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

(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