Resuming Normal Medicaid and Hawki Eligibility Processes

The Department of Human Services (DHS) has resumed some of the Medicaid eligibility processes for many members currently enrolled in Medicaid and Hawki. DHS is using a phased approach over the next several months to resume to normal operations. Many of the regular processes had been put on hold for more than a year due to the COVID-19 public health emergency (PHE).

 

Communication to Members

Most members will still maintain medical assistance eligibility throughout the PHE.

  • Members may be disenrolled if the member: requests disenrollment, dies, is no longer a resident of Iowa, is erroneously approved, or has aged out of the Hawki program.
  • Hawki members who have turned 19 years old, or will soon turn 19, will transition to Medicaid or will be referred to the federal marketplace for health care. (Sample notice letter Español)
  • Some members may transition to a different Medicaid program with different benefits.
  • Members may be transitioned from full Medicaid coverage to a Medicare Savings Program. (Sample notice letter / Español)
  • Some Long Term Services and Supports (LTSS) members, including those receiving Home- and Community-Based Services (HCBS) waivers and state plan HCBS habilitation services, Program for All-Inclusive Care for the Elderly (PACE), and facility coverage may be transitioned to a different Medicaid coverage group based on a review of circumstances. (Sample notice letter / Español)

Questions regarding a notice you received in the mail? Call the DHS Contact Center at 1-855-889-7985.

 

The Phases

As detailed in Informational Letter (IL) 2229-MC-FFS-CVD, in April 2021, DHS began using a phased approach to return to normal medical assistance eligibility processes in order to comply with the continued enrollment requirement under the Maintenance of Effort (MOE) provision of the federal Families First Coronavirus Response Act (FFCRA). the unwinding of Medicaid COVID-19 flexibilities will occur in five phases over several months.
 
Details regarding the first three phases is below. The remaining phases will start at the conclusion of the federal PHE. The Department is still determining what will be included in these phases.

 

Phase 1

Phase 1 was implemented on April 20, 2021, and included resuming some Medicaid eligibility operating procedures that did not require technical assistance. With the implementation of Phase 1, Medicaid will resume discontinuance of members that were approved for medical assistance in error, transition members to a coverage group they are now eligible for, and review eligibility for Hawki members who have turned 19 years old and no longer qualify for the Hawki program. These regular Medicaid eligibility procedures had been on hold since March 2020 due to the COVID-19 pandemic

 

Phase 2

Phase 2 was implemented in June 2021. As part of Phase 2, Income Maintenance (IM) workers have started acting on changes for all LTSS cases. Some LTSS members, including those receiving HCBS waivers and state plan HCBS habilitation services, PACE, and facility coverage may be transitioned to a different Medicaid coverage group based on a review of circumstances. Members affected by Phase 2 were sent a letter in the mail in June 2021 notifying them of an upcoming review.

After a review, if a member’s LTSS coverage ends, LTSS services may no longer be covered for the member, but they may be able to continue to receive other medical services through Medicaid until the end of the PHE, or until Medicaid is given federal direction to evaluate this type of coverage, whichever should come first. If the member is on Medicare, their medical benefits will be provided by Medicare, but Medicaid may help cover the cost of their Medicare premiums. Affected members will be sent a notice in the mail saying they will be ineligible after the PHE has ended. A separate official notice will be issued to the member at the end of the PHE when their coverage is discontinued.

Additionally, Phase 2 includes:

  • Resuming automated Medicaid system batch eligibility redeterminations for changes in household circumstances, and
  • Completing an annual renewal/redetermination when acting on changes in household circumstances.
  • Resuming system alerts that notify IM workers of pertinent program information known to the Department. IM workers will act on this information and complete a redetermination of eligibility, if appropriate.

 

Phase 3

Phase 3 is also now underway. Phase 3 includes issuing pre-populated annual medical assistance renewal/review forms to households. The first set of pre-populated forms were sent to members on June 22, 2021, for August 2021 eligibility. Pre-populated forms will continue to be sent to members each month. This allows DHS to begin working through the backlog of annual renewals now rather than waiting until after the PHE has ended, in order to maintain federal compliance.

Members who are deemed eligible for medical assistance upon their annual renewal month, will have their eligibility renewed for one year with a new renewal date. Members who are found ineligible during this annual renewal process, will continue to receive medical assistance through the duration of the PHE. Based on new CMS guidance, affected households will need to have eligibility evaluated when the PHE ends to see if medical assistance will continue. A review form will be issued to the household when eligibility for medical assistance must again be evaluated.

 

Phase 4

To be determined by the Department.

 

Information for Medicaid Providers

Most members will still maintain medical assistance eligibility throughout the PHE.

Providers should continue to confirm member eligibility through the Eligibility and Verification Information System (ELVS).

 

 

 

Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.)
1-800-338-8366 (Toll Free) 
515-256-4606 (Des Moines Area)
515-725-1351 (Fax)

For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.

Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.