Page 133

Title 8: Medicaid Page 129 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

Step Action 2 The MEPD billing system will identify all cases with overlapping Medically Needy and MEPD eligibility. The following actions will occur:  When the case has been changed from Medically Needy to MEPD, the aid type will be updated on SSNI after the premium has been paid.  When a Medically Needy spenddown case becomes a zero- premium MEPD case, the billing system will issue an informational WIFS E-mail message 456, which states “ESTD to IME MN Unit” to release spenddown.  When an MEPD case with a premium was a Medically Needy spenddown case, the billing system will send a WIFS E-mail after the premium has been paid with the message “ESTD/IME MN Unit” to release spenddown. 3 If necessary, ask the IME Medically Needy Unit to back out bills for months that the member is eligible for Medicaid under MEPD.  Any bill used toward meeting spenddown for these months will be backed out and paid under MEPD if it was incurred in a month that now is under MEPD eligibility.  If the spenddown has been met, send a request to the IME MN Unit to back out medical bills. See 14-I, Medicaid Eligibility Through Another Coverage Group. 4 The IME Medically Needy Unit notifies the worker if a Medically Needy recoupment is needed. See an example of a recoupment situation in the Comment section.

The Medically Needy certification period is April and May with a spenddown of $500. Spenddown is met with a $500 bill for services incurred on May 1. After having met spenddown, the member decides to change to MEPD and the case is approved for MEPD for the month of May. The worker requests that the certification period be shortened to the month of April with a spenddown of $250. This creates a recoupment for the month of April for $250. The IME Medically Needy Unit notifies the worker to complete a claim for Medically Needy up to $250.