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Title 8: Medicaid Page 49 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Residents of Institutions Revised October 10, 2025 Residents of Institutions for Mental… EXCEPTION: A person who enters a psychiatric medical institution for children before turning age 22 may receive Medicaid through age 22. When a Medicaid member who is over age 21 and under age 65 enters an institution for mental disease and is expected to remain for more than a calendar month, cancel the person’s Medicaid. EXCEPTION: Medicaid members enrolled with an MCO who are age 21 to 65 and are in an MHI for 15 or fewer days per month are eligible for payment to the MHI through the MCO. In this situation, do not cancel the member when they enter the MHI. Review the member’s eligibility and if they continue to be eligible under the same coverage group, leave the case active. The MHI facility worker will need to add the MHI stay to ISIS. Although a person who is between age 21 and age 65 and is living in an institution for mental disease may qualify for SSI benefits, the person is still categorically ineligible for Medicaid unless the exception listed in this section applies. Residents of Public Nonmedical Institutions Legal reference: 20 CFR 416.211, 42 CFR 435.1009-1010; 441 IAC 75.12(249A) Policy: Federal Medicaid regulations prohibit the use of federal Medicaid funds for people who are inmates of a public, non-medical institution. A “public institution is one that is the responsibility of a government unit or over which a governmental unit exercises administrative control. It includes, but is not limited to:  Publicly operated penal institutions,  Jails,  Work release centers, or  Wholly tax-supported care facilities, such as some county residential care facilities Department of Corrections (DOC) prisons and county jails are public institutions. EXCEPTION: A publicly operated community residence that serves fewer than 16 residents is not considered a public institution. For example, a county-owned and operated residential care facility that has fewer than 16 beds may be a publicly operated community residence.