Applicants for Medicaid coverage of nursing home care must meet one of the following criteria:
Must require licensed nursing care (RN or LVN);
Must meet two or more of the criteria for nursing home risk, as specified in the Resident Assessment Instrument-Home Care Assessment for Nursing Home Risk as revised in April 1996 and summarized as follows:
- needs assistance with one or more of the activities of dressing, personal hygiene, eating, toilet use, or bathing;
- has had a functional decline in the past 90 days;
- has a history of a fall two or more times in past 180 days;
- has a neurological diagnosis of Alzheimer's, Head Trauma, Multiple Sclerosis, Parkinson's, or Dementia;
- has a history of nursing facility placement within the last five years;
- has multiple episodes of urine incontinence daily; and
- goes out of one's residence one or fewer days a week.
Must have been living for 30 consecutive days in a medical facility that has a contract to accept Medicaid patients. Persons in this category must still be screened for medical necessity.