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Title 8: Medicaid Page 74 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised October 10, 2025 People Ineligible for SSI (or SSA)

Tom, age 12, an SSI recipient, moves into an ICF/MR. His parents are paying the cost of the ICF/MR from a trust fund established just for this care. Tom is canceled from SSI, since Medicaid does not pay at least 50% of the cost of care. Tom continues to be eligible for Medicaid in the ICF/MR under the SSI coverage group. Due to Social Security COLAs (503 Medical Only) Legal reference: 42 CFR 435.135, 441 IAC 75 (Rules in Process) Medicaid is available to social security recipients who meet all the following conditions:  They were eligible for and received social security and SSI or SSA benefits concurrently at some time since April 1977, and  They later lost eligibility for SSI or SSA benefits (for any reason), and  They would now be eligible for SSI or SSA if all social security cost-of- living adjustments (COLAs) since they were last concurrently eligible were deducted from income. This includes any COLA income received by the parent, spouse, or children since the applicant was canceled from SSI or SSA when that income is considered through deeming. This provision applies to any social security cost-of-living increase occurring after July 1, 1977. Two categories of people are affected:  Those who lose SSI or SSA directly because of a social security COLA.  Those who become ineligible for SSI or SSA for another reason and are then ineligible only for SSI or SSA only because of social security COLAs. For example, a person who became ineligible for SSI or SSA because resources exceeded limits may reapply when resources are under limits. The person may now be ineligible for SSI or SSA because of COLAs. If the person was simultaneously eligible for social security and SSI or SSA at some time since April 1977, examine eligibility for 503 coverage. In either circumstance, the person can be eligible for Medicaid under the 503 group if there was concurrent eligibility and the person’s current income without COLAs is within current eligibility limits.