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Title 8: Medicaid Page 52 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 Inpatient Medical Institutions Legal reference: 42 CFR 435.1010 A “medical institution” is one that:  Provides medical care  Has the necessary professional personnel, equipment, and facilities to manage the medical, nursing, and other health needs of patients on a continuing basis in accordance with accepted standards  Is authorized under State law to provide medical care; and  Is staffed by professional personnel who are responsible to the institution for professional medical and nursing services. An inmate of a penal institution who is admitted as an inpatient of a medical institution (hospital, nursing facility, juvenile psychiatric facility) that is not on the grounds of the penal institution and is not owned or operated by the penal institution may be eligible for Medicaid. The person must meet the other eligibility criteria before Medicaid can be approved. An inmate of a penal institution is not eligible for Medicaid when taken to a prison hospital or dispensary or when receiving outpatient care.

1. Ms. M is a disabled person who is serving a prison sentence. She received Medicaid before being incarcerated. She is taken by ambulance to the local, private hospital in a nearby town where she is treated and released, and then returned to prison. Ms. M is not eligible for Medicaid for her ambulance trip or treatment at the hospital because she was not admitted as an inpatient. 2. Mr. N is a prison inmate. Mr. N was eligible for Medicaid as a disabled person before being incarcerated. Mr. N is injured and must be treated as an inpatient in the prison hospital for several days. Mr. N is not eligible for Medicaid since he was treated in a hospital operated by the penal institution. 3. Mr. L is active on Medicaid. The worker receives a WISE alert that Mr. L has been incarcerated for more than 30 days. Mr. L’s Medicaid is limited to inpatient hospital claims until the worker receives an alert indicating Mr. L’s release.