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Title 8: Medicaid Page 89 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised May 22, 2026 People in Medical Institutions 300% Income Level Legal reference: 42 CFR 435.236, 441 IAC 75 (Rules in Process), 75 (Rules in Process), 75. (Rules in Process), P. L. 100-360 Medicaid is available to a person who meets all of the following requirements:  Receives care in a hospital, nursing facility, NF/MI, psychiatric medical institution, or ICF/ID and has been institutionalized for 30 consecutive days.  Meets the level of care requirements for the institution, as determined by the Iowa Medicaid Enterprise, Managed Care Organization, or Medicare. See 8-I, Medical Necessity.  Is age 65 or older, blind, disabled, or is under the age of 21.  Meets all SSI eligibility requirements except income. EXCEPTION: Do not consider resources for children under 21.  Has gross monthly income that is more than SSI standards but that does not exceed 300% of the federal SSI benefit for one, which currently is $2,982. If both spouses enter a medical institution and live in the same room, the income limit is two times $2,982, or $5,964. For all people in this coverage group, count income using SSI policies. For adults, count resources using SSI policies. For children under age 21, disregard resources of all household members. NOTE: See also FMAP- Related Coverage Groups: People in a Medical Institution Within the 300% Income Limit.

1. Tim, age 12, resides in a PMIC. He receives Medicaid and facility care under the coverage group for people who are ineligible for SSI due to residing in a medical institution, in which resources are an eligibility factor for children. Tim has monthly countable income of $100. In August, during the annual review, the worker determines Tim’s resources have permanently increased to $2,700 and will continue to be the same as of the first moment of the first day of September. The worker completes an automatic redetermination and finds Tim eligible under the 300% group.