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Title 8: Medicaid Page 49 Iowa Department of Health and Human Services Employees’ Manual Chapter E: Income Non-MAGI-Related In-Kind Income Revised April 11, 2025 In-Kind Support and Maintenance (ISM) Living in Another Person’s Household Legal reference: 20 CFR 416.1132-416.1133 A client is not living in another person’s household if:  The client has an ownership interest or a life estate interest in the home.  The client (or any person in the household who could have income deemed to the client) is liable to the landlord for paying any part of the rent. In this context, a landlord and tenant cannot be members of the same household.  The client pays at least a pro rata share of household and operating expenses.  All members of the household receive public assistance income- maintenance payments, such as FIP or SSI.  The client lives in an institution (an establishment which provides food, shelter, and some treatment or services to four or more people). An institution is not a household, and a household cannot exist within an institution.  The client lives in a noninstitutional care situation, such as a family- life home or a foster care home. A household must be a personal place of residence. A commercial establishment, such as a hotel or boarding house, is not a household. However, a household can exist within a commercial establishment if the client lives in the household as a roomer or boarder within the hotel or boarding house.

1. Mr. A lives in a boarding house and pays $200 per month to the owner for room and board. Several other people also live in the boarding house. Mr. A is not considered to be living in another person’s household. 2. Mr. B lives with Mr. A. Mr. B does not have rental liability to the boarding household owner and does not pay a pro rata share of the expenses. Mr. B is considered to be living in the household of another (Mr. A).