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4 Shield of Iowa. This amendment increases the total number of managed care counties to 82 and 17 fee for service counties remain.

• On June 23, 2008, Iowa submitted its twelfth amendment. With approval of this SPA, Iowa will be granting hardship exemptions to CHIP enrollees for premium payments when they are residing in a county in which a national disaster has been declared by FEMA. Premiums will be forgiven for the months of June and July 2008.

• On February 24, 2009, Iowa submitted its thirteenth amendment to expand the eligibility for children in its CHIP up to 300 percent of the FPL, using a block of income disregards. Additionally, the amendment allowed Iowa to continue utilizing a 20 percent income disregard in establishing income levels for purposes of determining premium amounts ($20 per month per child up to a family maximum of $40 per month) for the new expansion group. The State revised its submission to include a 30-day waiting period of uninsurance for CHIP coverage, only for children with family incomes above 250 percent of the FPL up to 300 percent of the FPL. Children with lower family incomes will not be subject to the 30-day waiting period. The State details a list of exceptions to the 30-day waiting period in the State plan. This SPA has a retroactive effective date of July 1, 2009.

Children Covered Under Program

• The State reported that there were 50,390 children ever enrolled in CHIP combination program during Federal Fiscal Year 2008, of which 17,709 were in the Medicaid expansion Program and 32,681 were enrolled in the Separate child health plan.

Administration

• The Department of Human Services (DHS) has contracted with a third-party administrator to provide, at a minimum, the following services for the non-Medicaid CHIP (hawk-i): distributes applications; determines eligibility; screens for Medicaid eligibility and coordinates with Medicaid Eligibility Worker; calculates, bills, and collects cost sharing; assists the family in selecting a health plan and enrolling the child in the selected plan; gathers encounter data from the health plans; and provides DHS with demographic, statistical, and encounter data for Federal reporting.

Health Care Delivery System

• For the hawk-i program, the State contracts with commercial insurers to deliver services for CHIP populations. Both fee-for-service and managed care plans may participate.

Benefit Package

• The hawk-i program provides benchmark-equivalent coverage.

• Iowa’s CHIP plan is richer than the State employees’ benchmark plan because State employees must pay additional copayments.