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In-Home Health-Related Care (IHHRC) Deduction for Unmet Medical Needs - Iowa

The established medical needs of ineligible family members, which are not otherwise met, are deducted from the family’s income.

The established medical needs of the client, which are not otherwise met and would not be met by Medicaid, are deducted from either the client’s or the family’s income.

"Established unmet medical needs" include costs such as prescriptions, visits to practitioners, and related travel expenses needed on an ongoing basis and not covered by insurance or Medicaid. Medicare premiums and health insurance premiums are not unmet medical needs.

Over-the-counter drugs and medication can be deducted as unmet medical needs when:

·        Prescribed in writing by a physician for a specific medical use (rather than an incidental use), and

·        Used to treat the condition for which the client is receiving in-home health-related care.

Travel outside of the community is payable by Medicaid and is not an unmet medical need. Travel within the client’s community is not payable by Medicaid and may be an unmet medical need.

Durable medical is equipment that is used repeatedly, serves a medical purpose, and is not useful to a person in the absence of an illness or injury. In order to consider the durable medical equipment a "medical need", the equipment must be necessary and reasonable either for treatment of an illness or injury or to improve the functioning of a physical disability.

Also see:

·           In-Home Health-Related Care Client Participation for Adults.

·           Income for In-Home Health-Related Care Assistance.

·           Nonfinancial Eligibility for In-Home Health-Related Care (IHHRC)

·           Payment for In-Home Health-Related Care (IHHRC)

·           Overview of Iowa's In-Home Health-Related Care (IHHRC)

·           Overview of Iowa's State Administered State Supplementary Assistance Programs.

·           Overview of Benefits in Iowa

Source: DHS Employees’ Policy Manual

Title 6, Other Income Maintenance (IM) Programs

·     Chapter B, State Supplemental Assistance, In-Home Health-Related Care, Client Participation, Deduction for Unmet Medical Needs, pages 45-47

Regulation citations: 441 IAC 177.4(7)"c", "d", and "e"

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