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Title 8: Medicaid Page 8 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Eligibility Revised January 13, 2023 Medical Assistance Eligibility Card Eligibility The Department’s Iowa Medicaid Enterprise (IME) is responsible for formulating Medicaid eligibility policy and procedure within the framework of state and federal law and regulations. See Chapter 8-F, Coverage Groups for more information on ways that people can qualify for Medicaid benefits. The Department is organized into five geographic service areas, each led by a service area manager. Income maintenance workers in the Department’s service areas determine Medicaid eligibility. However, in certain circumstances, eligibility determination is done by staff of the Social Security Administration or by qualified providers. Service areas are responsible for maintaining the Medicaid eligibility records for all members. Each member’s case is processed by an income maintenance worker, who enters eligibility information into a centralized automated system. Medical Assistance Eligibility Card Legal reference: 441 IAC 76.13(2), 441 IAC 80.5(1) The Department issues a Medical Assistance Eligibility Card, form 470-1911, to all Medicaid members. The Medical Assistance Eligibility Card is issued at time of approval (or when spenddown is met for a medically needy person). EXCEPTIONS: ▪ Members determined presumptively eligible for Medicaid have form 470-2580 or 470-2580(S), Presumptive Medicaid Eligibility Notice of Action, as evidence of eligibility rather than the Medical Assistance Eligibility Card. ▪ An individual who is eligible only for limited emergency Medicaid for aliens will be issued a Notice of Action, form 470-0485, 470-0485(S), 470-0485(M), or 470-0485(MS), which will include certification information. The card lists the member’s name, state identification number, and date of birth. Replacement cards can be issued upon a member’s request. Only the member named on the card can use the card. Members are responsible for: ▪ Notifying the provider of service that they are Medicaid members. ▪ Showing the card or providing the health care provider with information needed to verify Medicaid eligibility. Providers must check ELVS or the web portal to identify existing health insurance coverage and any service restrictions, such as lock-in. Services are covered only when provided under the Medicaid coverage group under which the member enrolled.