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Title 8: Medicaid Page 32 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups MAGI-Related Coverage Groups Revised February 28, 2025 People Who are Ineligible for FMAP Do not consider any month in which Medicaid was received under FMAP incorrectly and the individual should have received Medicaid under another coverage group. The other caretaker who is canceled from FMAP due to an increase in earned income is eligible to receive transitional Medicaid. The child will receive transitional Medicaid with the other caretaker. When transitional Medicaid ends, do an automatic redetermination to another coverage group for the other caretaker and for the children. Transitional Medicaid begins with the effective date of termination of FMAP. When ineligibility occurred in a prior month, the first month of transitional Medicaid is the first month that FMAP was erroneously granted, unless it is determined that FMAP was received through fraud, according to the transitional Medicaid definition of fraud. See Determining Eligibility for more information on determining if fraud exists.

1. Mrs. M timely reports an increase in earned income May 23. Timely notice cannot be given for June 1. FMAP is canceled July 1. Transitional Medicaid begins July 1. There is no overpayment for June. 2. Mr. J and his two children are receiving FMAP. He starts work but fails to report this to his worker until two months later. When the worker receives the verification of his new job, it shows Mr. J and his children are not eligible for transitional Medicaid because, according to the transitional Medicaid definition of fraud, Mr. J fraudulently received FMAP. Eligibility for Mr. J and the children is explored under other coverage groups. Transitional Medicaid coverage lasts for up to 12 months. Procedure: When an increase in income has been reported timely, transitional Medicaid shall be available for a period of up to 12 months. When at least one person on a case becomes transitional Medicaid eligible, the system will set the review month to 12 months from the start of transitional Medicaid.