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Title 8: Medicaid Page 5 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Overview Revised February 28, 2025 Summary of Aid Types and Fund Codes

Coverage Group Medical Aid Type Fund Code* Facility Case Aid Type Presumptive eligibility for breast and cervical cancer treatment (BCCT) 88-9 A

Presumptive eligibility for children 88-5 C

* Explanation of fund codes: A = Adult, Medicaid only C = Child, Medicaid only P = Conditionally eligible R = CMAP S = Considered person 1 = Adult, receives cash assistance 2 = Child, receives cash assistance 3 = Adult, state funding only 4 = Child, state funding only 9 = Limited benefits Presumptive Eligibility Legal reference: 42 CFR 435.1100-1103, 435.1110, 441 IAC 75 (Rules in Process), 76.1, 76.7 Medicaid shall be temporarily available to persons who are determined to be presumptively eligible for Medicaid. Presumptive eligibility shall be determined by a qualified entity (QE) and is based solely on the applicant’s attested circumstances as provided to the QE and entered by the QE directly online into the Medicaid Presumptive Eligibility Portal (MPEP) system. There are no verification requirements for a presumptive eligibility determination. Refer to the Medicaid Provider Manual, All Providers, II. Member Eligibility for policies and procedures related to presumptive eligibility determinations. Both approved and denied applications will automatically be sent to the Department for a formal Medicaid or Hawki eligibility determination, unless the applicant specifically opts out of receiving a full determination in writing. Refer to NJA0067, Presumptive Eligibility for the link to the Business Process for bringing the presumptive eligibility determination into ELIAS and processing the ongoing medical application, if applicable.