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What It Is

​Medicaid covers services to individuals with intellectual disabilities (IID) who require a planned program of active treatment on an inpatient basis and who meet patient status criteria of ICF/IID participating in the Medicaid program.

Eligibility

An individual shall meet ICF/IID criteria if the individual requires physical or environmental management or rehabilitation for moderate to severe retardation and meets the following criteria:

  • The individual has significant developmental disabilities or significantly subaverage intellectual functioning and requires a planned program of active treatment to attain or maintain the individual's optimal level of functioning, but does not necessarily require nursing facility or nursing facility with waiver services;
  • The individual requires a protected environment while overcoming the effects of developmental disabilities and subaverage intellectual functioning while:
    • Learning fundamental living skills;
    • Learning to live happily and safely within his own limitations;
    • Obtaining educational experiences that will be useful in self-supporting activities; or
    • Increasing his awareness of his environment; or
  • The individual has a psychiatric primary diagnosis or if:
    • The mental care needs are adequately handled in a supportive environment (i.e., ICF/IID) and
    • The individual does not require psychiatric inpatient treatment.

Exclusions

Individuals shall be specifically excluded from coverage in the following situations:

  • If the individual case is a combination of care needs beyond the capability of the facility or placement in the facility is inappropriate due to potential danger to the health and welfare of the individual, other residents, or staff of the facility; and
  • If the individual does not meet the preadmission screening and resident review criteria specified in 42 U.S.C. 1396r and 907 KAR 1:755 for entering or remaining in a facility

An individual who does not require a planned program of active treatment to attain or maintain the individual's optimal level of functioning shall not meet ICF/IID patient status.

An individual shall not be denied for ICF/IID services solely due to advanced age, or length of stay in an institution, or history of previous institutionalization, if the individual qualifies for ICF/IID services on the basis of all other factors.

Excluding an individual with intellectual or a developmental disability to qualify for ICF/IID services, the disability shall have manifested itself prior to the individual's 22nd birthday.

Apply

An application for Medicaid may be made by calling your local Department for Community Based Services Office at 1-800-306-8959 or visiting benefind.

At the time of application, an individual or family should bring proof of:

  • Social Security Number
  • Proof of identity (drivers license)
  • Proof of citizenship (birth certificate)
  • Health insurance
  • Medical bills
  • Income
  • Resources
  • Life insurance policies or burial reserves

A Medicaid application is more likely to be processed sooner if the individual or family provides the above information.

There are Medicaid Waiver programs that can provide Medicaid coverage for many different services that help you stay in your home.

Information

For billing questions: contact (800) 807-1232

Documentation