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Title 8: Medicaid Page 59 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Nonfinancial Non-MAGI-Related Eligibility Revised October 10, 2025 Presence of Age, Blindness, or Disability Presence of Age, Blindness, or Disability Legal reference: 20 CFR 416.801 and 416.901; 42 CFR 436.540, 436.541; 441 IAC 50.2(1), 50.2(3)“d”,75.1(249A), and 75 (Rules in Process); Balanced Budget Act of 1997 (P. L. 105-33) Policy: To be eligible for Medicaid under a non-MAGI-related coverage group, a person must:  Be 65 years of age or older, or  Be blind or disabled based on the criteria used for Supplemental Security Income (SSI). The criteria for establishing disability for adults (over age 18) are:  The person must be unable to earn income in the amount of “substantial gainful activity” because of a severe physical or mental impairment. EXCEPTION: This requirement does not apply to Medicaid for employed people with disabilities.  The impairment must be medically documented and must be expected to last continuously for 12 months or result in death. To be eligible for SSI on the basis of blindness, a person must have central visual acuity of 20/200 or less in the better eye with the use of corrective lens or visual field restriction to 20 degrees or less. The criteria for establishing disability for children (under age 18) are:  The child must be unable to earn income in the amount of “substantial gainful activity” because of a severe physical or mental impairment.  The impairment must have a physical or mental disability that results in marked and severe functional limitation and must be expected to last continuously for 12 months or result in death. Children who were receiving SSI as of August 22, 1996, but lost eligibility due to the change disability criteria made on that date may qualify as disabled if they continue to meet the criteria in effect before the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P. L. 104-193). When a person is applying on the basis of disability and the existence of a disability cannot be documented through receipt of federal disability benefits, the Department must determine whether the applicant is disabled.