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Title 8: Medicaid Page 88 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised October 10, 2025 People in Medical Institutions Ineligible for SSI Due to Residence in a Medical Institution Legal reference: 42 CFR 435.211, 441 IAC 75 (Rules in Process) When a person enters a medical institution in which Medicaid will be paying at least 50% of the cost of care, the SSI program reduces the person’s maximum benefit rate to $30 per month. This means that people who were eligible for SSI while living in their home will lose SSI eligibility when they enter a medical institution if their income is greater than $30. Medicaid is available to a person who would be eligible for SSI or SSA if the person was not living in a medical institution. Begin eligibility on the first day of the month the person entered the institution. Begin payment for the nursing facility on day of entry, provided level of care has been met. Retroactive benefits may also be available for up to three months before the month of application if all requirements are met.

1. Mr. A, a 67-year-old person living in a nursing facility, has been using his resources to pay privately. In July 1996, Mr. A applies for Medicaid because his resources have been depleted and are now less than $2,000. Mr. A’s only income is social security of $400. Because Mr. A’s income does not exceed the SSI payment standard for an individual living at home, his correct coverage group beginning July 1996 is “people ineligible for SSI due to residence in a medical institution.” 2. Ms. J enters a nursing facility and applies for Medicaid on July 20. Her only income is social security of $400. In the month of July, Ms. J’s resources are $2,200. As of August 1, her resources are reduced to $1,900. For the month of July, eligibility is determined under the Medically Needy group. Beginning August 1, because Ms. J’s income is less than the SSI payment standard for one person living at home and her resources are then less than the SSI resources standard, her correct Medicaid coverage group is “people ineligible for SSI due to residence in a medical institution.” Eligibility is not determined under the “300% income level” coverage group. The 30-day stay requirement does not apply for the month of August.