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Title 8: Medicaid Page 31 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Case Maintenance Additional MAGI-Related Case Maintenance Revised November 4, 2022 Budgeting For Ongoing Eligibility For MAGI-Related… ▪ If the household would have been eligible under the Medically Needy program, determine the spenddown amount for each certification period. See 8-J, Income Policies. ▪ See 8-A, When Timely Notice Is Not Required, for more information on when timely notice is not required.

1. Positive Change Timely Reported:

Mr. and Mrs. X receive Medicaid under MAGI-related for themselves and their children. Mr. X is the only one with income. Mrs. X reports on August 3 that Mr. X has left the home July 25.

Although the loss of a household member is negative, this change is positive because Mr. X is the only one with income. Since this change was reported timely in August, Mr. X is canceled effective September 1 and his income is no longer used for eligibility purposes. No claim is established for August.

Had this same change been reported untimely, a claim for Mr. X would have been completed for the month of August and any months thereafter, since the change occurred in July and was not reported timely. 2. Negative Change Timely Reported:

Mr. B receives Medicaid for himself and his children under MAGI-related. On July 23, he timely reports beginning unearned income that will make him and his children only conditionally eligible under Medically Needy (MN) with a spenddown. He provides verification timely on August 5.

The effect of the change on eligibility is adverse and requires a timely notice. The effective date of the change is September 1. The MN certification period is September/October. No claim is established for August, since the change was reported timely.

The children remain continuously eligible under MAGI-related Medicaid until the annual review. If the children are no longer eligible at the annual review due to income, they will be considered for Hawki. 3. Negative Change Timely Reported:

Ms. G and her children receive Medicaid under MAGI-related. Ms. G starts a new job and receives her first paycheck on May 23. Ms. G reports the change timely by June 2. The worker requests verification and it is returned timely by June 15.

The effective date of the change is July 1 if the worker acts on the change by timely notice in June. The effective date of the change is August 1 if the worker acts on the change after timely notice in June but before timely notice in July.

No claim is established in either situation because the verification was received after August 10.

If Ms. G and her children go over income for FMAP and are otherwise eligible for transitional Medicaid (TM), TM begins the first of the month after MAGI-related ends.

The children remain continuously eligible until the annual review. If the children are no longer eligible at the annual review due to income, and TM does not apply, they are considered for Hawki.