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Title 8: Medicaid Page 133 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Non-MAGI-Related Coverage Groups Revised October 10, 2025 Medicaid for Kids with Special Needs (MKSN) Comment: This requirement applies only to parents who live with the child, not to a non-custodial parent. Procedure: The employer may contribute 100% of the cost for the employee alone, but make lower contributions for premiums required to cover family members. Confirm the amount the employer annually contributes towards the premium amount that would include the child in the health insurance coverage. The following charts detail the specific procedures that you must use to evaluate the health insurance enrollment requirement for applications and for eligibility reviews.

Application Processing Step Action 1 Notify the parents about their responsibility concerning the health insurance requirement by giving them Comm. 337, Medicaid for Kids with Special Needs (MKSN). 2 Send form 470-4633, Health Insurance Information for Kids with Special Needs, and the Insurance Questionnaire, form 470-2826 or 470-2826(S), to the parents to request information about:  The availability of employer health insurance,  The enrollment status of the child in the health insurance plan, and  The employer contribution to the premium amount to provide coverage for the child 3 The parents must: 1. Check the correct box on the 470-4633 to describe the status of their child’s health insurance coverage, and 2. Either:  Complete Insurance Questionnaire, form 470-2826 or 470-2826(S), and return it to the worker, or  Take the second page of form 470-4633 to the employer to be completed and returned to the worker.