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FMAP Nonfinancial Eligibility - Iowa

A child in need can receive Medicaid under the Family Medical Assistance Program (FMAP) until the age of 18 without regard to school attendance when a parent or needy specified relative in the child’s eligible group also receives Medicaid under FMAP.

An 18-year-old child can receive FMAP if a full-time student in a secondary school, or in the equivalent level of vocational or technical training, and reasonably expected to complete the program before reaching age 19.

Deprivation

NOTE: Deprivation has been eliminated as eligibility criterion for FMAP effective January 1, 2001.

FMAP and FMAP-related Medically Needy coverage groups require that a child be deprived of parental support or care as a condition of eligibility. An otherwise eligible child is considered deprived of parental support or care when one or both parents are:

·        Deceased.

·        Continually absent from the home.

·        Physically or mentally incapacitated.

·        Unemployed.

Neither an able-bodied stepparent nor a friend in the home disqualifies a child from assistance, as long as the child meets the other eligibility factors. Deprivation is determined by the circumstances of the natural or adoptive parents, regardless of whether:

·        The parents were married to each other, or

·        The parent was the chief breadwinner or devoted himself or herself primarily to the care of the child.

Eligible Group

The FMAP eligible group consists of all eligible persons living together. The group is considered a separate and distinct group, regardless of other persons in the home and the relationship or liability of these other persons to the eligible group.

The following persons must be included in the FMAP eligible group if living together and meeting nonfinancial eligibility requirements, unless they are an SSI recipient:

·        The dependent child.

·        Any brother or sister of the dependent child (of whole, or half-blood, or adoptive) who meets the deprivation, age, and school attendance requirements.

·        Any natural or adoptive parent of the dependent child.

An eligible group must have at least one dependent child and one eligible specified relative to be considered eligible for FMAP.

If the only child in the family is receiving Medicaid as a newborn child of a Medicaid-eligible mother, the mother cannot establish eligibility under the FMAP coverage group, unless the mother requests that the child be removed from newborn status and added to her eligible group. This is because the mother’s eligibility must be established as though the "newborn" does not exist.

Exceptions: The parent or needy relative can be the only member of the eligible group if:

·        The only eligible child receives SSI. The child who receives SSI is not considered a "dependent child." This also means that other children in the home can be excluded from the eligible group because the children are not siblings of a dependent child; or

·        The parent or needy specified relative chooses to exclude the only child(ren) in order to receive coverage for only the parent or needy relative; or

·        The dependent child is ineligible.

A person cannot be included in the eligible group if that person is ineligible for a non-financial reason. Examples are a person who:

·        Has no social security number.

·        Is an ineligible alien.

·        Is sanctioned.

People Voluntarily Excluded from the Eligible Group

An applicant or recipient may voluntarily exclude the following people from the FMAP-related eligible group:

·        Siblings of eligible children (whether whole, half, or adoptive).

·        Self-supporting parents of minor unmarried parents.

·        Stepparents of eligible children.

·        Children living with a specified relative.

Persons whose needs are voluntarily excluded from the eligibility determination are not entitled to Medicaid under any coverage group.

See Also:

·           Family Medical Assistance Program Overview

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter C, Nonfinancial Eligibility, Age, Page 77, Revised January 11, 2000

·                        Chapter C, Nonfinancial Eligibility, Deprivation, Page 78, Revised September 21, 1999

·                        Chapter C, Nonfinancial Eligibility, Eligible Group, Pages 88, 90, 93 & 94, Revised September 21, 1999

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