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Title 5: Centrally Administered Programs Page 35 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Nonfinancial Eligibility Factors Revised July 3, 2009 Children For Whom Benefits Are Not Requested

1. Ms. A applies for hawk-i for two of her children. She also lists a third child on the application. None of the three children have any income. However, Ms. A states she is not requesting coverage for the third child because the child’s father carries health insurance for the child. Ms. A’s countable income exceeds 150 percent of the federal poverty level (FPL) for a family size of three and coverage would be subject to a monthly premium. If Ms. A includes her third child in the family size as a considered person, her countable income would be less than 150 percent of FPL and the two children would be eligible for free hawk-i coverage. This information is provided to Ms. A so she can choose whether to include or exclude the third child. Document her decision in the case file. 2. Mr. and Mrs. B apply for hawk-i for their child and Mrs. B’s child from a previous relationship for whom she receives child support. Both children are uninsured. The countable income of all four family members exceeds hawk-i income limits and hawk-i coverage for the two children would be denied. However, if Mrs. B’s child from a previous relationship and that child’s child support income were excluded, the remaining countable income would be less than 200 percent of FPL and the common child would be eligible for hawk-i but subject to a monthly premium. This information is provided to Mr. and Mrs. B so they can make the decision whether to exclude Mrs. B’s child. The third-party administrator cannot assume that the family will decide to exclude the child. Document the family’s decision in the case file. Voluntary Exclusion Legal reference: 441 IAC 86.2(3)“c” A child whose inclusion in the hawk-i family size causes ineligibility for the child’s siblings may be voluntarily excluded when determining family size. The income of any child excluded when determining family size is not counted when determining countable family income.