Page 57

Title 8: Medicaid Page 53 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 Non-MAGI-Related Eligibility Under Levings Rule Legal reference: AR-88-6(8), 604F.2d 591 For non-MAGI-related groups, an inmate of a public nonmedical institution is not eligible for payment of Medicaid services other than inpatient hospital. EXCEPTION: Due to a U.S. District Court ruling, Levings vs. Califano, residents of public nonmedical institutions can be eligible for SSI (and therefore also non-MAGI-related Medicaid) if they:  Live in the institution on a voluntary basis and  Are paying for the full cost of their care in the institution or will be paying for the full cost if SSI or State Supplementary Assistance is approved. For the purposes of the Levings exception, assume the person is a voluntary resident unless there is evidence to the contrary. If the person has a legal guardian or court-appointed representative, the person is a voluntary resident if the guardian or representative has the right to remove the person from the institution. If a court order instructs that a person be placed in a specific institution, the person is not living in the facility voluntarily. However, if a court instructs only that a person be placed in a facility providing a certain type of care (without indicating a specific facility), and the person chooses a public institution, the person’s residence in the institution is voluntary, as long as the person retains the right to leave that institution. A person is paying for “all of the institutional care” if the person pays the facility’s usual charges for food, shelter, and other services. The person’s payment to the facility must come from personal income or resources or from third-party payments to the institution (e.g., Medicare or private insurance payments). Payment of all or part of the cost of care by a local government agency (e.g., county governments, state health or welfare agencies) is not considered a third-party payment under this exception. The Social Security Administration has determined that State Supplementary Assistance payments are considered as personal income. This means that if a person is or will be paying the entire cost of RCF care with a combination of State Supplementary Assistance and other income, this exception applies.