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Title 8: Medicaid Page 136 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)

The worker advises Ms. G that:  Bobby is not required to be enrolled in the health insurance at that time.  If Ms. G decides to terminate Bobby’s coverage, then she must report the change to the worker within ten days.  If the employer increases its contribution to at least half of the annual cost of the health insurance premiums required to have Bobby covered by the health insurance, then Bobby would be required to be enrolled. 2. Eddie and Ellie are disabled 7-year-old twins receiving SSI cash benefits and Medicaid under SSI Medicaid. Their father, Mr. E, receives a pay raise, and their worker receives notification from SDX of their SSI cancellation due to being over SSI income limits. The worker contacts the SSI representative to confirm the date of the next disability review. The worker sets a reminder for a disability review date for each child, because it is the Department’s responsibility to follow up on disability reviews after the child is canceled from SSI cash benefits. Eddie and Ellie remain continuously eligible for Medicaid under the Ineligible for SSI Due to coverage group until the next eligibility review. The date of the next Medicaid eligibility review is either:  The date of the next disability review, if this date is within the next 12 months, or  12 months after the date of SSI cancellation, if the date of the next disability review is more than 12 months away. Since Medicaid ended under the Ineligible for SSI Due to coverage group, the worker includes both Eddie and Ellie on the same MKSN case. The household size is four, including both parents and the two children. Mr. E provides proof that Eddie and Ellie are enrolled in his employer health insurance plan and that his employer paid over half the annual cost of premiums for the “employee plus children” coverage. Mr. E inquires about the Health Insurance Premium Payment (HIPP) program paying for the premiums. The worker explains that the HIPP program could not pay for the premiums because Eddie and Ellie will be on the MKSN group, which is ineligible for the HIPP reimbursements.