Iowa Admin. Code r. 441-75.13 - Categorical relatedness

Current through Register Vol. 44, No. 20, April 6, 2022

(1) FMAP-related Medicaid eligibility. Medicaid eligibility for persons who are under the age of 21, pregnant women, or specified relatives of dependent children who are not blind or disabled shall be determined using the income criteria in effect for the family medical assistance program (FMAP) as provided in subrule 75.1(14) unless otherwise specified. Income shall be considered prospectively.
(2) SSI-related Medicaid. Except as otherwise 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 Supplemental Security Income (SSI) program administered by the United States Social Security Administration.
a. SSI policy reference. The statutes, regulations, and policy governing eligibility for SSI are found in Title XVI of the Social Security Act ( 42 U.S.C. Sections 1381 to 1383f ), in the federal regulations promulgated pursuant to Title XVI ( 20 CFR 416.101 to 416.2227 ), and in Part 5 of the Program Operations Manual System published by the United States Social Security Administration. The Program Operations Manual System is available at Social Security Administration offices in Ames, Burlington, Carroll, Cedar Rapids, Clinton, Council Bluffs, Creston, Davenport, Decorah, Des Moines, Dubuque, Fort Dodge, Iowa City, Marshalltown, Mason City, Oskaloosa, Ottumwa, Sioux City, Spencer, Storm Lake, and Waterloo, or through the Department of Human Services, Division of Financial, Health, and Work Supports, Hoover State Office Building, 1305 East Walnut, Des Moines, Iowa 50319-0114.
b. Income considered. For SSI-related Medicaid eligibility purposes, income shall be considered prospectively.
c. Trust contributions. Income that a person contributes to a trust as specified at 75.24(3)"b " shall not be considered for purposes of determining eligibility for SSI-related Medicaid.
d. Conditional eligibility. For purposes of determining eligibility for SSI-related Medicaid, the SSI conditional eligibility process, by which a client may receive SSI benefits while attempting to sell excess resources, found at 20 CFR 416.1240 to 416.1245, is not considered an eligibility methodology.
e. Valuation of life estates and remainder interests. In the absence of other evidence, the value of a life estate or remainder interest in property shall be determined using the following table by multiplying the fair market value of the entire underlying property (including all life estates and all remainder interests) by the life estate or remainder interest decimal corresponding to the age of the life estate holder or other person whose life controls the life estate.

If a Medicaid applicant or recipient disputes the value determined using the following table, the applicant or recipient may submit other evidence and the value of the life estate or remainder interest shall be determined based on the preponderance of all the evidence submitted to or obtained by the department, including the value given by the following table.

Age Life Estate Remainder Age Life Estate Remainder Age Life Estate Remainder
0 .97188 .02812 37 .93026 .06974 74 .53862 .46138
1 .98988 .01012 38 .92567 .07433 75 .52149 .47851
2 .99017 .00983 39 .92083 .07917 76 .51441 .49559
3 .99008 .00992 40 .91571 .08429 77 .48742 .51258
4 .98981 .01019 41 .91030 .08970 78 .47049 .52951
5 .98938 .01062 42 .90457 .09543 79 .45357 .54643
6 .98884 .01116 43 .89855 .10145 80 .43569 .56341
7 .98822 .01178 44 .89221 .10779 81 .41967 .58033
8 .98748 .01252 45 .88558 .11442 82 .40295 .59705

Age Life Estate Remainder Age Life Estate Remainder Age Life Estate Remainder
9 .98663 .01337 46 .87863 .12137 83 .38642 .61358
10 .98565 .01435 47 .87137 .12863 84 .36998 .63002
11 .98453 .01547 48 .86374 .13626 85 .35359 .64641
12 .98329 .01671 49 .85578 .14422 86 .33764 .66236
13 .98198 .01802 50 .84743 .15257 87 .32262 .67738
14 .98066 .01934 51 .83674 .16126 88 .30859 .69141
15 .97937 .02063 52 .82969 .17031 89 .29526 .70474
16 .97815 .02185 53 .82028 .17972 90 .28221 .71779
17 .97700 .02300 54 .81054 .18946 91 .26955 .73045
18 .97590 .02410 55 .80046 .19954 92 .25771 .74229
19 .97480 .02520 56 .79006 .20994 93 .24692 .75308
20 .97365 .02635 57 .77931 .22069 94 .23728 .76272
21 .97245 .02755 58 .76822 .23178 95 .22887 .77113
22 .97120 .02880 59 .75675 .24325 96 .22181 .77819
23 .96986 .03014 60 .74491 .25509 97 .21550 .78450
24 .96841 .03159 61 .73267 .26733 98 .21000 .79000
25 .96678 .03322 62 .72002 .27998 99 .20486 .79514
26 .96495 .03505 63 .70696 .29304 100 .19975 .80025
27 .96290 .03710 64 .69352 .30648 101 .19532 .80468
28 .96062 .03938 65 .67970 .32030 102 .19054 .80946
29 .95813 .04187 66 .66551 .33449 103 .18437 .81563
30 .95543 .04457 67 .65098 .343902 104 .17856 .82144
31 .95254 .04746 68 .63610 .363690 105 .16962 .83038
32 .94942 .05058 69 .62086 .37914 106 .15488 .84512
33 .94608 .05392 70 .60522 .39478 107 .13409 .86591
34 .94250 .05750 71 .58914 .41086 108 .10068 .89932
35 .93868 .06132 72 .57261 .42739 109 .04545 .95455
36 .93460 .06540 73 .55571 .44429
(3) Resource eligibility for SSI-related Medicaid for children. Resources of all household members shall be disregarded when determining eligibility for children under any SSI-related coverage group except for those groups at subrules 75.1(3), 75.1(4), 75.1(6), 75.1(9), 75.1(10), 75.1(12), 75.1(13), 75.1(23), 75.1(25), 75.1(29), 75.1(33), 75.1(34), 75.1(36), 75.1(37), and 75.1(38).

This rule is intended to implement Iowa Code section 249A.3.

Notes

Iowa Admin. Code r. 441-75.13

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