Page 104

Title 8: Medicaid Page 100 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Nonfinancial MAGI-Related Eligibility Revised October 10, 2025 Absence Questionable Cases Legal reference: 441 IAC 75 (Rules in Process) In questionable cases, you may need verification before you can consider a parent absent and determine eligibility. Do not take action based on suspicion or complaint alone when you believe that an “absent parent” is not absent. Try to get several items that support your belief. The following are examples of situations that could justify more verification:  The case was recently denied or canceled because the “absent parent’s” income or resources were considered.  The absent parent moves in and out of the home frequently.  Living expenses exceed income.  The parent’s absence occurs when the parent is on strike or during slack times for a self-employment business, etc.  There is no verifiable residence for the absent parent.  The verifiable residence for the absent parent is very close to the child’s home. The absent parent may be out of contact with the family, especially if the separation was recent. The client may verify the circumstance by providing a statement from the landlord, minister, lawyer, or other knowledgeable nonrelative. Apply the “prudent person” concept and document the basis for the decision on all questionable cases. Temporary Absence Legal reference: 42 CFR 435.403(j)(3), 441 IAC 75.53 Policy: Include in the eligible group the needs of a person who is temporarily out of the home, if otherwise eligible. A temporary absence exists when the person is:  Out of the home to secure education or training.  In a medical institution for less than a year as verified by a physician’s statement.  Out of the home for another reason and the person intends to return to the home within three months. Document the temporary absence and request verification as needed.