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Title 8: Medicaid Page 32 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…

4. Positive Change Not Timely Reported but Required to Be Reported:

Mr. F’s children receive Medicaid under MAGI-related. In June, Mr. F reports that he got a new job the previous December with a new company and had a decrease in income.

Due to this change, Mr. F is eligible for Medicaid under MAGI-related. The effective date of the income change is July 1, since he reported the job in June.

The worker explains to Mr. F that it appears he would now be eligible for Medicaid. Mr. F states he has health insurance and doesn’t want Medicaid.

In August, Mr. F calls his worker and requests Medicaid. He says he has medical bills that his health insurance didn’t cover for the past six months.

Mr. F’s request for Medicaid is treated as an application. The worker explores whether Mr. F is eligible for August and ongoing. Mr. F is not eligible for Medicaid for February through July because this application for Medicaid was in August. 5. Negative Change Not Timely Reported but Required to Be Reported:

Ms. C and her children receive Medicaid under MAGI-related. On September 3, it is discovered that Ms. C failed to timely report beginning earned income. Ms. C received her first paycheck on July 23. Since the change was not reported timely, the effective date of the change is August 1. The worker redetermines Medicaid eligibility for August, September, and ongoing.

If a change in eligibility occurs, a timely notice must be issued. If appropriate, a claim is established for Ms. C.

If eligibility is only under Medically Needy with a spenddown, the certification period is August and September.

The children remain continuously eligible under MAGI-related Medicaid until the annual review. If they are over income for MAGI-related Medicaid at the annual review, they are considered for Hawki. 6. Required to Be Reported:

Mr. G and his children are approved for Medicaid under FMAP in November. In December, Mr. G goes from part-time employment to full-time employment at the same company. Mr. G reports this to his worker the following February. The increase in income makes the family over income for FMAP.

The worker acts on the report and the family is eligible for transitional Medicaid (TM) beginning March 1.

It is not a negative action to change coverage from FMAP to TM since they are both full Medicaid programs. Therefore, a ten-day negative action is not sent for FMAP. 7. Addition of Household Member Reported Timely; Cancellation and Automatic Redetermination; Information Received by 10th of Month:

Ms. K and her children receive Medicaid under FMAP. On April 20, Mr. K joins the household and the change is timely reported to the Department. Mr. K requests Medicaid and has unearned income. The worker requests necessary information and it is timely provided May 10.

The unearned income makes the family over income for MAGI-related Medicaid. The children are continuously eligible until the annual review when eligibility is examined.