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Title 8: Medicaid Page 56 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups MAGI-Related Coverage Groups Revised February 28, 2025 Mothers and Children (MAC) Program

At the time of the annual Medicaid review, the children are split into separate MAC cases based on MAC eligibility requirements or are canceled as necessary to meet standard Medicaid eligibility guidelines. Composite MAGI Households If a household with income above FMAP limits has some members who might be eligible for MAGI-related Medicaid coverage and some who would not, determine eligibility under both MAGI-related Medicaid and the Medically Needy coverage groups. Examine MAGI-related Medicaid eligibility before Medically Needy. If some household members are eligible under each group, establish two separate cases. Examples of MAGI/Medically Needy composite households include:  Households with parents aged 19 or older and their children.  Households with a pregnant woman who also has insured children over the age of one when family income is equal to or less than 375% of the federal poverty level but more than 167% of the federal poverty level.  Households with infants and insured children when family income is equal to or less than 375% of the federal poverty level but more than 167% of the federal poverty level. When determining eligibility, the household size is usually the same for each program, but may be different. Include the following in both eligible groups:  People who are categorically eligible under MAGI-related Medicaid.  People who are categorically eligible under Medically Needy.  Any additional people who must be considered when determining household size. Enter MAGI-eligible people as considered people on Medically Needy spenddown cases. Do not include them on zero-spenddown cases. See 8-C, Nonfinancial Eligibility, and 8-J, Medically Needy, for more information.