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Title 8: Medicaid Page 137 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 explains that a condition of eligibility for MKSN is that Eddie and Ellie remain enrolled in the employer health insurance plan as long as the employer pays at least half of the cost of the premiums to provide coverage to the children. Several months later Mr. E reports that for the upcoming year, the employer contribution would be reduced to only 40% of the annual cost of premiums. Mr. E sends proof of this change to the worker. The worker notifies Mr. E that he is no longer required to maintain employer health insurance coverage for Eddie and Ellie as a condition of their MKSN eligibility. NOTE: The policy for continuous eligibility for children went into effect July 1, 2008. 3. Mr. and Mrs. B apply for MKSN for their child, Betty. The household includes: Mr. B, Mrs. B Child, Ann, age 16, who is on Medicaid under an HCBS waiver group Child, Bill, age 15 Child, Betty, age 7, who received SSI until February 2008, when her income went over the SSI limit Ann is not included in the household size because she receives Medicaid as a separate case. The household size is four. Betty is income-eligible for MKSN. Betty has been determined to be disabled by the Social Security Administration. Since Betty is no longer eligible for SSI cash benefits, the worker contacts the SSI representative to find out the date scheduled for the next disability review. The worker sets a reminder for the disability review date. Mr. B provides proof that his employer pays more than half of the annual cost of premiums required for the “family” coverage rate. Betty is not currently enrolled in the plan.