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Title 8: Medicaid Page 42 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Residency Revised October 10, 2025 Incapability of Expressing Intent Generally, if HHS has not been declared the person’s legal guardian or does not have some other legal relationship to the person, HHS does not arrange for a person’s entry into an institution. Arrangements for a person to enter a facility are generally made by the person entering the facility or by someone acting on the person’s behalf, such as a responsible relative or hospital staff. If there is a question about whether HHS was the placing agency, check whether or not HHS was legally responsible for the person’s welfare at the time the person entered the institution. If HHS was not legally responsible, then generally HHS could not be considered to have placed the person. Eligibility in Out-of-State Medical Institutions When a person wants Iowa Medicaid to pay for care in an out-of-state facility, the issue of residency must be decided. Under federal Medicaid regulations, when a person in an institution satisfies the residency requirements, no state can deny eligibility on the grounds that the person did not establish residency in the state before entering the institution. If a person was not an Iowa resident before entering an out-of-state facility, Medicaid eligibility cannot be established until the person actually moves to Iowa, unless:  The person was placed by Iowa, or  The person is under 21 and residency must be determined by the residency of the person’s parents. When an Iowa resident enters an out-of-state facility, the person’s intent for living out of state must be established:  If the person expects to remain in that facility permanently or indefinitely, the person is considered to be a resident of the state in which the person is living.  If the person entered the out-of-state facility with the intent of remaining in that facility but now wants to return to Iowa, the person must return to Iowa before Medicaid can be approved based on residency.  If the person can establish that the person’s intent when the person entered the facility was to return to Iowa, and the person still intends to return to Iowa, the person can be approved for Iowa Medicaid while in the out-of-state facility.