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Title 8: Medicaid Page 128 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 Relationship to Medically Needy Legal reference: 441 IAC 75 (Rules in Process) and 75 (Rules in Process) Policy: People who qualify both for MEPD with a premium and for Medically Needy with or without a spenddown may choose which coverage group they want. Members who chose Medically Needy with a spenddown over MEPD with a premium may change their mind and request that eligibility be redetermined under MEPD during a current Medically Needy certification period. Procedure: Respond to requests from MEPD members with premiums to change to Medically Needy as follows:  If a change has occurred and the member no longer qualifies under MEPD, the member can be changed to Medically Needy with a spenddown for any month. It does not matter whether an MEPD premium has already been paid for that month.  If the member has not paid the MEPD premium for a month, the member may be changed to Medically Needy in that month.  If there has been no change that disqualifies the member from MEPD and the member has already paid the MEPD premium for a month, deny the request for a change to Medically Needy for that month. The following chart gives the processing steps when a Medically Needy member with a spenddown wants to change to MEPD.

Step Action 1 Approve MEPD beginning with the month the member elects as the first month for MEPD. Do not take any action to end the Medically Needy spenddown process at this time. It does not matter what the Medically Needy spenddown status is or if Medicaid eligibility has been approved for a month when MEPD eligibility will begin.