Nursing facilities provide 24-hour care for individuals who need nursing or skilled nursing care. Medicaid helps with the cost of care in nursing facilities, but you must be medically and financially eligible for care in a nursing facility.
Who is eligible?
Medicaid is a health insurance program for certain groups of people based on income levels. In addition to meeting certain income levels, you need to be in eligibility groups before you can be considered for Medicaid.
How do you apply?
- Application Checklist for Facility Medicaid
- Application for Health Coverage and Help Paying Costs, form 470-5170
- Appendix A, Application for Health Coverage, form 470-5433 or form 470-5433 in Spanish
- Insurance Questionnaire, form 470-2826
- Resources Upon Entering a Medical Facility, form 470-2577
- Case Activity Report, form 470-0042
- Level of Care Certification for Facilities, form 470-4393
- Authorization for the Department to Release Information, form 470-2115
- Information for Application Assistance for Nursing Facility Medicaid Applicants and Families
- Resource Definitions
- Income Sources Definitions
- Medicaid Case Mix Payer Change, form 470-5667
To apply for Nursing Facility Medicaid benefits please complete the Application for Health Coverage, write NURSING FACILITY MEDICAID on top of page 1, and mail, fax or email to the DHS – Centralized Facility Eligibility Unit at:
Imaging Center 1
Iowa Department of Health and Human Services
417 E Kanesville Blvd
Council Bluffs, IA 51503
FAX: 515-564-4040
Email: facilities@dhs.state.ia.us
Nursing Home Compare
This is a web-based portal administered by the Centers for Medicare and Medicaid Services (CMS) that provides detailed information about every Medicare and Medicaid-certified nursing home in the country and allows consumers to compare information about nursing homes. Use this information along with other information that you gather about nursing home facilities to help you make choices for you and your family. Nursing Home Compare is run by Medicare.
Information Resources
- Civil Money Penalty Quality Improvement Initiative (CMPQII) Program
- Flow Chart for Nursing Facility Managed Care Enrollment Process
- Medical Prior Authorization Submission Tips (Video)
- Nursing Facility Level of Care (LOC) Certification Form Tips (Video)
- Prior Authorization (PA) Form Tips (Video)
- Nursing Facilities Rates
- Nursing Facility (NF) Compilation Report
- Skilled Special Populations Nursing Facilities in Iowa
- Hospital Based Swing Bed Facilities in Iowa
- Nursing Facility Closures
Protecting Your Resources and Income
Medicaid can help married couples pay the cost of a spouse's care in a medical facility. These policies apply only if you or your spouse plan to stay, or have stayed, in a hospital, nursing facility or other medical facility for 30 consecutive days or more.
When can Medicaid help?
Medicaid may pay up to the full facility cost depending on your resources and income. To find out if you or your spouse qualifies for Medicaid, you will need to complete an application online or pickup one at your local HHS office. To get Medicaid, the spouse in the medical facility must be age 65 or older, blind or disabled.
What resources can be protected?
What things owned and the money saved by the couple that can be kept for the spouse at home depends on the couples' total combined resources as of the first day of the month the spouse entered the medical facility. All resources must be listed on the Medicaid application. HHS will determine which resources are countable to determine eligibility, and then split the amount between the spouse in the facility and the spouse at home.
The spouse at home can keep:
- Half of the total resources, or $24,720* whichever is greater,
- But no more than $123,600*.
The amount of resources kept by the spouse at home may be increased by a court order or by an appeal decision.
To be eligible for Medicaid long-term care coverage, the applicant cannot have more than $2,000 after resources are split between the spouses.
What is the income limit?
The income of the spouse in the medical facility cannot exceed three times the monthly Supplemental Security Income (SSI) cash benefit for Medicaid to help pay the cost of care.
What income can be protected?
The spouse in the medical facility can keep $50 of monthly income for personal needs. If the spouse in the facility earns money, they can also keep an additional $65 per month. HHS worker will determine if income from the spouse in the facility can be given to the spouse at home and dependent relatives living with the spouse to help them pay for their living expenses.
Does it matter whose name the income is in?
In most cases, when income is in the name of one individual, HHS considers the income belongs to that individual. If the income is in the names of both spouses, HHS considers one half belongs to each spouse. If there is trust property, the income shall be considered according to the trust document. The income of each spouse must be recorded by HHS and any changes in income of either spouse must be reported to your local HHS office within 10 days of the change.
* These amounts are indexed for inflation and change when the federal government releases the annual inflation amount.