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Title 8: Medicaid Page 38 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

Mr. A and his two children receive Medicaid under FMAP. He receives unemployment compensation. On April 10, Mr. A reports that one of his children permanently moved out on April 5 to live with relatives. Countable income of Mr. A and the remaining child exceeds FMAP limits for a two-person eligible group. Effective May 1, eligibility for the child is established under MAC and conditional eligibility for Mr. A is established under IHAWP. A notice of decision is issued April 12. On April 15, Mr. A reports that he will begin working April 20 and his first check will be received April 30. Although his earned income would exceed the FMAP limits for a two-person eligible group, eligibility has already been established under another coverage group for May based on the earlier reported change. Therefore, Mr. A and his child are not eligible for transitional Medicaid. Requirements After Eligibility Is Established Legal reference: 441 IAC 75 (Rules in Process) During all 12 months of the transitional Medicaid period, the household must continue to cooperate with Quality Control, DIAL, CSS Third-Party Liability, and the Health Insurance Premium Payment Unit. If a person fails to cooperate, sanctions are applied. The eligible group must:  Continue to include a parent or other caretaker whose income is used or an ineligible parent or other caretaker whose income is used, and  Continue to include a child, as defined by FMAP policy, and  Timely report any changes in the household composition. The requirement of the eligible group to include a child is met if:  A child is absent, as described in 8-C, Absence, or  The only child in the home is an SSI recipient, or  The only child in the home is a “considered” person.