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Title 5: Centrally Administered Programs Page 15 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Application Processing Revised July 3, 2009 When an Application Is Not Required When the referral is made using the Referral to the hawk-i Program, form 470-3565, it must be accompanied by a copy of the notice of decision stating the reason why the child is ineligible for Medicaid. When the automated hawk-i referral process is used, no additional information accompanies the referral. Do not require an application when adding a child to an active hawk-i case. Add the child for the remainder of the current enrollment period. See Reporting Changes for more information. Referrals from Medicaid to hawk-i Legal reference: 441 IAC 86.4(3) If a child is not eligible for Medicaid due to family income exceeding Medicaid limits or because the child was voluntarily excluded from the Medicaid family size, the Department will make a referral to the third-party administrator for an eligibility determination under the hawk-i program. The referral will be made regardless of whether the child is an applicant whose Medicaid eligibility is being denied or a member whose Medicaid eligibility is being canceled. The referral will be made either by: ♦ Submitting an automated referral via the Department’s Automated Benefit Calculation (ABC) system, or ♦ Completing the Referral to the hawk-i Program, form 470-3563, and submitting it along with a copy of the Medicaid notice of decision. Regardless of the referral method, the referral shall be forwarded to the third-party administrator within 24 hours of the decision to deny or cancel Medicaid eligibility or the next working day, whichever is sooner. If the Referral to the hawk-i Program, form 470-3563, is used, date-stamp the referral. Notify the family of the referral, and complete a hawk-i eligibility determination. The time frame for processing the referral begins with the day the referral is received by the third-party administrator. Under rare circumstances, additional information will be needed in order to make a hawk-i eligibility determination.