Page 122

Official source

Title 8: Medicaid Page 118 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised October 10, 2025 Medicaid for Employed People with Disabilities

Premium Schedule If the gross monthly income of the person getting MEPD is: The percentage of the federal poverty level is: The premium amount is: $1,957 or less At or below 150% 0 Above: $1,957 Above 150% $43 $2,152 165% $59 $2,348 180% $70 $2,609 200% $82 $2,935 225% $97 $3,261 250% $113 $3,913 300% $141 $4,565 350% $171 $5,217 400% $202 $5,869 450% $233 $7,173 550% $291 $8,478 650% $351 $9,782 750% $413 $11,086 850% $488 $13,042 1000% $586 $14,998 1150% $685 $16,955 1300% $790 $19,302and above 1480% $913 Months Between Application Date and Approval Date Procedure: When a disability determination needs to be completed, it may take two or more months to get a decision on disability. At the time of approval, there may be more than two months between the effective date of MEPD eligibility and the date the ELIAS entries are made to approve MEPD. “Back months” include all the months from the month when approval entries are made in ELIAS back to the first month of MEPD eligibility. The member may not need MEPD coverage for all of the back months, so the member may not want to have premium payments credited to those months. When premiums are assessed, ask the member to provide a signed statement that identifies the back months the member does not want MEPD coverage.

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Page 122

Official source

Title 8: Medicaid Page 118 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised October 10, 2025 Medicaid for Employed People with Disabilities

Premium Schedule If the gross monthly income of the person getting MEPD is: The percentage of the federal poverty level is: The premium amount is: $1,957 or less At or below 150% 0 Above: $1,957 Above 150% $43 $2,152 165% $59 $2,348 180% $70 $2,609 200% $82 $2,935 225% $97 $3,261 250% $113 $3,913 300% $141 $4,565 350% $171 $5,217 400% $202 $5,869 450% $233 $7,173 550% $291 $8,478 650% $351 $9,782 750% $413 $11,086 850% $488 $13,042 1000% $586 $14,998 1150% $685 $16,955 1300% $790 $19,302and above 1480% $913 Months Between Application Date and Approval Date Procedure: When a disability determination needs to be completed, it may take two or more months to get a decision on disability. At the time of approval, there may be more than two months between the effective date of MEPD eligibility and the date the ELIAS entries are made to approve MEPD. “Back months” include all the months from the month when approval entries are made in ELIAS back to the first month of MEPD eligibility. The member may not need MEPD coverage for all of the back months, so the member may not want to have premium payments credited to those months. When premiums are assessed, ask the member to provide a signed statement that identifies the back months the member does not want MEPD coverage.