Iowa Administrative Code

excess income. This rule is intended to implement Iowa Code sections 249A.3, 249A.3A and 249A.4. [ARC 9763C, IAB 11/26/25, effective 1/1/26]

provided in 441—Chapters 75 and 76, persons who are 65 years of age or older, blind, or disabled are eligible for Medicaid only if eligible for the SSI program administered by the SSA. 75.80(1) SSI policy reference. The statutes, regulations, and policy governing eligibility for …

75.81(1) Applicants receiving federal benefits. An applicant receiving SSI on the basis of disability, social security disability benefits under Title II of the Act, or railroad retirement benefits based on the Social Security Act’s definition of disability by the Railroad Retire…

required to participate in the cost of medical institution care. However, no client participation is charged when the combination of Medicare payments and the Medicaid benefits available to qualified Medicare beneficiaries covers the cost of institutional care. 75.83(1) Income co…

When an individual resides in a continuing care retirement community or life care community that collects an entrance fee on admission, the entrance fee paid will be considered a resource available to the individual for purposes of determining the individual’s Medicaid eligibilit…

Notwithstanding any other provision of this chapter, if an individual’s equity interest in the individual’s home exceeds the limit set annually according to subrule 75.85(1), the individual will not be eligible for Medicaid with respect to nursing facility services or other long-…

75.9(1) Requirement. As a condition of eligibility, except as provided by subrule 75.9(2), a Medicaid client must provide to the department all social security numbers issued to each individual (including children) for whom Medicaid is sought. 75.9(2) Exceptions to requirement. T…

4. A tax-filer who claims the applicant as a dependent; (3) An authorized representative described in subrule 76.9(2); or (4) A responsible person described in subrule 76.9(1). b. How and where to file. (1) An application may be filed online on the department’s website or www.hea…

any time before the eligibility determination has been made. The applicant may request that the application be withdrawn entirely or request withdrawal for any month covered by the application process except as provided in the medically needy program in accordance with the provis…

notices and other communications are to be provided by the department in an electronic format through the individual’s electronic account rather than by regular mail. The applicant may change the selection at any time. Notices and other communications provided through the individ…

76.12(1) Adding a new person. a. Adding an eligible person. For members whose eligibility is based on the MAGI methodology, a new application is not required when an eligible person is added to an existing Medicaid household. Such a person is considered to be included in the appl…

76.13(1) Enrollment date. The department will enroll applicants who have been determined to be eligible in the Medicaid program. a. First day of the month. The effective date of enrollment is the first day of the month that the application was filed or the first day of the first …

of determining continued enrollment in Medicaid pursuant to 441—Chapter 75. 76.14(1) Reenrollment frequency. a. The department will conduct eligibility reviews for members whose eligibility is based on the MAGI methodology once every 12 months and no more frequently than once eve…

and current members shall report changes in circumstances as required in this rule. 76.15(1) A change in circumstance that may affect the eligibility of applicants and members must be reported within ten days of the date the change occurred. Changes required to be reported are de…

a change in a member’s circumstances otherwise comes to the attention of the department, its effect on eligibility will be evaluated and eligibility will be redetermined regardless of whether the report of change was required by rule 441—76.15(249A). When the department has infor…

Whenever a Medicaid member no longer meets the eligibility requirements of the current coverage group, the department will automatically redetermine eligibility for other Medicaid coverage groups unless the reason for ineligibility is due to not meeting the requirements in rule 4…

medical assistance from the department. Applications for Medicaid must be made as provided in this rule. 76.2(1) Application with the department or qualified entity. a. Who can file. An application may be filed by: (1) The applicant; (2) An adult in the applicant’s household, as …

has been screened and that the applicant has been found to be potentially eligible for Medicaid or hawki, the department will treat the application as if it had been received directly by the department pursuant to rule 441—76.2(249A). [ARC 9702C, IAB 11/12/25, effective 1/1/26]

assistance, the department will use express lane procedures as allowed by 42 U.S.C.§1396a(e)(13) and as described in this rule. 76.4(1) For purposes of initial enrollment, the department will rely on a determination of the child’s eligibility for the Supplemental Nutrition Assist…

individual has been approved for SSI, the department will treat the referral as an application for medical assistance and will process the application as if received directly by the department. The SSI recipient may be required to provide additional information when necessary to …

42 U.S.C. §1320b-14(c)(3) when the individual has indicated that the individual wants to apply for the Medicare savings program will be treated by the department as an application for the Medicare savings program and will be processed as if the application were received directly …

Medicaid based on a presumptive eligibility determination by a qualified entity at a presumptive provider pursuant to this rule. 76.7(1) Presumptive provider. A presumptive provider is an organization approved by the department to conduct and authorize presumptive eligibility det…

76.8(1) Accurate information. Clients, and those individuals acting on behalf of clients, are responsible for giving complete and accurate information needed to establish eligibility. 76.8(2) Additional information or verification needed to determine eligibility. An applicant or …

76.9(1) Responsible person. If an applicant or member is unable to act on the applicant’s or member’s own behalf because the applicant or member is a minor or is incompetent, incapacitated, or deceased, a responsible person may act for the applicant or member. a. Except as provid…

the state of Iowa are eligible to participate in the program. Physicians in other states are also eligible if duly licensed to practice in that state. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

that they are certified to participate in the Medicare program (Title XVIII of the Social Security Act as amended to July 1, 2026) and, unless otherwise exempted, have submitted a surety bond as required by subrules 77.10(2) through 77.10(4). 77.10(1) Definitions. “Assets” includ…

dealers in medical equipment and appliances, prosthetic devices and medical supplies in Iowa or in other states are eligible to participate in the program. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

that they meet the eligibility requirements for participation in the Medicare program (Title XVIII of the Social Security Act as amended to July 1, 2026) and Iowa Code section 147A.8. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

eligible to participate in the medical assistance program when the provider is accredited by one of the following bodies: 1. The Joint Commission (TJC) accreditation, or 2. The Healthcare Facilities Accreditation Program (HFAP), or 3. The Commission on Accreditation of Rehabilita…

duly licensed by the state of Iowa. Hearing aid dispensers in other states will be eligible to participate if they are duly licensed in that state. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

licensed by the state of Iowa. Audiologists in other states will be eligible to participate when they are duly licensed in that state. In states having no licensure requirement for audiologists, an audiologist shall obtain a license from the state of Iowa. [ARC 0314D, IAB 5/27/26…

participate in the medical assistance program when they are accredited pursuant to 441—Chapter 24. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

screening centers when they have the staff and facilities needed to perform all of the elements of screening specified in rule 441—78.18(249A) and meet the department’s standards for a child health screening center. The staff members must be employed by or under contract with the…

licensed, in independent practice, and are eligible to participate in the Medicare program. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

the medical assistance program are retail dealers in orthopedic shoes prescribed by physicians or podiatrists and shoe repair shops specializing in orthopedic work as prescribed by physicians or podiatrists. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

requirements of this rule. 77.2(1) Licensure. Participating retail pharmacies must be licensed in the state of Iowa or duly licensed in another state. Out-of-state retail pharmacies delivering, dispensing, or distributing drugs by any method to an ultimate user physically located…

that they are certified to participate in the Medicare program (Title XVIII of the Social Security Act as amended to July 1, 2026). [ARC 0314D, IAB 5/27/26, effective 7/1/26]

that they are certified to participate as a laboratory in the Medicare program (Title XVIII of the Social Security Act as amended to July 1, 2026). An independent laboratory is a laboratory that is independent of attending and consulting physicians’ offices, hospitals, and critic…

are certified to participate in the Medicare program (Title XVIII of the Social Security Act as amended to July 1, 2026). [ARC 0314D, IAB 5/27/26, effective 7/1/26]

77.23(1) All psychologists licensed to practice in the state of Iowa pursuant to Iowa Code chapter 154B are eligible to participate in the medical assistance program. Psychologists in other states are eligible to participate when they are duly licensed to practice in that state a…

Medicaid program if the center provides a team of professionals to render prenatal and postpartum care and enhanced perinatal services (see rule 441—78.25(249A) for more information). The prenatal and postpartum care shall be in accordance with the American College of Obstetricia…

hospitals are eligible to participate in the medical assistance program if the ambulatory surgical centers are certified to participate in the Medicare program (Title XVIII of the Social Security Act as amended to July 1, 2026). Freestanding ambulatory surgical centers providing …

participate in the Medicaid program when the Centers for Medicare and Medicaid Services has notified the Medicaid program of the federally qualified health centers’ eligibility as allowed by Section 6404(b) of Public Law 101–239 as amended to July 1, 2026. [ARC 0314D, IAB 5/27/26…

eligible to participate in the Medicaid program if they are duly licensed and registered by the state of Iowa as advanced registered nurse practitioners certified pursuant to 481—Chapter 621. 77.27(1) Advanced registered nurse practitioners in another state shall be eligible to p…

Medicare program are eligible to participate in Medicaid. Speech-language pathologists who are not enrolled in the Medicare program are eligible to participate in Medicaid if they are licensed and in independent practice, as an individual or as a group. 77.28(1) Speech-language p…

are eligible for participation in the program. Physician associates duly licensed to practice in other states are also eligible for participation. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

eligible to participate in the program. [ARC 0314D, IAB 5/27/26, effective 7/1/26]

as an approved provider of HCBS habilitation services, a provider shall meet the general requirements in subrules 77.30(2) through 77.30(5) and shall meet the requirements in the subrules applicable to the individual services being provided. 77.30(1) Definitions. “Certified emplo…

Medicaid program as providers of behavioral health services. 77.31(1) Licensed marital and family therapists (LMFT). Any person licensed by the board of behavioral health professionals as a marital and family therapist pursuant to 481—Chapter 880 is eligible to participate. A mar…

are licensed or receive reimbursement from at least two third-party payors. [ARC 0314D, IAB 5/27/26, effective 7/1/26]