Page 45

Title 5: Centrally Administered Programs Page 38 Iowa Department of Human Services Employees’ Manual Chapter E: Healthy and Well Kids in Iowa (hawk-i) Income Revised August 20, 2010 Verification of Income Eligibility for the hawk-i program exists when income anticipated to be received during the 12-month enrollment period is within established limits. Use actual income already received to project income for the enrollment period unless it is not representative of anticipated income. Income used to determine a child ineligible for Medicaid shall be used in the hawk-i eligibility calculation when a referral is made to hawk-i from the Medicaid program. Unearned income shall be verified through data matches when possible, or through award letters, copies of warrants, or other verification. Self-employment income shall be verified using business records or income tax returns from previous years if they are representative of anticipated earnings. Earnings from the 30 days before the date of application may be used to verify earned income, if it is representative of the income expected in the future. Pay stubs, tip records, tax records, and employer’s statements are also acceptable forms of verification of earned income. The period examined is the period before the date a valid application is received, not the period before the date a complete application is received. A valid application is one that contains at least a legible name, address, and signature.

1. A hawk-i application is received March 3 from Mr. and Mrs. A. The application form contains a name, address, and signature. However, some questions were left blank and income information was not sent with the application. A request is sent to Mr. and Mrs. A asking them to complete the application and to send in their pay information. The completed application is received March 15. The 30-day period remains the 30 days before March 3. 2. A hawk-i application is received April 12 from Mrs. B. The application form contains a legible name and address, but is not signed. A request is sent to Mrs. B asking her to sign the application. The signed application is received April 23. The 30-day period is the 30 days before April 23.