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Title 8: Medicaid Page 46 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 Payment will be approved for out-of-state skilled care when the following criteria are met:  The facility is eligible to participate in the Iowa Medicaid program.  The facility has been certified for Medicare and Medicaid participation by the state where it is located.  The placement is recommended because: • Moving the person back to Iowa would endanger the person’s health, • Services are not readily available in Iowa, or • The out-of-state placement is cost-effective.  The placement is temporary until services are available to the resident in Iowa or the program of treatment is completed. When the type of skilled care needed is available from any skilled facility, out- of-state payment will not be approved if there is a skilled facility in the area that will accept the resident, unless the client can explain why that facility is not acceptable and how the client intends to return to Iowa. When the out-of-state skilled care is designed for very specialized types of rehabilitation services, the placement may be approved on the basis that no appropriate facility is available in Iowa, if the client intends to return. When a person is on Medicare, Medicare will pay for 100 days of skilled care. For a Medicare-covered skilled stay, members may go to any Medicare skilled facility they choose. However, if the person wants Medicaid to pay the cost of out-of-state care once the Medicare coverage is exhausted or otherwise wants Medicaid, the person would have to meet residency requirements and a determination of intent must be made. When a Medicaid-Eligible Person Moves to Iowa Legal reference: 441 IAC 75.10(2) Policy: If a Medicaid-eligible person from another state becomes an Iowa resident, grant Iowa Medicaid eligibility beginning with the month of Iowa residency if:  The person meets all eligibility criteria and  The person surrenders the other state’s medical card, if a card was issued for any months for which the person is requesting Iowa Medicaid.