Iowa Administrative Code › Agency 441 - Human Services Department › Title VIII - Medical Assistance › Chapter 86 - Healthy and Well Kids in Iowa (HAWK-I) Program › Rule 441-86.10 - Reporting Changes

Current through Register Vol. 47, No. 3, July 24, 2024
Changes that may affect eligibility shall be reported timely
				  to the department. "Timely" shall mean no later than ten working days after the
				  change occurred. The ten working-day period begins the first working day
				  following the date of the change. The parent, guardian, or other adult
				  responsible for the child shall report the change unless the child is
				  emancipated, married, or otherwise in an independent living situation, in which
				  case the child shall be responsible for reporting the change.
(1)
Iowa residence is
				abandoned.
The abandonment of Iowa residence shall be reported
				following the move from the state.
(2)
Other insurance
				coverage.
Enrollment of the child in other health insurance coverage
				shall be reported.
(3)
Decrease in income.
If the family reports a decrease in
				income, the department shall ascertain whether the change affects the premium
				obligation of the family. If the change is such that the family is no longer
				required to pay a premium in accordance with the provisions of rule
				441-86.8 (5141), premiums will
				no longer be charged beginning with the month following the month of the report
				of the change.
(4)
Decrease
				in income.
If the family reports a decrease in income, the department
				shall ascertain whether the change affects the premium obligation of the
				family. If the change is such that the family is no longer required to pay a
				premium in accordance with the provisions of rule
				441-86.8 (5141), premiums will
				no longer be charged beginning with the month following the month of the report
				of the change.
(5)
Information reported by a third party.
Information reported by
				a third party shall not be acted upon until the information is verified in
				accordance with subrule 86.3(7).
(6)
Cooperation.
The
				provisions of subrule 86.3(7) shall apply when a request for information or
				verification is made due to a change. In addition, failure of the enrollee or
				of the person acting on behalf of the enrollee to provide requested information
				or verification that may affect eligibility for the program shall result in
				cancellation and recoupment of all payments made by the department on behalf of
				the enrollee during the period in question.
(7)
Effective date of change in
				eligibility
a. When a change in
				circumstances has a positive effect on eligibility, the change in eligibility
				shall be effective no earlier than the month following the month in which the
				change in circumstances was reported, regardless of when the change was
				reported.
b. When a change in
				circumstances has an adverse effect on eligibility, the change in eligibility
				shall be effective no earlier than the month following the issuance of a timely
				notification, in accordance with the provisions of rule
				441-86.11 (5141). When the
				change in circumstances was not reported timely, as defined in this rule,
				benefits shall be recouped beginning with the month following the month in
				which the change occurred.
c. When
				an anticipated change in circumstances is reported before the change occurs, no
				action shall be taken until the change actually occurs and is verified in
				accordance with the provisions of subrule 86.3(7).