Current through Register Vol. 47, No. 6, September 18, 2024
The certification process to determine eligibility for direct
health care under the program shall include the following requirements:
(1)
Age.
a. Maternal health program-no age
restrictions.
b. Child health
program-birth through 21 years of age.
c. CYSHCN program-birth through 21 years of
age.
(2)
Income.
a. Income guidelines
will be the same as those established for the state's Title XXI program.
Guidelines are published annually by DHHS. Department income guidelines will be
adjusted following any change in DHHS guidelines.
b. Income information will be provided by the
individual.
c. Proof of Title XIX,
Title XXI (HAWK-I), or WIC eligibility will automatically serve in lieu of an
application.
d. All income of
family members as defined by DHHS poverty guidelines will be used in
calculating the individual's gross income for purposes of determining initial
and continued eligibility.
e.
Income will be calculated as follows:
(1)
Annual income will be estimated based on the individual's income for the past
three months unless the individual's income will be changing or has changed,
or
(2) In the case of self-employed
families the past year's income tax return (adjusted gross income) will be used
in estimating annual income unless a change has occurred.
(3) Terminated income will not be
considered.
f.
Individuals will be screened for eligibility for Title XIX, Title XXI (HAWK-I),
and WIC. If an individual's income falls within the eligibility guidelines for
Title XIX, Title XXI (HAWK-I), or WIC, the individual may be referred to the
Iowa department of human services or other enrollment source to apply for
coverage. Children, youth and pregnant women shall be considered for Title XIX
presumptive eligibility.
g. An
individual whose income is above the poverty level established by Title XXI and
below 302 percent of the federal poverty guidelines will qualify for services
on a sliding fee scale, as determined by the local agency's cost for the
service. The department provides annual guidelines based on poverty levels
established annually by DHHS. An individual whose income is at or above 302
percent will qualify for services at full fee.
h. Eligibility determinations must be
performed at least once annually. Should the individual's circumstances change
in a manner which affects third-party coverage or Title XIX/Title XXI
eligibility, eligibility determinations shall be completed more frequently.
(3)
Residency. Individuals must be currently residing in
Iowa.
(4)
Pregnancy. An individual applying for the prenatal program
shall have verification of pregnancy by an independent health provider, the
maternal health contract agency, a family planning (Title X) agency, or a
positive home pregnancy test.
(5)
Children and youth with special health care needs. An
individual applying for CHSC services shall be determined to have a special
health care need as defined by the federal MCHB. Care/service coordination,
family support or other non-clinic services are provided at no charge to the
family. Clinic services are provided without charge to families with adjusted
gross incomes below 185 percent of the federal poverty guidelines. Families
above this threshold are responsible for payment according to a sliding fee
scale based on tax exemptions, adjusted gross income, and extenuating
circumstances.
