Page 49

Title 8: Medicaid Page 45 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Residency Revised October 10, 2025 Eligibility in Out-of-State Medical Institutions To do this, discuss the following with the client or the client’s representative and make a decision about intent:  Reason for entry into the out-of-state facility.  A statement of when the client intends to return.  A statement of under what circumstances the client would return.  A statement of why any available facilities in Iowa are not acceptable. Guidelines for Discharge Planners Advise local hospital social workers not to make any out-of-state placements of Medicaid members if the member wants to continue to receive Iowa Medicaid unless the local office has determined that Iowa Medicaid will pay the out-of-state facility. For members who want to maintain Iowa residency, the first placement options should be in Iowa. The person’s name should immediately be placed on the waiting list for an Iowa facility, so that when the person is ready for discharge from the hospital, the bed may be available. For short-term placements, the member may choose an out-of-state facility, as long as the member intends to return to Iowa. Review these placements annually for intent to return to Iowa. For long-term placements, the hospital should try to place the patient where the patient wants to live on a long-term basis immediately from the hospital. A patient who wants to apply and live in another state can be placed in that state. If it is agreeable to the patient, the patient could be placed in another state until an in-state placement is available. The patient will need to return to Iowa to remain eligible for Iowa Medicaid. Patients and families intending to apply for Medicaid need to be advised of that requirement. Approval for Out-of-State Skilled Care Legal reference: 441 IAC 81.20 For fee-for-service, skilled care in an out-of-state facility requires approval from the Iowa Medicaid Enterprise (IME). For individuals under a Managed Care Organization (MCO), the MCO will make the approval.