hawk-i Insurance for Children
by: Iowa Legal Aid
September 2002
What do you do when your children have no health insurance but you have too much money to be eligible for Title 19? You may want to consider the hawk-i program.
Many Iowa children can get health insurance through the "hawk-i"program. Healthy and Well Kids in Iowa (hawk-i) is Iowa's version of what is known nationwide as CHIP - Children Health Insurance Program. Through CHIP, the federal government makes funds available to all states to expand coverage of health insurance to children.
The hawk-i program only insures children under age 19. The income guidelines for the hawk-i program are fairly generous. At present, the income guideline is 200% of the federal poverty guidelines. Families also get a 20% earned income deduction. This means a family can earn up to 220% of the federal poverty guidelines and still qualify for the program. Although the number of eligible children is 33,250, only a third of those who could qualify are enrolled in hawk-i.
What does hawk-i cost?
For many eligible household, the premium is free and for others the cost is $10 per child per month and no more than a total of $20 per month. To find what your cost would be,
Next, look at the chart below. Find the range where the number on line (8) falls to see how much it would cost to get hawk-i health insurance.
All of the figures took effect April 1, 2002, when new federal poverty guidelines were released.
If you are eligible, changes in income during the 12-month enrollment period do not affect the child's eligibility to participate in hawk-i. However, if income has decreased, a family may request a review to determine whether they are required to continue paying the premium.
Non-financial eligibility criteria.
In order to be eligible for the hawk-i program, a child must be uninsured. A child who is currently enrolled in a health plan may not be eligible. A child may not be eligible until six months have gone by since being enrolled in an employer-sponsored health plan. The rules for the hawk-i program state that there are a number of exceptions to the 6-month rule, and they are:
1. Employment was lost due to factors other than voluntary termination.
2. Coverage was lost due to the death of a parent.
3. There was a change in employment to a new employer that does not provide an option for dependent coverage.
4. The child moved to an area of the state where the plan does not have a provider network established.
5. The employer discontinued health benefits to all employees.
6. The coverage period allowed by COBRA expired.
7. The parent became self-employed.
8. Health benefits were terminated because of a long-term disability.
9. Dependent coverage was terminated due to an extreme economic hardship on the part of either the employee or the employer. Extreme economic hardship for employees shall mean that the employee's share of the premium for providing employer-sponsored dependent coverage exceeded 5% of the family's gross annual income.
10. There was a substantial reduction in either lifetime medical benefits or benefit category available to an employee and dependents under an employer's health care plan.
11. Child Health Insurance Program (CHIP) coverage in another state was terminated due to the family's move to Iowa.
A child must be a resident of Iowa in order to be eligible for the hawk-i program. The child who is receiving hawk-i has to be a citizen or lawfully-admitted alien. The citizenship or alien status of the parent or responsible person is not to be considered in determining eligibility of the child. In fact, the parents do not need to disclose their citizenship or alien status for the hawk-i program. A child will not be eligible for hawk-i if the child is eligible for health insurance coverage as a dependent of a State of Iowa employee.
Finally, if a child is eligible for Medicaid through Title 19, the child will not be eligible for hawk-i. When hawk-i gets an application, they screen it for potential eligibility for Medicaid. They refer Medicaid-eligible applicants to the Department of Human Services, which will contact the family to see if they wish to receive Title 19 benefits.
The parent or caretaker of the child must file the application for hawk-i benefits. A non-custodial parent cannot file the application for a child.
What happens when I send in my application?
Applications forms go a company called MAXIMUS, which has a contract with the Department of Human Services to administer the hawk-i program.
MAXIMUS will review your application and determine if you are eligible for hawk-i. If it appears you may be eligible for Medicaid, they will refer your application to the Department of Human Services. If you are eligible, then you will be able to receive insurance for your child from one of three private insurance companies.
You are entitled to get a decision in writing of any planned action that effects the enrollee's eligibility or amount of benefits. If you disagree with the planned action, you can file an appeal with the Iowa Department of Human Services (IDHS). The appeal should be in writing and filed with the local or state IDHS office. The appeal should also be filed within 30 days from the date of the adverse action. There is a "good cause" exception for up to 90 days to file an appeal, but it is not recommended that you rely upon this exception. If you are appealing a denial of assistive technology, you may be eligible for free legal assistance in an appeal through the AT Legal Project of the Iowa Program for Assistive Technology at the University of Iowa College of Law, (319) 335-9023 (Voice and/or TDD), and Iowa Legal Aid 1-800-532-1275 (Voice and/or TDD). If the appeal does not concern assistive technology, lower income Iowans can contact Iowa Legal Aid to see if they can obtain legal representation.
Currently three companies provide insurance through the hawk-i program. Where you live in the state determines whether or not you are eligible for a particular insurance company. A few counties in the state offer a choice between two different companies. Each company's coverage is a little bit different, but they all have to provide basic health insurance. The three companies are Wellmark ( 1-800-800-1043); Iowa Health Solutions (1-800-928-8004); and John Deere Health Plan, Inc., (1-800-247-9110, TDD 1-800-884-4327).
Under the hawk-i program, these insurance companies provide the insurance, and you will receive an insurance card with the program's name and information on coverage. Under the hawk-i program each plan must cover the following:
- Doctor visits
- Outpatient hospital services
- Well child visits
- Vaccines and shots (immunizations)
- Emergency care
- Inpatient hospital services
- Prescription medicines
- Eye glasses and vision exams
- Dental care and exams
- Hospice care
- Speech therapy and physical therapy
- Ambulance services
- Nursing care services
- Durable medical equipment
- Hearing exams
- Home health care
- Chiropractic care
- Mental health/substance abuse care
Each plan does provide for payment of assistive technology. Generally, under all three plans, durable medical equipment is covered, so long as it is medically necessary. Hearing aids and eye glasses are covered with certain limitations as to costs, and from which provider you may have to purchase the products.
To get an application, you can call hawk-i at 1-800-257-8563 (TDD 1-888-422-2319) Monday through Friday 7:00 a.m. to 7:00 p.m., or you can download an application off the web at http://www.hawk-i.org. Both English and Spanish versions are available.
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