Page 69

Effective Date:

Approval Date: 69

hawk-i Referral Process A Desk Guide for Income Maintenance Workers Policy: Refer children under age 19 to the hawk-i program when any child for whom a family is applying is over income for Medicaid or is conditionally eligible for MN. (Employees‟ Manual Chapters 8-B & 8-G) Making a Referral: Referring a Denied Application Referring a Cancelled Case

To refer an application that has been denied or an application that has been approved only for MN with a spenddown:  Fill out the referral form* and send it to hawk-i with copies of: 1. the Medicaid application 2. the income verification 3. the notice of decision  Make the referral within one working day from the time that you know that the child is not eligible for Medicaid or that they must meet a spenddown under Medically Needy.  The Medicaid application date will become the hawk-i filing date. To refer a case that has been cancelled or must now meet a spenddown under MN:  Fill out the referral form* and send it to hawk-i with copies of: 1. the income verification 2. the notice of decision  Make the referral within one working day from the time that you know that the child is not eligible for Medicaid or that they must meet a spenddown under Medically Needy.  If eligible, there will be no break in coverage for children moving from Medicaid to hawk-i. The family does not have to fill out a separate hawk-i application. * “Referral to the Healthy and Well Kids in Iowa (hawk-i) Program,” form 470-3565, is available in State Approved Forms on Outlook.

Send the referral and accompanying verification to: (Do not send case records or original application forms)

Interoffice Mail: Department of Human Services OR FAX: 515-457-7701

Attn: MAXIMUS/hawk-i Program

IME

100 Army Post Road

Des Moines, IA 50315 Questions? Call hawk-i Customer Service: 1-800-257-8563 OVER