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Title 8: Medicaid Page 135 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)

Medicaid Review Processing Step Action 1 At the annual Medicaid eligibility review, verify whether:  The child has remained enrolled in the health insurance, or  The employer has reduced its contribution to less than 50% of the annual cost of premiums to provide coverage to the child. 2 If the employer still contributes at least 50% of the annual cost of premiums required to provide coverage to the child, inform the parents that the child must remain enrolled.

If the employer does not pay at least 50% of the annual cost of premiums required to provide coverage for the child, inform the parent that it is not required to enroll the child nor keep the child enrolled. MKSN Case Examples

1. Ms. G applies for MKSN for her son, Bobby. Ms. G is covered by Medically Needy with a spenddown. Since Medically Needy with a spenddown is less than full Medicaid coverage, Ms. G is included in the MKSN household size and her income is counted. The worker determines that Bobby meets the income requirements for a household size of two. Bobby has not had a disability determination from the Social Security Administration. The worker follows procedures in 8-C, When the Department Determines Disability, to refer Bobby for a DHS determination. Disability Determination Services (DDS) determines that Bobby is disabled. The worker sets a reminder for the continuing disability review (CDR) scheduled by DDS for three years in the future. The worker verifies that:  Bobby is enrolled in Ms. G’s employer health insurance under the “family” coverage rate.  The employer does not pay at least half of the annual cost of premiums required to cover Bobby under the family premium rate.