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Title 8: Medicaid Page 19 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Cooperation in Obtaining Medical Resources Revised October 10, 2025 Good Cause for Failure to Cooperate Good Cause for Failure to Cooperate Legal reference: 441 IAC 75.21, 75 (Rules in Process) The Third-Party Liability or the IM worker may be responsible for determining if good cause for failure to cooperate exists. Good cause for failure to cooperate exists when the applicant, member, parent, or family has one or more of the following situations:  Serious illness or death of a member of the family.  A family emergency or a household disaster, such as a fire, flood, or tornado.  Verified good cause reasons beyond the applicant, member, or parent’s control.  Not receiving a request for information for a reason that was not the member’s or responsible parent’s fault. A member or parent’s failure to provide a forwarding address does not qualify. Cooperation with Investigations and Quality Control Legal reference: 441 IAC 75.29 and 76.8(249A) Medicaid clients must cooperate with Quality Control reviewers when their case is selected for verification of eligibility. Apply a sanction to the Medicaid case if Quality Control sends you form 470-0479, Noncooperation Notice on an active client. Do not sanction children who are continuously eligible. See 8-F, Cooperation with DIAL and QC. Department of Inspections, Appeals, and Licensing (DIAL) conducts front-end investigations of applicant and member cases. DIAL also conducts fraud investigations. DIAL will send you the results of an investigation. Take into consideration the findings of the investigator. The evidence in the findings is considered verified information. Do not delay determining eligibility pending receipt of the investigator’s report. Apply a sanction to the Medicaid case if the DIAL report says the client is not cooperating. When a sanction is applied, Medicaid is not available until cooperation occurs.