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Title 8: Medicaid Page 43 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Residency Revised October 10, 2025 State Placement When a person uses the person’s own funds or other resources to pay for care in a facility with the intention of living there permanently or for an indefinite period of time, then the person has made a commitment to that facility and it appears to be the person’s home. If the facility is out-of-state, then that is considered the state of residence the person chose. If the person applies for Iowa Medicaid and states a desire to return to Iowa, then the person must establish that the person always intended to return to Iowa, e.g., the person’s name may be on a waiting list at an Iowa facility. Residency can also be established by actually returning to Iowa with intent to remain. One of the main reasons for Iowa residents to seek out-of-state care is the lack of a reasonable alternative in Iowa. See Intent to Return to Iowa From an Out-of- State Facility and Guidelines for Discharge Planners. Payment for out-of-state skilled care requires prior approval from central office. See Approval for Out-of-State Skilled Care. When a person is approved for Iowa Medicaid in an out-of-state facility based on an intent to return to Iowa, the local office must periodically verify this intent. Intent to Return to Iowa from an Out-of-State Facility Legal reference: 441 IAC 75.10 If a person has a reasonable explanation for entering an out-of-state facility and has the intent to return to Iowa, the person can be approved for Medicaid based on residency. If there is no intent to return to Iowa, cancel the case with timely notice and refer the client to the state in which the client is living to apply for Medicaid. If no reasonable nursing facility arrangement can be made for a person in Iowa, you can approve payment for an out-of-state facility if the person intends to return to Iowa. A “reasonable” nursing facility arrangement is one that a person who intends to return to Iowa would reasonably be expected to accept. Consider such factors as:  Level of care.  Location.  Participation in Iowa Medicaid.