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Title 8: Medicaid Page 134 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)

Application Processing Step Action 4 If the child is already enrolled in the parent’s employer group health insurance:  Ask the parents to provide verification of the enrollment.  Advise the parents that the child should not be disenrolled, unless the parents provide proof that the employer paid less than 50% of the cost of annual premiums for coverage that includes the child. 5 If the child is not enrolled in the parent’s employer group insurance:  Request information about the cost of health insurance premiums that are required to provide coverage for the child.  Check the information to see if the employer pays at least half the cost to the premiums that are required to cover the child. 6 If the employer pays at least half the premium cost required to cover the child, then tell the parent:  If the parent can enroll the child without a waiting period, then the parent must provide verification of the child’s enrollment before Medicaid can be approved.  If the parent verifies the need to wait to enroll the child at a later date, such as during the open enrollment period, Medicaid can be approved since the employer insurance is not currently available to the child. 7 If the parents cannot enroll the child until a later date, set a reminder to follow up on:  The enrollment of the child during the open enrollment period, or  If not enrolled on the follow-up date, that the employer reduced its contribution to less than 50% of the annual cost of premiums to provide coverage to the child.