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Medically Needy Eligibility - Iowa

The Medically Needy coverage group is available only to persons who are not eligible under other Medicaid coverage groups because of excess income or resources.

Persons eligible for the Medically Needy coverage group are:

·     Children under the age of 21 who would be eligible for FMAP, CMAP, or SSI except that their income or resources exceed the limits.

·     Pregnant women over income limits for MAC.

·     Pregnant women not eligible for continuous eligibility for pregnant women.

·     Women in the postpartum period.

·     Newborn children of Medically Needy Medicaid-eligible mothers.

·     Persons who are aged, blind, or disabled and who would be eligible for SSI except that their income or resources exceed the limits.

NOTE: Residents of Residential Care Facilities (RCFs) whose income is over the RCF Income limits are eligible through the Medically Needy coverage group if they are categorically eligible, e.g., under 21, pregnant, aged, blind, or disabled. The Medically Needy coverage group does not pay for RCF care, but it does pay for other Medicaid-covered services the client receives if spenddown is met.

See Also:

·           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 J, Medically Needy, Determining the Coverage Group, Who is Eligible for Medically Needy.

Legal reference: 441 IAC 76.1(249A); 75.35(a); 83.2(1)"b"

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