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Title 8: Medicaid Page 57 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

1. Household composition: Mrs. J, who is pregnant with one unborn child; Mr. J; Child A (age 13 months); and Child B (age 5). The family applies for Medicaid and the household’s net monthly countable income is $6,000. Since this amount exceeds 167% of the federal poverty level for a five-member household (including the unborn child), Child A and Child B are not eligible for Medicaid under the MAC program. However, since the income is below 215% of the federal poverty level for a five-member household, Mrs. J is eligible for Medicaid under the Pregnant Women coverage group. Eligibility under the Medically Needy program is examined for Mr. J and eligibility under Hawki is examined for the children. See 8-J, Applying Medical Expenses to Spenddown for more information on attaining Medically Needy eligibility. 2. Mr. and Mrs. V, Child A (age 6 months), Child B (age 18 months) and Child C (age 14 years) apply for Medicaid. Mr. V has earned income of $3,500 per month. Mrs. V has earned income of $2,500 per month. Since the couple’s total countable earned income of $6,000 does not exceed 300% of the federal poverty level for a five-member household, Child A is eligible for MAC. Child B and Child C are over income for MAC because the countable income exceeds 167% of the federal poverty level for a five-member household. Child B and Child C are examined for eligibility under the Hawki program. Eligibility under the Medically Needy program is examined for Mr and Mrs. V. Medical bills for the children that were incurred before the Medicaid eligibility date may be used to meet the spenddown of the Medically Needy household, if the household remains legally obligated for them. Continued MAC Coverage of Children Receiving Inpatient Care Legal reference: 441 IAC 75 (Rules in Process) Infants and children who are currently eligible for MAC remain eligible when they are inpatients in a medical institution, even if they turn age one or 19, as long as they continue to meet the income requirements in effect before the age change. They remain eligible through the month the continuous inpatient stay ends.