Medicaid Rules That Change

At 18, your child can manage their Medicaid benefits and make medical decisions privately. You won’t have access to your child’s medical records unless they authorize it. That's why it's important to teach your child how to make health decisions and manage benefits now, so that they will know how to do so later.

Income-Based Medicaid

Children 18 or younger can get Healthy and Well Kids in Iowa (Hawki), whether or not they have a disability, if their household's income is 307% of the Federal Poverty Guidelines (FPG) or less ($8,443 per month or less for a family of four).

When your child turns 19, they are no longer eligible for Hawki and must meet regular Medicaid requirements. For adults, the income limit for the Iowa Health and Wellness Plan (IHAWP) is 138% of FPG ($1,835 per month for a single person living alone; $3,795 per month for a family of four).

Note: If you don’t claim your child as a dependent on your taxes after they turn 19, Medicaid may consider them a single person living alone instead of a member of your household, even if they still live in your house.

Disability-Based Medicaid

If your child is 18 or younger and has a disability, they may qualify for Medicaid through Supplemental Security Income (SSI) benefits. If they do not qualify for SSI because your family has too much income or too many resources, they may qualify for Medicaid for Kids with Special Needs (MKSN) if your family's gross income is 300% of FPG or less ($8,250 per month for a family of four). (MKSN has no resource limit.)

When your child turns 19, they will no longer be eligible for Medicaid for Kids with Special Needs. To get disability-based Medicaid, they will have to qualify for SSI or a Medicaid waiver program.

Note: It may be easier for your child to qualify for SSI and disability-based Medicaid as an adult, because parental income is no longer counted and does not affect eligibility.

If your child doesn’t qualify for the Iowa Health and Wellness Plan or disability-based Medicaid as an adult, look into other health coverage options:

• If your child earns money from work, they may qualify for Medicaid for Employed People with Disabilities (MEPD), which has higher income and resource limits than regular Medicaid.
• If you or your child’s other parent can get employer-sponsored coverage, your child can be on that plan until they turn 26.
• If employer-sponsored coverage is not available, your child can get an individual plan on HealthCare.gov and may get tax subsidies to help pay for it. To get this help, your family’s income has to be between 138% and 400% of the Federal Poverty Guidelines ($62,600 for an individual; $128,600 for a family of four).

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,960
	$5,680
	$15,650
	$5,500
	400
	307
Iowa Health and Wellness Plan (138% FPG)
Healthy and Well Kids in Iowa (Hawki) (307% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (400% FPG)
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). Disability-based Medicaid eligibility is not included here. For private plans with subsidies, your monthly premium amount depends on your income.

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Rules that Don't Change At 18 or 19

Most other eligibility rules for Medicaid and private health insurance don't change when your child turns 18 or 19:

• Disability-Based Medicaid covers children and adults who get SSI benefits and some low-income people with disabilities who don't get SSI. If your child gets SSI as a child and keeps getting it after they turn 18, their Medicaid coverage will not change.
  • Note: It may be easier for your child to qualify for SSI and disability-based Medicaid as an adult, because parental income is no longer counted and does not affect eligibility.
• Medicaid for Employed People with Disabilities (MEPD) covers people who are under 65 years old, have a disability, work, and have more income or resources than the disability-based Medicaid limit.
• Employer-sponsored coverage through your job or your child’s other parent's job must allow your children to be on the plan until their 26th birthday.
• Individual coverage from HealthCare.gov is an option for children and adults who do not have access to other health coverage.
  • They may get tax subsidies to help pay for this coverage. To get this help, your family’s income has to be between 138% and 400% of the Federal Poverty Guidelines ($62,600 for an individual; $128,600 for a family of four).