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Title 8: Medicaid Page 59 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

One of the family members receives and reports a salary increase while Bobby is still hospitalized. The family’s net countable income now exceeds 302% of poverty. Medicaid under MAC is canceled effective the first of the next month allowing a ten-day notice. An automatic redetermination is completed to the 300% group if the child has been hospitalized for 30 consecutive days. Medicaid/Hawki Composite Families This section is designed to provide guidance in situations where some family members have health care coverage through the Hawki program and other family members receive or are applying for Medicaid. When children in a family receive health care coverage through Hawki and other family members apply for Medicaid, determine if the children on Hawki are Medicaid-eligible, according to MAGI-related Medicaid household composition policy. See 8-C, MAGI Household Size for more information.

Mrs. A applies for Hawki for her two children, who both are over age 1. Family income exceeds 167% of poverty but does not exceed 302% of poverty. Hawki coverage is approved for the children beginning October 1. In January, Mrs. A is injured in an accident and applies for Medicaid. Family income still exceeds 167% of poverty, so the children remain Hawki eligible. Mrs. A is only conditionally eligible for Medically Needy with a spenddown. Her Hawki-eligible children are “considered persons” in her eligible group and are coded with fund code “S.” Eligibility and spenddown for Mrs. A will be based on a three-member eligible group. If the children are found to be Medicaid-eligible under coverage groups other than Medically Needy with a spenddown, the family can choose to leave the children on Hawki until the Hawki annual review or to have the children begin receiving Medicaid. If the family chooses to have the children begin receiving Medicaid, no additional action by the worker processing the Medicaid application is necessary in order for the Hawki coverage to be canceled. If the family chooses to have the children continue to receive Hawki, a system override will be required. Contact DHS, SPIRS Help Desk for instructions.