249J.5 - EXPANSION POPULATION ELIGIBILITY.
249J.5 EXPANSION POPULATION ELIGIBILITY.
1. Except as otherwise provided in this chapter, an individual
nineteen through sixty-four years of age shall be eligible solely for
the expansion population benefits described in this chapter when
provided through the expansion population provider network as
described in this chapter, if the individual meets all of the
following conditions:
a. The individual is not eligible for coverage under the
medical assistance program in effect on or after April 1, 2005.
b. The individual has a family income at or below two 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.
c. The individual fulfills all other conditions of
participation for the expansion population described in this chapter,
including requirements relating to personal financial responsibility.
2. Individuals otherwise eligible solely for family planning
benefits authorized under the medical assistance family planning
services waiver, effective January 1, 2005, as described in 2004 Iowa
Acts, chapter 1175, section 116, subsection 8, may also be eligible
for expansion population benefits provided through the expansion
population provider network.
3. Individuals with family incomes 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 shall also be eligible for obstetrical
and newborn care under the expansion population if deductions for the
medical expenses of all family members would reduce the family income
to two hundred percent of the federal poverty level or below. Such
individuals shall be eligible for the same benefits as those provided
to individuals eligible under section 135.152. Eligible individuals
may choose to receive the appropriate level of care at any licensed
hospital or health care facility, with the exception of individuals
in need of such care residing in the counties of Cedar, Clinton,
Iowa, Johnson, Keokuk, Louisa, Muscatine, Scott, and Washington, who
shall be provided care at the university of Iowa hospitals and
clinics.
4. Enrollment for the expansion population may be limited,
closed, or reduced and the scope and duration of expansion population
services provided may be limited, reduced, or terminated if the
department determines that federal medical assistance program
matching funds or appropriated state funds will not be available to
pay for existing or additional enrollment.
5. Eligibility for the expansion population shall not include
individuals who have access to group health insurance, unless the
reason for not accessing group health insurance is allowed by rule of
the department.
6. Each expansion population member shall provide to the
department all insurance information required by the health insurance
premium payment program.
7. The department shall contract with the county general
assistance directors to perform intake functions for the expansion
population, but only at the discretion of the individual county
general assistance director.
8. If the department provides intake services at the location of
a provider included in the expansion population provider network, the
department shall consider subcontracting with local nonprofit
agencies to promote greater understanding between providers, under
the medical assistance program and included in the expansion
population provider network, and their recipients and members.
9. Following initial enrollment, an expansion population member
shall reenroll annually by the last day of the month preceding the
month in which the expansion population member initially enrolled.
The department may provide a process for automatic reenrollment of
expansion population members. Section History: Recent Form
2005 Acts, ch 167, §5, 66; 2006 Acts, ch 1184, §112, 127