A person is not eligible for medical assistance for any care
or services received while the person is an inmate of a public institution. For
the purpose of this rule, "inmate of a public institution" and "public
institution" are defined by 42 CFR Section 435.1010 as amended to August 25,
2011.
(1)
Suspension.
Medical assistance shall be suspended, rather than canceled, for the first 12
continuous calendar months that a person is an inmate of a public institution
if all of the following conditions are met:
a. The
department is notified of the person's
entry into the public institution through either:
(1) A monthly report which is provided to the
department by the public institution and includes the person's name, date of
birth, and social security number and the date the person entered the
institution; or
(2) Other verified
notice received by the department.
b. The person has entered a public
institution on or after January 1, 2012, and has been in the public institution
for 30 days or more.
c. On the date
of entry into the public institution, the person was a Medicaid
member.
d. The person is eligible
for medical assistance as an individual except for institutional
status.
(2)
Coverage during suspension. While medical assistance is
suspended, payment will be
made only for services received while the person is not an
inmate of a public institution.
(3)
Reinstatement. The
Medicaid case for an inmate who is released from a public institution while
Medicaid is suspended will be reopened without an application if both of the
following conditions are met:
a. The
department is notified of the person's release from the public institution
through either:
(1) A monthly report which is
provided to the department by the public institution and includes the person's
name, date of birth, and social security number and the date the person was
released from the institution; or
(2) Other verified notice received by the
department.
b. All
information available to the
department indicates that the person is currently
eligible for Iowa Medicaid as an individual.
This rule is intended to implement Iowa Code section 249A.3
and 2011 Iowa Acts, Senate File 482, division IX.
Notes
Iowa Admin. Code
r. 441-75.12
ARC 9957B, lAB 1/11/12,
effective 1/1/12
