514I.8 Eligible child.
1.
a.Effective July 1, 1998, and notwithstanding any medical assistance program
eligibility criteria to the contrary, medical assistance shall be provided to, or on behalf of, an
eligible child under the age of nineteen whose family income does not exceed one hundred
thirty-three percent of the federal poverty level, as defined by the most recently revised
poverty income guidelines published by the United States department of health and human
services.
b.Effective July 1, 2000, and notwithstanding any medical assistance program eligibility
criteria to the contrary, medical assistance shall be provided to, or on behalf of, an eligible
infantwhosefamilyincomedoesnotexceedtwohundredpercentofthefederalpovertylevel,
as defined by the most recently revised poverty income
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514I.8 Eligible child.
1. a. Effective July 1, 1998, and notwithstanding any medical assistance program
eligibility criteria to the contrary, medical assistance shall be provided to, or on behalf of, an
eligible child under the age of nineteen whose family income does not exceed one hundred
thirty-three percent of the federal poverty level, as defined by the most recently revised
poverty income guidelines published by the United States department of health and human
services.
b. Effective July 1, 2000, and notwithstanding any medical assistance program eligibility
criteria to the contrary, medical assistance shall be provided to, or on behalf of, an eligible
infantwhosefamilyincomedoesnotexceedtwohundredpercentofthefederalpovertylevel,
as defined by the most recently revised poverty income guidelines published by the United
States department of health and human services.
c. Effective July 1, 2009, and notwithstanding any medical assistance program eligibility
criteria to the contrary, medical assistance shall be provided to, or on behalf of, a pregnant
7 HEALTHY AND WELL KIDS IN IOWA PROGRAM, §514I.8B
woman or an eligible child who is an infant and whose family income is at or below three
hundred percent of the federal poverty level, as defined by the most recently revised poverty
income guidelines published by the United States department of health and human services.
2. A child may participate in the Hawki program if the child meets all of the following
criteria:
a. Is less than nineteen years of age.
b. Is a resident of this state.
c. Is a member of a family whose income does not exceed three hundred percent of
the federal poverty level, as defined in 42 U.S.C. §9902(2), including any revision required
by such section, and in accordance with the federal Children’s Health Insurance Program
Reauthorization Act of 2009, Pub. L. No. 111-3. The modified adjusted gross income
methodology prescribed in section 2101 of the federal Patient Protection and Affordable Care
Act, Pub. L. No. 111-148, shall be used to determine family income under this paragraph.
d. Is not eligible for medical assistance pursuant to chapter 249A.
e. Is not currently covered under a group health plan as defined in 42 U.S.C.
§300gg-91(a)(1) unless allowed by rule of the advisory council.
f. Is not a member of a family that is eligible for health benefits coverage under a state
health benefits plan on the basis of a family member’s employment with a public agency in
this state.
g. Is not a patient in an institution for mental diseases.
3. In accordance with the rules adopted by the advisory council, a child may be
determined to be presumptively eligible for the program pending a final eligibility
determination. Following final determination of eligibility, a child shall be eligible for a
twelve-month period. At the end of the twelve-month period, a review of the circumstances
of the child’s family shall be conducted to establish eligibility and cost sharing for the
subsequent twelve-month period. Pending such review of the circumstances of the child’s
family, the child shall continue to be eligible for and remain enrolled in the same plan if
the family complies with requirements to provide information and verification of income,
otherwise cooperates in the annual review process, and submits the completed review
form and any information necessary to establish continued eligibility in a timely manner in
accordance with administrative rules.
4. Once an eligible child is enrolled in a plan, the enrollee may request to change plans
within ninety days of initial enrollment for any reason and at any time for cause, as defined
in 42 C.F.R. §438.56(d)(2). Otherwise, an enrollee may change plan enrollment once a year
on the enrollee’s anniversary date.