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Title 8: Medicaid Page 29 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Cooperation with Child Support Services Revised October 10, 2025 Good Cause for Refusal to Cooperate Notify the client of your final decision in writing. This notification must explain the decision and the basis for the decision. If the decision is that good cause does not exist, give the client the opportunity to cooperate. Notify the client that continued refusal to cooperate will result in the loss of Medicaid for the adult who fails to cooperate. If the decision is that good cause does exist and a referral to CSS is required, consult with the CSS to decide whether medical support enforcement can proceed without risk of harm to the child, parent, or other caretaker if the enforcement activities do not involve their participation. (See 8-B, Referrals to CSS.) When medical support enforcement activities will proceed without the cooperation of the parent or other caretaker, notify the client in writing. At least once every six months, review the circumstances that led to the determination of good cause when the circumstances are subject to change. If circumstances have changed and good cause no longer exists, notify the client in writing that child support enforcement activities will proceed, if a referral is required. Also, notify CSS within two working days of the determination that good cause no longer exists. Failure to Cooperate in Obtaining Support Legal reference: 441 IAC 75.14 Deny or cancel Medicaid benefits for an applicant or member whom CSS reports failed to cooperate in obtaining medical support or establishing liability without good cause. Sanction only the parent or other caretaker for failing to cooperate. If the parent of a child who is receiving SSI or non-MAGI-related Medicaid fails to cooperate and that parent is receiving Medicaid on another case, cancel the parent’s Medicaid coverage. If the parent cooperates on or after the effective date of cancelation, the parent will need to reapply.

1. Mrs. M, age 31, is receiving SSI and Medicaid. Without good cause, she fails to cooperate in obtaining medical support for her two children who are receiving Medicaid. Mrs. M’s Medicaid is canceled. However, the children continue to receive Medicaid if otherwise eligible.