reglab/statecodes huggingface dataset:
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.10 - Residency Requirements

Current through Register Vol. 47, No. 3, July 24, 2024
Residency in Iowa is a condition of eligibility for medical
				  assistance.
(1)
Definitions.
a.
Institutions.
For purposes of this rule, "institution" means
				an "institution" or a "medical institution" as those terms are defined in 42
				CFR § 435.1010 as amended to July 13, 2007. For purposes of state
				placement, "institution" also includes foster care homes licensed as set forth
				in 45 CFR § 1355.20 as amended to January 6, 2012, and providing food,
				shelter and supportive services to one or more persons unrelated to the
				proprietor.
b.
Incapable of
				expressing intent regarding residency.
For purposes of this rule, an
				individual is considered to be "incapable of indicating intent regarding
				residency" if the individual:
1. Has an IQ of
				49 or less or has a mental age of seven or less;
2. Has been judged legally incompetent;
				or
3. Has been determined to be
				incapable of indicating intent regarding residency by a physician, psychologist
				or other person licensed by the state in the field of intellectual
				disability.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.12 - Inmates of Public Institutions

Current through Register Vol. 47, No. 3, July 24, 2024
A person is not eligible for medical assistance for any care
				  or services received while the person is an inmate of a public institution. For
				  the purpose of this rule, "inmate of a public institution" and "public
				  institution" are defined by 42 CFR Section 435.1010 as amended to August 25,
				  2011.
(1)
Suspension.
Medical assistance shall be suspended, rather than canceled, for the first 12
				continuous calendar months that a person is an inmate of a public institution
				if all of the following conditions are met:
a. The department is notified of the person's
				entry into the public institution through either:
(1) A monthly report which is provided to the
				department by the public institution and includes the person's name, date of
				birth, and social security number and the date the person entered the
				institution; or
(2) Other verified
				notice received by the department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.14 - Establishing Paternity and Obtaining Support

Current through Register Vol. 47, No. 3, July 24, 2024
(1) As a condition of eligibility, adult
				Medicaid applicants and members in households with an absent parent shall
				cooperate in obtaining medical support for themselves and for any other person
				in the household for whom Medicaid is requested and for whom the applicant or
				member can legally assign rights for medical support, except when the applicant
				or member has good cause for refusal to cooperate as defined in subrule
				75.14(8).
a. The adult applicant or member
				shall cooperate in the following:
(1)
				Identifying and locating the parent of the child for whom Medicaid is
				requested.
(2) Establishing the
				paternity of a child born out of wedlock for whom Medicaid is
				requested.
(3) Obtaining medical
				support and payments for medical care for the applicant or member and for a
				child for whom Medicaid is requested.
(4) Rescinded lAB 2/3/93, effective
				4/1/93.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.15 - Disqualification for Long-term Care Assistance Due to Substantial Home Equity

Current through Register Vol. 47, No. 3, July 24, 2024
Notwithstanding any other provision of this chapter, if an
				  individual's equity interest in the individual's home exceeds $500,000, the
				  individual shall not be eligible for medical assistance with respect to nursing
				  facility services or other long-term care services except as provided in
				  75.15(2). This provision is effective for all applications or requests for
				  payment of long-term care services filed on or after January 1, 2006.
(1) The limit on the equity interest in the
				individual's home for purposes of this rule shall be increased from year to
				year, beginning with 2011, based on the percentage increase in the consumer
				price index for all urban consumers (all items; United States city average),
				rounded to the nearest $1,000.
(2)
				Disqualification based on equity interest in the individual's home shall not
				apply when one of the following persons is lawfully residing in the home:
a. The individual's spouse; or
b. The individual's child who is under age 21
				or is blind or disabled as defined in Section 1614 of the federal Social
				Security Act.
This rule is intended to implement Iowa Code section
				  249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.16 - Client Participation in Payment for Medical Institution Care

Current through Register Vol. 47, No. 3, July 24, 2024
Medicaid clients are required to participate in the cost of
				  medical institution care. However, no client participation is charged when the
				  combination of Medicare payments and the Medicaid benefits available to
				  qualified Medicare beneficiaries covers the cost of institutional care.
(1)
Income considered in determining
				client participation.
The department determines the amount of client
				participation based on the client's total monthly income, with the following
				exceptions:
a.
FMAP-related
				clients.
The income of a client and family whose eligibility is
				FMAP-related is not available for client participation when both of the
				following conditions exist:
(1) The client
				has a parent or child at home.
(2)
				The family's income is considered together in determining
				eligibility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.17 - Verification of Pregnancy

Current through Register Vol. 47, No. 3, July 24, 2024
For the purpose of establishing Medicaid eligibility for
				  pregnant women under this chapter, the applicant's self-declaration of the
				  pregnancy and the date of conception shall serve as verification of pregnancy,
				  unless questionable.
(1)
Multiple pregnancy.
If the pregnant woman claims to be
				carrying more than one fetus, a medical professional who has examined the woman
				must verify the number of fetuses in order for more than one to be considered
				in the household size.
(2)
Cost of examination.
When an examination is required and other
				medical resources are not available to meet the expense of the examination, the
				provider shall be authorized to make the examination and submit the claim for
				payment.
This rule is intended to implement Iowa Code section
				  249A.3.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.18 - Continuous Eligibility for Pregnant Women

Current through Register Vol. 47, No. 3, July 24, 2024
A pregnant woman who applies for Medicaid prior to the end of
				  her pregnancy and subsequently establishes initial Medicaid eligibility under
				  the provisions of this chapter shall remain continuously eligible throughout
				  the pregnancy and the 60-day postpartum period, as provided in subrule
				  75.1(24), regardless of any changes in family income.
This rule is intended to implement Iowa Code section
				  249A.3.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.19 - Continuous Eligibility for Children

Current through Register Vol. 47, No. 3, July 24, 2024
A child under the age of 19 who is determined eligible for
				  ongoing Medicaid shall retain that eligibility for up to 12 months regardless
				  of changes in family circumstances except as described in this rule.
(1)
Exceptions to coverage.
This rule does not apply to the following children:
a. Children whose eligibility was determined
				under the newborn coverage group described at subrule 75.1(20).
b. Children whose eligibility was determined
				under the medically needy coverage group described at subrule
				75.1(35).
c. Children whose medical
				assistance is state-funded only.
d.
				Children whose citizenship is not verified within the "reasonable period"
				described at paragraph 75.11(2)
"c."
e. Children who are eligible only in a
				retroactive month.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.20 - Disability Requirements for Ssi-related Medicaid

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Applicants receiving federal
				benefits.
An applicant receiving supplemental security income on the
				basis of disability, social security disability benefits under Title II of the
				Social Security Act, or railroad retirement benefits based on the Social
				Security law definition of disability by the Railroad Retirement Board, shall
				be deemed disabled without further determination of disability.
(2)
Applicants not receiving federal
				benefits.
When disability has not been established based on the
				receipt of social security disability or railroad retirement benefits based on
				the same disability criteria as used by the Social Security Administration, the
				department shall determine eligibility for SSI-related Medicaid based on
				disability as follows:
a. A Social Security
				Administration (SSA) disability determination under either a social security
				disability (Title II) application or a supplemental security income application
				is binding on the department until changed by SSA unless the applicant meets
				one of the following criteria:
(1) The
				applicant alleges a disabling condition different from, or in addition to, that
				considered by SSA in making its determination.
(2) The applicant alleges more than 12 months
				after the most recent SSA determination denying disability that the applicant's
				condition has changed or deteriorated since that SSA determination and alleges
				a new period of disability which meets the durational requirements, and has not
				applied to SSA for a determination with respect to these allegations.
(3) The applicant alleges less than 12 months
				after the most recent SSA determination denying disability that the applicant's
				condition has changed or deteriorated since that SSA determination, alleges a
				new period of disability which meets the durational requirements, and:
1. The applicant has applied to SSA for
				reconsideration or reopening of its disability decision and SSA refused to
				consider the new allegations, or
2.
				The applicant no longer meets the nondisability requirements for SSI but may
				meet the department's nondisability requirements for Medicaid
				eligibility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.22 - Aids/hiv Health Insurance Premium Payment Program

Current through Register Vol. 47, No. 3, July 24, 2024
For the purposes of this rule, "AIDS" and "HIV" are defined
				  in accordance with Iowa Code section
				  141A.1.
(1)
Conditions of
				eligibility.
The department shall pay for the cost of continuing
				health insurance coverage to persons with AIDS or HIV-related illnesses when
				the following criteria are met:
a. The person
				with AIDS or HIV-related illness shall be the policyholder, or the spouse of
				the policyholder, of an individual or group health plan.
b. The person shall be a resident of Iowa in
				accordance with the provisions of rule 441- 75.10(249A).
c. The person shall not be eligible for
				Medicaid. The person shall be required to apply for Medicaid benefits when it
				appears Medicaid eligibility may exist. Persons who are required to meet a
				spenddown obligation under the medically needy program, as provided in subrule
				75.1(35), are not considered Medicaid-eligible for the purpose of establishing
				eligibility under these provisions.
When Medicaid eligibility is attained, premium payments shall
				  be made under the provisions of rule
				  441-75.21 (249A) if all criteria
				  of that rule are met.
d. A
				physician's statement shall be provided verifying the policyholder or the
				spouse of the policyholder suffers from AIDS or an HIV-related illness. The
				physician's statement shall also verify that the policyholder or the spouse of
				the policyholder is or will be unable to continue employment in the person's
				current position or that hours of employment will be significantly reduced due
				to AIDS or HIV-related illness. The Physician's Verification of Diagnosis, Form
				470-2958, shall be used to obtain this information from the
				physician.
e. Gross income shall
				not exceed 300 percent of the federal poverty level for a family of the same
				size. The gross income of all family members shall be counted using the
				definition of gross income under the supplemental security income (SSI)
				program.
f. Liquid resources shall
				not exceed $10,000 per household. The following are examples of countable
				resources:
(1) Unobligated cash.
(2) Bank accounts.
(3) Stocks, bonds, certificates of deposit,
				excluding Internal Revenue Service defined retirement
				plans.
g. The health
				insurance plan must be cost-effective based on the amount of the premium and
				the services covered.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.23 - Disposal of Assets for Less Than Fair Market Value After August 10, 1993

Current through Register Vol. 47, No. 3, July 24, 2024
In determining Medicaid eligibility for persons described in
				  441-Chapters 75 and 83, a transfer of assets occurring after August 10, 1993,
				  will affect Medicaid payment for medical services as provided in this
				  rule.
(1)
Ineligibility for
				services.
When an individual or spouse has transferred or disposed of
				assets for less than fair market value as defined in 75.23(11) on or after the
				look-back date specified in 75.23(2), the individual shall be ineligible for
				medical assistance as provided in this subrule.
a.
Institutionalized
				individual.
When an institutionalized individual or the spouse of the
				individual disposed of assets for less than fair market value on or after the
				look-back date, the institutionalized individual is ineligible for medical
				assistance payment for nursing facility services, a level of care in any
				institution equivalent to that of nursing facility services, and home- and
				community-based waiver services. The period of ineligibility is equal to the
				number of months specified in 75.23(3). The department shall determine the
				beginning of the period of ineligibility as follows:
(1) Transfer before February 8, 2006. When
				the transfer of assets was made before February 8, 2006, the period of
				ineligibility shall begin on the first day of the first month during which the
				assets were transferred, except as provided in subparagraph (3).
(2) Transfer on or after February 8, 2006.
				Within the limits of subparagraph (3), when the transfer of assets was made on
				or after February 8, 2006, the period of ineligibility shall begin on the later
				of:
1. The first day of the first month
				during which the assets were transferred; or
2. The date on which the individual is
				eligible for medical assistance under this chapter and would be receiving
				nursing facility services, a level of care in any institution equivalent to
				that of nursing facility services, or home- and community-based waiver
				services, based on an approved application for such care, but for the
				application of this rule.
(3) Exclusive period. The period of
				ineligibility due to the transfer shall not begin during any other period of
				ineligibility under this rule.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.24 - Treatment of Trusts Established After August 10, 1993

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of determining an individual's eligibility for,
				  or the amount of, medical assistance benefits, trusts established after August
				  10, 1993, (except for trusts specified in 75.24(3)) shall be treated in
				  accordance with 75.24(2).
(1)
Establishment of trust.
a.
				For the purposes of this rule, an individual shall be considered to have
				established a trust if assets of the individual were used to form all or part
				of the principal of the trust and if any of the following individuals
				established the trust other than by will: the individual, the individual's
				spouse, a person (including a court or administrative body, with legal
				authority to act in place of or on behalf of the individual or the individual's
				spouse), or a person (including a court or administrative body) acting at the
				direction or upon the request of the individual or the individual's
				spouse.
b. The term "assets," with
				respect to an individual, includes all income and resources of the individual
				and of the individual's spouse, including any income or resources which the
				individual or the individual's spouse is entitled to but does not receive
				because of action by the individual or the individual's spouse, by a person
				(including a court or administrative body, with legal authority to act in place
				of or on behalf of the individual's spouse), or by any person (including a
				court or administrative body) acting at the direction or upon the request of
				the individual or the individual's spouse.
c. In the case of a trust, the principal of
				which includes assets of an individual and assets of any other person or
				persons, the provisions of this rule shall apply to the portion of the trust
				attributable to the individual.
d.
				This rule shall apply without regard to:
(1)
				The purposes for which a trust is established.
(2) Whether the trustees have or exercise any
				discretion under the trust.
(3) Any
				restrictions on when or whether distribution may be made for the
				trust.
(4) Any restriction on the
				use of distributions from the trust.
e. The term "trust" includes any legal
				instrument or device that is similar to a trust, including a
				conservatorship.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.27 - Aids/hiv Settlement Payments

Current through Register Vol. 47, No. 3, July 24, 2024
The following payments are exempt as income and resources
				  when determining eligibility for or the amount of Medicaid benefits under any
				  coverage group if the payments are kept in a separate, identifiable
				  account:
(1)
Class settlement
				payments.
Payments made from any fund established pursuant to a class
				settlement in the case of Susan Walker v. Bayer Corporation, et al., 96-C-5024
				(N.D. 111.) are exempt.
(2)
Other settlement payments.
Payments made pursuant to a release
				of all claims in a case that is entered into in lieu of the class settlement
				referred to in subrule 75.27(1) and that is signed by all affected parties in
				the cases on or before the later of December 31, 1997, or the date that is 270
				days after the date on which the release is first sent to the person (or the
				legal representative of the person) to whom payment is to be made are exempt.
This rule is intended to implement Iowa Code sections 249A.3
				  and 249A.4.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.28 - Recovery

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Definitions.
"Administrative overpayment"
means medical
				  assistance incorrectly paid to or for the client because of continuing
				  assistance during the appeal process or allowing a deduction for the Medicare
				  Part B premium in determining client participation while the department
				  arranges to pay the Medicare premium directly.
"Agency error"
means medical assistance
				  incorrectly paid to or for the client because of action attributed to the
				  department as the result of one or more of the following circumstances:
1.Misfiring or loss of forms or
				documents.
2. Errors in typing or
				copying.
3. Computer input
				errors.
4. Mathematical
				errors.
5. Failure to determine
				eligibility correctly or to certify assistance in the correct amount when all
				essential information was available to the department.
6. Failure to make prompt revisions in
				medical payment following changes in policies requiring the changes as of a
				specific date.
"Client"
means a current or former Medicaid
				  member.
"Client error"
means medical assistance
				  incorrectly paid to or for the client because the client or client's
				  representative failed to disclose information, or gave false or misleading
				  statements, oral or written, regarding the client's income, resources, or other
				  eligibility and benefit factors. "Client error" also means assistance
				  incorrectly paid to or for the client because of failure by the client or
				  client's representative to timely report as defined in rule
				  441-76.15(249A).
"Department"
means the department of human
				  services.
"Premiums paid for medical assistance"
means
				  monthly premiums assessed to a member or household for Medicaid, IowaCare or
				  the Iowa Health and Wellness Plan coverage.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.29 - Investigation by Quality Control or the Department of Inspections and Appeals

Current through Register Vol. 47, No. 3, July 24, 2024
An applicant or member shall cooperate with the department
				  when the applicant's or member's case is selected by quality control or the
				  department of inspections and appeals for verification of eligibility unless
				  the investigation revolves solely around the circumstances of a person whose
				  income and resources do not affect medical assistance eligibility. (See
				  department of inspections and appeals rules in 481-Chapter 72.) Failure to
				  cooperate shall serve as a basis for denial of an application or cancellation
				  of medical assistance unless the Medicaid eligibility is determined by the
				  Social Security Administration. Once a person's eligibility is denied or
				  canceled for failure to cooperate, the person may reapply but shall not be
				  determined eligible until cooperation occurs.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.52 - Continuing Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Reviews.
Eligibility factors shall be reviewed at least
				annually for the FMAP-related programs. Reviews shall be conducted using
				information contained in and verification supplied with the review form
				specified in subrule 75.52(3).
(2)
Additional reviews.
A redetermination of specific eligibility
				factors shall be made when:
a. The member
				reports a change in circumstances (for example, a change in income, as defined
				at rule 441-75.50 (249A)), or
b. A change in the member's circumstances
				comes to the attention of a staff member.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.53 - Recovery

Current through Register Vol. 47, No. 3, July 24, 2024
Notwithstanding the provisions of rule
				  441-75.10
				  (249A), the following rules shall apply when determining eligibility for
				  persons under FMAP or FMAP-related coverage groups.
(1)
Definition of resident.
A resident of Iowa is one:
a. Who is living
				in Iowa voluntarily with the intention of making that person's home there and
				not for a temporary purpose. A child is a resident of Iowa when living there on
				other than a temporary basis. Residence may not depend upon the reason for
				which the individual entered the state, except insofar as it may bear upon
				whether the individual is there voluntarily or for a temporary purpose;
				or
b. Who, at the time of
				application, is living in Iowa, is not receiving assistance from another state,
				and entered Iowa with a job commitment or seeking employment in Iowa, whether
				or not currently employed. Under this definition the child is a resident of the
				state in which the specified relative is a resident.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.54 - Eligibility Factors Specific to Child

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Age.
Unless otherwise
				specified at rule
				441-75.1 (249A),
				Medicaid shall be available to a needy child under the age of 18 years without
				regard to school attendance.
a. A child is
				eligible for the entire month in which the child's eighteenth birthday occurs,
				unless the birthday falls on the first day of the month.
b. Medicaid shall also be available to a
				needy child aged 18 years who is a full-time student in a secondary school, or
				in the equivalent level of vocational or technical training, and who is
				reasonably expected to complete the program before reaching the age of 19 if
				the following criteria are met.
(1) A child
				shall be considered attending school full-time when enrolled or accepted in a
				full-time (as certified by the school or institute attended) elementary,
				secondary or the equivalent level of vocational or technical school or training
				leading to a certificate or diploma. Correspondence school is not an allowable
				program of study.
(2) A child shall
				also be considered to be in regular attendance in months when the child is not
				attending because of an official school or training program vacation, illness,
				convalescence, or family emergency. A child meets the definition of regular
				school attendance until the child has been officially dropped from the school
				rolls.
(3) When a child's education
				is temporarily interrupted pending adjustment of an education or training
				program, exemption shall be continued for a reasonable period of time to
				complete the adjustment.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.55 - Eligibility Factors Specific to Specified Relatives

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Specified relationship.
a. A child may be considered as meeting the
				requirement of living with a specified relative if the child's home is with one
				of the following or with a spouse of the relative even though the marriage is
				terminated by death or divorce:
Father or adoptive father.
Mother or adoptive mother
Grandfather or grandfather-in-law, meaning the subsequent
				  husband of the child's natural grandmother, i.e., stepgrandfather or adoptive
				  grandfather
Grandmother or grandmother-in-law, meaning the subsequent
				  wife of the child's natural grandfather, i.e., stepgrandmother or adoptive
				  grandmother
Great-grandfather or great-great-grandfather
Great-grandmother or great-great-grandmother.
Stepfather, but not his parents.
Stepmother, but not her parents.
Brother, brother-of-half-blood, stepbrother, brother-in-law
				  or adoptive brother
Sister, sister-of-half-blood, stepsister, sister-in-law or
				  adoptive sister
Uncle or aunt, of whole or half blood.
Uncle-in-law or aunt-in-law.
Great uncle or great-great-uncle.
Great aunt or great-great-aunt.
First cousins, nephews, or nieces.
b. A relative of the putative father can
				qualify as a specified relative if the putative father has acknowledged
				paternity by the type of written evidence on which a prudent person would
				rely.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.58 - Need Standards

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Definition of eligible group.
The eligible group consists of
				all eligible persons specified below and living together, except when one or
				more of these persons have elected to receive supplemental security income
				under Title XVI of the Social Security Act or are voluntarily excluded in
				accordance with the provisions of rule
				441-75.59
				(249A). There shall be at least one child, which may be an unborn child, in the
				eligible group except when the only eligible child is receiving supplemental
				security income.
a. The following persons
				shall be included (except as otherwise provided in these rules) without regard
				to the person's employment status, income or resources:
(1) All dependent children who are siblings
				of whole or half blood or adoptive.
(2) Any parent of such children, if the
				parent is living in the same home as the dependent children.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.59 - Persons Who May Be Voluntarily Excluded From the Eligible Group When Determining Eligibility for the Family Medical Assistance Program (FMAP) and Fmap-related Coverage Groups

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Exclusions from the eligible group.
In determining eligibility
				under the family medical assistance program (FMAP) or any FMAP-related Medicaid
				coverage group in this chapter, the following persons may be excluded from the
				eligible group when determining Medicaid eligibility of other household
				members.
a. Siblings (of whole or half blood,
				or adoptive) of eligible children.
b. Self-supporting parents of minor unmarried
				parents.
c. Stepparents of eligible
				children.
d. Children living with a
				specified relative, as listed at subrule 75.55(1).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.60 - Pending Ssi Approval

Current through Register Vol. 47, No. 3, July 24, 2024
When a person who would ordinarily be in the eligible group
				  has applied for supplemental security income benefits, the person's needs may
				  be included in the eligible group pending approval of supplemental security
				  income.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.70 - Financial Eligibility Based on Modified Adjusted Gross Income (MAGI)

Current through Register Vol. 47, No. 3, July 24, 2024
Notwithstanding any other provision of this chapter,
				  effective January 1, 2014, financial eligibility for medical assistance shall
				  be determined using "modified adjusted gross income" (MAGI) and "household
				  income" pursuant to
				  42 U.S.C §
										1396a(e)(14), to the extent
				  required by that section as a condition of federal funding under Title XIX of
				  the Social Security Act. For this purpose, financial eligibility for medical
				  assistance includes any applicable purpose for which a determination of income
				  is required, including the imposition of any premiums or cost
				  sharing.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 75 - Conditions of Eligibility › Rule 441-75.71 - Income Limits

Current through Register Vol. 47, No. 3, July 24, 2024
Notwithstanding any other provision of this chapter,
				  effective January 1, 2014, the following income limits apply to the following
				  coverage groups, as identified by the legal references provided:
Coverage Group
Legal Reference
Household Size (persons)
Income Limit (per month)
Family Medical Assistance Program and Child
						  Medical Assistance Program
441-subrule 75.1(14) and 441-subrule
						  75.1(15); 42 CFR Part 435.110; Title XIX of the Social Security Act, Section
						  1931
1
$447
2
$716
3
$872
4
$1,033
5
$1,177
6
$1,330
7
$1,481
8
$1,633
9
$1,784
10
$1,950
over 10
$1,950 plus $178 for each additional person
Mothers and Children, for pregnant women and for infants
						  under one year of age
441-subrule 75.1(28); 42 CFR Part 435.116;
						  Title XIX of the Social Security Act, Section 1902
375% of the federal poverty level for the household
Mothers and Children, for children aged 1 through 18
						  years
441-subrule 75.1(28); 42 CFR Part 435.116;
						  Title XIX of the Social Security Act, Section 1902
167% of the federal poverty level for the household
Medicaid for Independent Young Adults
441-subrule 75.1(42); Title XIX of the
						  Social Security Act, Section 1902(a)(10)(A)(ii)(VII)
254% of the federal poverty level for the household
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.2 - Application With the Department

Current through Register Vol. 47, No. 3, July 24, 2024
This rule describes the process of applying for medical
				  assistance directly with the department of human services.
(1)
Application for eligibility
				effective prior to January 1, 2014.
Application for the Medicaid or
				HAWK-I program to be initially effective prior to January 1, 2014, must be made
				as provided in this subrule.
a.
Forms.
(1) An application
				for family medical assistance-related Medicaid programs shall be submitted on
				Health and Financial Support Application, Form 470-0462 or Form 470-0462(S);
				Health Services Application, Form 470-2927 or Form 470-2927(S); HAWK-I
				Application, Comm. 156; or HAWK-I Electronic Application Summary and Signature
				Page, Form 470-4016.
(2) An
				application for SSI-related Medicaid shall be submitted on Health Services
				Application, Form 470-2927 or Form 470-2927(S), or Health and Financial Support
				Application, Form 470-0462 or Form 470-0462(S).
(3) An application for Medicaid for persons
				in foster care shall be submitted on Health Services Application, Form 470-2927
				or Form 470-2927(S).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.3 - Referrals From a Health Insurance Marketplace

Current through Register Vol. 47, No. 3, July 24, 2024
Upon receipt of a referral from a health insurance
				  marketplace indicating that an application filed with the health insurance
				  marketplace has been screened and that the applicant has been found to be
				  potentially eligible for Medicaid or HAWK-I, the department will treat the
				  referral as an application for medical assistance and will process the
				  application as if received directly by the department. The applicant is
				  required to cooperate as described in this chapter for applications received
				  directly by the department.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.4 - Express Lane Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
For purposes of the initial enrollment of a child in medical
				  assistance, the department will use express lane procedures as allowed by
				  42 U.S.C. §
										1396a(e)(13) and as
				  described in this rule.
(1) For
				purposes of initial enrollment, the department shall rely on a determination of
				the child's eligibility for food assistance pursuant to 441-Chapter 65 as
				establishing that a child under the age of 19 meets all eligibility
				requirements established in 441-subrule 75.1(28) except for citizenship or
				alienage requirements, unless:
a. The child's
				household already includes other persons receiving Medicaid based on the use of
				the modified adjusted gross income methodology, or
b. The child was previously granted express
				lane eligibility and the household has not had at least a two-month break in
				food assistance eligibility since that time, or
c. The household's income as calculated by
				the food assistance program exceeds the income limit for the mothers and
				children coverage group found at 441-subparagraph
				75.1(28)
"a"
(1).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.5 - Enrollment Through Ssi

Current through Register Vol. 47, No. 3, July 24, 2024
Upon receipt of a referral from the Social Security
				  Administration indicating that an individual has been approved for SSI, the
				  department will treat the referral as an application for medical assistance and
				  will process the application as if received directly by the department. The SSI
				  recipient shall be required to complete SSI Medicaid Information, Form
				  470-0364, 470-03 64(S), 470-03 64(M), or 470-03 64(MS), when additional
				  information is necessary to determine Medicaid eligibility. The SSI recipient
				  may be required to attend an interview to clarify information on this
				  form.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.6 - Referral for Medicare Savings Program

Current through Register Vol. 47, No. 3, July 24, 2024
Referrals received from the federal Social Security
				  Administration pursuant to
				  42 U.S.C.
				  1320 b - 14(c)(3) when the individual has
				  indicated that the individual wants to apply for the Medicare savings program
				  will be treated by the department as an application for the Medicare savings
				  program and will be processed as if the application were received directly by
				  the department. The date on which the referral is transmitted by the Social
				  Security Administration shall be treated as the date of application. When
				  requested to do so, the applicant must complete Medicare Savings Programs
				  Additional Information Request, Form 470-4846, to provide additional
				  information needed to determine Medicare savings program
				  eligibility.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.7 - Presumptive Eligibility

Current through Register Vol. 47, No. 3, July 24, 2024
Individuals may be temporarily enrolled in Medicaid based on
				  a presumptive eligibility determination by a qualified entity pursuant to this
				  rule.
(1)
For eligibility
				effective prior to January 1, 2014.
a. Applicants for presumptive eligibility for
				children will complete Application: Presumptive Health Care Coverage for
				Children, Form 470-4855 or 470-4855(S).
b. Applicants for presumptive eligibility for
				pregnant women or for presumptive eligibility for breast and cervical cancer
				coverage group shall complete Health Services Application, Form 470-2927 or
				Form 470-2927(S).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.8 - Applicant Responsibilities

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Accurate information.
Applicants are responsible to give complete and accurate information needed to
				establish eligibility.
(2)
Time frames for providing information or verification.
Applicants shall have ten calendar days to supply the information or
				verification requested by the department.
(3)
Extensions.
The
				applicant may request an extension of a reasonable period of time when the
				applicant is making every effort but is unable to secure the required
				information or verification.
(4)
Failure to comply.
An application shall be denied if the
				applicant does not attend a required interview, if applicable under subrule
				76.2(1) or 76.2(2), or if the department does not receive one of the following
				by the due date:
a. The information or
				verification,
b. An authorization
				to obtain the information or verification, or
c. A request for an extension of the due
				date.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.9 - Responsible Persons and Authorized Representatives

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Responsible person.
If
				an applicant or member is unable to act on the applicant's or member's own
				behalf because the applicant or member is a minor or is incompetent,
				incapacitated, or deceased, a responsible person may act for the applicant or
				member. Except as provided in paragraph 76.9(1)
"a"
below, the
				responsible person shall be a family member, friend or other person who has
				knowledge of the applicant's or member's financial affairs and circumstances
				and has a personal interest in the applicant's or member's welfare. The
				responsible person shall assume the applicant's or member's position and
				responsibilities during the application process or for ongoing eligibility. The
				responsible person may designate an authorized representative as provided for
				in subrule 76.9(2) to represent the applicant or member. However, the
				designation of an authorized representative does not relieve the responsible
				person from assuming the applicant's or member's position and responsibilities
				during the application process or for ongoing eligibility.
a. When there is no person as described above
				to act on behalf of the minor, incompetent, incapacitated, or deceased
				applicant or member, any individual or organization may be allowed to act as
				the responsible person if the individual or organization conducts a diligent
				search and completes Inability to Find a Responsible Person, Form 470-3356,
				attesting to the individual's or organization's inability to find a responsible
				person to act on behalf of the minor, incompetent, incapacitated, or deceased
				applicant or member.
b. The
				department may require verification of the applicant's or member's incompetence
				or death and of the responsible person's relationship to the applicant or
				member.
c. Copies of all
				departmental correspondence with the applicant or member shall be provided to
				the recognized responsible person.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.10 - Right to Withdraw the Application

Current through Register Vol. 47, No. 3, July 24, 2024
The applicant may withdraw the application at any time before
				  the eligibility determination has been made. The applicant may request that the
				  application be withdrawn entirely or request withdrawal for any month covered
				  by the application process except as provided in the medically needy program in
				  accordance with the provisions of 441-subrule 75.1(35).
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.11 - Choice of Electronic Notifications

Current through Register Vol. 47, No. 3, July 24, 2024
The applicant is responsible to indicate if notices and other
				  communications are to be provided by the department in an electronic format
				  through the individual's electronic account, rather than by regular mail. The
				  applicant may change the selection at any time. Notices and other
				  communications provided through the individual's electronic account are deemed
				  to be received upon the sending of an e-mail to the individual notifying the
				  individual of the notice or other communication.
Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 76 - Enrollment and Reenrollment › Rule 441-76.12 - Application Not Required

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Adding a new person.
a.
Adding an eligible person.
For members whose eligibility is
				based on the modified adjusted gross income methodology, a new application is
				not required when an eligible person is added to an existing Medicaid-eligible
				group. Such a person is considered to be included in the application that
				established the existing eligible group. However, in these instances, the date
				of application to add a person is the date the change is reported. When it is
				reported that a person is anticipated to enter the home, the date of
				application to add the person shall be no earlier than the date of entry or the
				date of report, whichever is later.
b.
Adding a person previously
				ineligible due to a failure to cooperate.
In those instances where a
				person previously ineligible for Medicaid for failure to cooperate in obtaining
				medical support or establishing paternity as described at 441-subrule 75.14(2)
				is to be granted Medicaid benefits, the person shall be granted Medicaid
				benefits effective the first of the month in which the person becomes eligible
				by cooperating in obtaining medical support or establishing
				paternity.
c.
Adding a
				person previously ineligible due to failure to provide a social security
				number.
In those instances where a person previously ineligible for
				Medicaid for failure to provide a social security number or proof of
				application for a social security number as described at rule 441 -75.7(249A)
				is to be granted Medicaid benefits, the person shall be granted Medicaid
				benefits effective the first of the month in which the person becomes eligible
				by providing a social security number.
d.
Adding a person who was
				voluntarily excluded.
In those instances where a person who has been
				voluntarily excluded from the eligible group in accordance with the provisions
				of rule
				441-75.59
				(249 A) is being added to the eligible group, the person shall be added
				effective the first of the month after the month in which the household
				requests that the person no longer be excluded.