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Title 8: Medicaid Page 41 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Residency Revised October 10, 2025 Incapability of Expressing Intent  Medical documentation from a physician, psychologist, or other person licensed by the state in the field of intellectual disability indicates the person is incapable of expressing intent.

1. Ms. V, a 76-year-old woman, comes to Iowa to enter a nursing facility. She intends to return to Wisconsin. She is not an Iowa resident. 2. Mr. C, age 24, was living in Los Angeles when he is involved in a car accident. He remains in a coma. Mr. C is moved to a hospital in Iowa to be close to his parents. Mr. C becomes an Iowa resident. His residency is where he is living, because he became incapable of expressing intent after age 21. 3. Mr. M, a 25-year-old living in an Iowa ICF-MR, was injured at age 15. The court issued an order that he was not competent and appointed a legal guardian. After placing Mr. M in an ICF-MR, his guardian moved to Florida. Mr. M is an Iowa resident because his entry into the living arrangement occurred while his guardian was a resident of Iowa. State Placement Legal reference: 42 CFR 435.403, 441 IAC 75.10(249A) “State placement” is an arrangement by any state agency, including an agency under contract with the state for such purposes, for a person to be placed in an institution in another state. Providing information to the person or acting on behalf of a person is not state placement. Examples of actions that are not considered state placement are:  Providing information about the availability of services or medical benefits in another state.  Assisting the person in locating an out-of-state institution.  Approving Medicaid eligibility for a person in an out-of-state facility. If the person who is living out of state alleges placement by a state agency, obtain verification from the placing agency. NOTE: If the person is an SSI recipient, use the state of residence as indicated on the SDX. If the SSI recipient has been placed by the State of Iowa in an out of state institution, the representative payee or the Social Worker who placed them in the out of state institution must make certain SSI is aware this is an out of state placement and the State of Iowa is the placing agency.