WAG 20-08-03-d: Department of Human Services (DHS) Facilities

PM 20-08-03-d.

Hospital Services sends "State Operated Institution Provider Information Sheet" to local offices. The sheet lists the DHS covered settings served by the Family Community Resource Center. An update of the sheet is sent when changes occur. Payment is made only for facilities on the sheet.

DHS - Office of Mental Health (OMH) or Office of Developmental Disabilities (ODD) must immediately tell the Family Community Resource Center when a client is admitted or readmitted to a DHS facility. The Family Community Resource Center must call the Family Community Resource Center in another county when there's a question of a client living in a DHS facility in that county.

TANF Cash and Medical Clients Who Enter a DHS Facility

  1. (FCRC) Tell TANF Cash and Medical clients who live in a DHS covered setting for more than 90 days they are ineligible for TANF, but may be eligible for AABD Medical.

    NOTE: Potential eligibility only exists for services in a DHS covered setting. 

  2. (FCRC) Set a control to send Form 157 before person is removed from case.
  3. (FCRC) Do not enter a date in Item 42 of Form 552 for a person in a TANF Cash or Medical case who is not expected to be in a DHS facility for more than 90 days.
  4. (FCRC) Remove the person from a TANF Cash or Medical case if they have been in the facility for over 90 days. It does not make any difference whether the facility is a DHS covered setting or not.
  5. (FCRC) Use TAR 53, Decreased Need for Other Requirements, in Item 33 of Form 552.
  6. (FCRC) Enter TAR 77 in Item 33 and the date of institutionalization when the only child in a TANF unit is admitted to a DHS facility, if the case is being canceled because the child is being deleted.
  7. (FCRC) Complete a discharge action on Long Term Care Update Authorization Document (Form 2449), if a TANF Cash or Medical client is temporarily moved to a DHS non-covered setting.

Temporary Discharge to Hospital

  1. (FCRC) Redetermine eligibility for client readmitted to a DHS facility after a temporary discharge.
  2. (FCRC) Send Temporary Medical Eligibility Card (Form 1411) to hospital after client returns to DHS facility.

Temporary Move to Non-Covered Setting

  1. (FCRC) Establish control to review the case within 6 months of when a client is temporarily moved from a DHS covered setting to a DHS non-covered setting.
  2. (FCRC) Decide at the review if DHS non-covered setting has been certified or client moved into a DHS covered setting.
  3. (FCRC) Code Form 552.
    1. Use TAR 77 in Item 33 to cancel the case if the client is not in a covered setting before end of 6 months.
    2. Use the date of the move to a DHS non-covered setting in Item 42.
    3. Continue to use code 12, State Hospital, in Item 20 for all clients living in DHS facility. This keeps a medical card from being issued.
  4. (FCRC) Complete Form 2449 to show discharge from DHS covered setting.
  5. (FCRC) Complete Long Term Care Authorization (Form 2299) only if within 6 months the DHS non-covered setting has been certified or client moved into a DHS covered setting.
    1. Use date of certification to complete Form 2299 if client is in facility on certification date.

Pre-release from DHS Facilities

For clients being placed in non-state operated facilities who are not receiving medical assistance.

  1. (DHS Facility) Applies, or helps the applicant apply, for SSI.
  2. (DHS Facility) Refers parent or guardian, for a child under 18, to apply for the child using Request for Financial Assistance/Medical - FS (Form 2378C).
  3. (DHS Facility) Sends Request for Medical Assistance - Hospital/Long Term Care/Supportive Living Facility Application (Form 2378H) to Family Community Resource Center.

    NOTE: Not required for child applicants. 

  4. (DHS Facility) Verifies pending SSI application using SSA Verification Memo for Interim Assistance (Form 2289).
  5. (DHS Facility) Attaches Form 183 to Form 2378H, if SSI application has not been made and disability must be decided by CAU.
  6. (DHS Facility) Notifies SSA and Family Community Resource Center if delay in placement occurs.
  7. (FCRC) Send copy of application decision notice to DHS facility.
  8. (DHS Facility)  Notifies SSA of decision.
  9. (SSA) Approves SSI application if client is eligible.


  1. (FCRC) Notify applicant (see WAG 01-06-02).
  2. (FCRC) Send original to guardian, if there is one.
  3. (FCRC) Use Notice of Decision - Long Term Care (Form 458LTC) and Form 1411 to notify provider when a DHS patient is in a general hospital.