WAG 20-08-08.

If an LTC facility voluntarily withdraws from the Medicaid program, HFS continues to pay for services to clients in the facility if:

  • the client was a resident of the facility when it withdrew, and the client's date of eligibility is on or before the date of withdrawal; and
  • the facility continues to receive certification surveys and enters into provider agreements.

Example: A facility voluntarily withdraws from participation on 06/01/95. A person enters the facility in 05/95 and applies for benefits in 06/95. The client is approved for benefits effective 05/95. Since the client was a resident before the facility withdrew and the eligibility date is before the facility withdrew, payments may be made to the facility.

HFS will not pay for services for:

  • new admissions after the date of withdrawal; and
  • residents whose date of eligibility is after the date of withdrawal.

Example: A facility voluntarily withdraws from participation on 06/01/95. A person applies and is approved for medical benefits effective 07/95. Payment is not made since the date of eligibility is after the date of withdrawal.

If an SLF voluntarily withdraws from the Medicaid program, HFS pays for services only through the date prior to the effective date of withdrawal.

Example: An SLF voluntarily withdraws from participation on 07/01/98. Payment to the facility may be made only through 06/30/98.