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Title 8: Medicaid Page 51 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Residents of Institutions Revised October 10, 2025 Residents of Public Nonmedical Institutions If someone is listed as serving a special sentence or you find something questionable, request additional information regarding their individual status. Regardless of the label attached to any particular custody status, an important consideration of whether an individual is an “inmate” is his or her legal ability to exercise personal freedom. If full Medicaid benefits are paid while an inmate is incarcerated, HHS will seek repayment of the incorrect benefits paid from the member or provider. In order to get either type of Medicaid, the person must also meet all other eligibility requirements for Medicaid, including, but not limited to:  Income and asset limits.  Citizenship and Identity  Have a medical necessity for the service that is provided (i.e., if in a nursing facility, require the level of care provided by the facility. An inmate of a public nonmedical institution is not eligible for non-MAGI-related Medicaid except as listed under Non-MAGI-Related Eligibility Under Levings Rule. Halfway House Legal reference: 42 CFR 435.1010 Some people in halfway houses (called “community residential facilities”) are serving a prison sentence or have been placed on a work release program. Other people in halfway houses are on probation or parole and are ordered to live in a halfway house as a condition of the probation or parole. People serving a prison sentence and those who have been placed on a work release program are considered inmates and are not Medicaid-eligible. But people placed on probation or parole who are living in a halfway house are not considered inmates and can be eligible for Medicaid, as long as they meet the other eligibility criteria. To determine eligibility, you must verify whether the person living in a halfway house is serving a sentence, is on a work release program, or is on probation or parole.