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Title 8: Medicaid Page 32 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Sanctions and Appeals Revised October 10, 2025

Sanctions and Appeals Legal reference: 42 CFR 431.200, 431.220, and 433.147; 441 IAC 7.5(17A), 75 (Rules in Process), 75.14(249A), 75.21(249A), 76.8(249A), and 80.3(249A) A sanction is a penalty for not cooperating with the Department. The penalty is the loss of Medicaid eligibility. A person may be sanctioned for failure to cooperate with:  Child Support Services (CSS)  Third-Party Liability (TPL) Unit  Department of Inspections, Appeals, and Licensing (DIAL)  Quality Control (QC) When you reinstate or reopen a case that includes a sanctioned person, you will receive a Notice of Decision or Notice of Action. If you receive an appeal on this Notice of Decision or Notice of Action, you will need to include the following in your appeal summary:  An explanation of when the sanction was originally issued,  The original Notice of Decision or Notice of Action sanctioning the person, and  The current Notice of Decision or Notice of Action reinstating or reopening the household. The household has rights to appeal the sanction based only on the original Notice of Decision sanctioning the individual. However, the way Medicaid was calculated may be appealed, which is true for all decisions. If a sanctioned person applies for Medicaid and the sanction has not been cured, the sanctioned person should receive a Notice of Decision or Notice of Action that gives the person the right to appeal the sanction. Residency Legal reference: 42 CFR 435.403 and 435.956(c), 441 IAC 75.10(249A), Iowa Code Section 249A.3 A person must be a resident of Iowa to be eligible for Iowa Medicaid. In general, a resident of Iowa is a person who is living in the state with the intent to remain permanently or for an indefinite period. However, other rules may apply, based on age, institutional or foster care status, ability to indicate intent, or disability.