441—75.10 (249A) Residency requirements. Residency in Iowa is a condition of eligibility for medical assistance.
	 75.10(1) Definitions.
“Incapable of expressing intent” shall mean that the person meets one or more of the following conditions:
	  1. 	 Has an IQ of 49 or less or has a mental age of seven or less.
	  2. 	 Is judged legally incompetent.
	  3. 	 Is found incapable of indicating intent based on medical documentation obtained from a physician, psychologist or other person licensed by the state in the field of mental retardation.
“Institution” shall mean an establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor. Foster care facilities are included.
	 75.10(2) Determining residency. Residency is determined according to the following criteria:
	  a.   	 Persons aged 21 and over.
	 (1) 	 For any person not residing in an institution the state of residence is the state where the person is:
	  1. 	 Living with the intention to remain there permanently or for an indefinite period (or, if incapable of expressing intent, where the person is living), or
	  2. 	 Living and which the person entered with a job commitment or seeking employment (whether or not currently employed).
	 (2) 	 For any institutionalized person who became incapable of indicating intent before age 21, the person’s state of residence is:
	  1. 	 That of the parent applying for Medicaid on the person’s behalf, if the parents reside in separate states. If a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent’s.
	  2. 	 The parent’s or legal guardian’s state of residence at the time of placement. If a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent’s.
	  3. 	 The current state of residence of the parent or legal guardian who files the application if the person is institutionalized in the state. If a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent’s.
	  4. 	 The state of residence of the person who has been abandoned by the person’s parents and does not have a legal guardian is the state in which the person is institutionalized.
	 (3) 	 For any institutionalized person who became incapable of expressing intent at or after age 21, the state of residence is the state in which the person is physically present, except where another state makes a placement.
	 (4) 	 For any other institutionalized person the state of residence is the state where the person is living with the intention to remain there permanently or for an indefinite period.
	  b.   	 Persons under age 21.
	 (1) 	 For any person who is emancipated from the person’s parents or who is married and capable of expressing intent, the state of residence is the state where the person is living with the intention to remain there permanently or for an indefinite period.
	 (2) 	 For any person not residing in an institution or foster home whose Medicaid eligibility is based on blindness or disability, the state of residence is the state in which the person is living.
	 (3) 	 For any other person not in an institution or foster home and not subject to subparagraph (1) or (2) above, the state of residence is determined in accordance with rule 441—75.53(249A).
	 (4) 	 For any person in an institution or foster home who is neither married nor emancipated, the state of residence is:
	  1. 	 The parent’s or legal guardian’s state of residence at the time of placement. If a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent’s.
	  2. 	 The current state of residence of the parent or legal guardian who files the application if the person is in institutionalized or in foster care in that state. If a legal guardian has been appointed and parental rights are terminated, the state of residence of the guardian is used instead of the parent’s.
	  3. 	 The state of residence of the person who has been abandoned by the person’s parents and does not have a legal guardian is the state in which the person is institutionalized or in foster care.
	  c.   	 Persons placed by a state in an out-of-state foster home or institution. A state arranging or actually making the placement of a person in an institution or foster home in another state is considered the person’s state of residence. However, a Title IV-E eligible child placed out of state by the department is eligible for Medicaid from the other state. Therefore, the Title IV-E eligible child shall only receive Iowa Medicaid until the receiving state provides coverage. A Title IV-E eligible child placed in Iowa by another state shall be considered eligible for Iowa Medicaid.
	  d.   	 Medicaid-eligible persons receiving Medicaid from another state and gaining Iowa residency. These persons shall be granted Medicaid beginning with the month of residency in Iowa if the person is otherwise eligible and surrenders the other state’s medical card. Good cause for not surrendering the other state’s medical card shall exist when:
	 (1) 	 The other state does not issue medical cards.
	 (2) 	 The other state’s medical card is a magnetic stripe or a computer chip card that contains more than Medicaid-related information.
	 (3) 	 The other state’s medical card: was left with Medicaid-eligible members of the person’s household in the other state who did not move to Iowa with the person; was lost, mutilated, or destroyed; was not kept by the person upon the person’s move to Iowa; or was previously surrendered to the other state.
In addition to surrendering the other state’s medical card or establishing good cause, the cancellation of Medicaid in the other state shall be verified.
This rule is intended to implement Iowa Code section 249A.3.