medically necessary, to children up to age 21. |
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Web Site
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http://www.ncdhhs.gov/dma/
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Year First Initiated
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1971
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Available State Wide
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Yes
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Geographic Area Served
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Grants Provided
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No
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Competitive Bidding
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No
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Competitive Bidding Details
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Waiting List
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No
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Waiting List Start Date
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Number Waiting
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Waiting List Details
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Income Eligibility
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Yes
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Income Eligibility Method
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Eligibility for Medicaid is determined by the county departments of social services (DSS) and the Social Security Administration (SSA) for Supplemental Security Income (SSI) recipients.
Children institutionalized 12 months or less:
200% FPL - MIC - children under age 6
133% FPL - MIC children age 1-5
100% FPL - MIC children age 6-18
MAF-C/N, HSF categorically needy:
1 person - $362
2 - $472
3 - $544
4 - $594
5 - $648
MAF, MAD, MAA, MAB Medically Needy:
1 person - $242
2 - $317
3 - $367
4 - $400
5 - $433
Adult:
1. Gross income less than Medicaid reimbursement rate for facility, or
2. Net countable income less than the facility's private rate, or
3. Net countable income minus facility's private rate for 31 days compared to total amount of predictible medical expenses that will not be covered by the nursing facility.
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Income Eligibility Type
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Earned income such as: wages, self-employment
Unearned income such as: RSDI, unemployment, VA, retirement, child/spousal support, worker's compensation, etc.
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Whose Income Eligibility
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Parental financial responsibility applies for children under age 21 institutionalized 12 months or less. Recipient only for adults and for children institutionalized over 12 months.
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Income Disregard
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Yes
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Income Disregard Desc
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Adults: $30 Personal needs allowance Unmet medical needs - depends on the amount for each recipient, if any.
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Income Verified
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Yes
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Income Verified Method
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Electronic match with ESC, SSA, wage stubs, verification from source of income, such as VA, employer, award letter, self-employment records
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Income Criteria
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Federal and State Statutes are used as a base for setting income levels.
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Income Eligibility Change
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1/1/2006
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Income Eligibility Method Prior To Change
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185% MIC children less than 1
133% MIC children 1-5
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Income Eligibility Other
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Age Range Start
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Age Range End
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0
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100+
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Authorization Level
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Authorization Type
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Citation
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Federal
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Public Law
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Section 1905(d) of the Social Security Act
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Federal
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Code of Federal Regulations
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42 CFR 440.150 and 483
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State
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Administrative Rules
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10A NCAC 22O.0108; .0408; .0409
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Budget Information
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State Fiscal Year (SFY)
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As of the month of
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Authorized Budget Fiscal Year 2024
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SFY 2023-2024 Year To Date Expenditures
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Balance
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Salary and Fringes (1X)
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0
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0
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0
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Salary Other (1X)
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0
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0
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0
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Operating (2X-5X)
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0
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0
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0
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Contracts/Allocations (6X)
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0
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0
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0
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Reserves (7X)
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0
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0
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0
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Transfers (8X)
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0
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0
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0
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Total Requirements
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0
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0
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0
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Receipts-Federal
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0
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0
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0
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Receipts- Local receipts
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0
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0
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0
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Receipts- Other receipts
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0
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0
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0
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Total Receipts
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0
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0
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0
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General Fund Appropriations
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0
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0
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0
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Match
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State
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Local
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Other
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0
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0
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0
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