Medicaid Eligibility for Young People

Medicaid helps people with low income pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Healthy and Well Kids in Iowa (Hawki) offers health benefits to children who don't qualify for Medicaid because their family's income is too high.

If you get Supplemental Security Income (SSI) or used to get SSI benefits and now qualify for SSI's 1619(b) status, you also get Medicaid automatically and don't need to worry about the rules on this page.

If you don't get SSI benefits, Medicaid and Hawki rules depend on whether you are:

• 18 or younger, or
• 19 or older.

Medicaid and Hawki If You Are 18 or Younger

If you are 18 or under:

1. You may qualify for income-based Medicaid or Hawki if your family has low income, regardless of whether you have a disability.
2. If you have a disability and your family has low income, you may qualify for disability-based Medicaid through Supplemental Security Income (SSI) or through Medicaid for Kids with Special Needs.

1. Income-Based Medicaid and Hawki

If you are 18 or younger and your family's income is 307% of the Federal Poverty Guidelines (FPG) or less ($8,443 per month for a family of four), you may either qualify for income-based Medicaid (if your family's income is very low) or Healthy and Well Kids in Iowa (Hawki) (if your family's income is moderate). It doesn't matter how much your family has in resources.

Depending on your family's income, you may have to pay a small monthly premium for Hawki coverage. Learn more about what your premium may be.

You can get income-based Medicaid or Hawki whether or not you have a disability.

If your family's income is 138% of FPG or less ($3,795 per month for a family of four), your parents may also qualify for Medicaid through the Iowa Health and Wellness Plan (IHAWP).

Check if your family's income is low enough for you to get income-based Medicaid or Hawki:

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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2. Disability-Based Medicaid

If you get SSI, you automatically get Medicaid and do not have to fill out an additional application. You can read more about how to qualify for SSI on the SSI Eligibility page.

If you have a disability and don't get SSI because your family has too much income or too many resources, you 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). Medicaid doesn't count the income of family members who have Medicaid coverage, so you may qualify even if you think your family's income is above this limit. There is no limit on how many resources your family can have.

If your parent has the option of an employer-sponsored health plan and the employer pays at least 50% of the cost of the premiums, you must be enrolled in the plan in order to be eligible for Medicaid for Kids with Special Needs.

Tip: If you make money at work, you should look into Medicaid for Employed People with Disabilities (MEPD). With MEPD, you can keep your Medicaid coverage even if your income or resources are too high for SSI, and you may qualify even if your family's income is too high for Medicaid for Kids with Special Needs.

Medicaid if You Are 19 or Older

If you are 19 or older:

1. You may qualify for Medicaid through the Iowa Health and Wellness Plan if you have low income, regardless of whether you have a disability.
2. If you have a disability, you may get disability-based Medicaid through Supplemental Security Income (SSI) or, if you work and have higher income or resources than SSI's limits, through Medicaid for Employed People with Disabilities (MEPD).

1. The Iowa Health and Wellness Plan

If you are 19 or older and your income is 138% of the Federal Poverty Guidelines (FPG) or less ($1,835 per month if you are single), you may qualify for Medicaid through the Iowa Health and Wellness Plan (IHAWP). Once you turn 19, Medicaid no longer looks at your parents' income.

If you are pregnant, you can qualify if you have income at or below 220% of FPG ($3,967 per month if you are single and pregnant with your first child; the baby is counted as a member of the family).

There is no limit on how many resources you can have.

Check whether your income is low enough for you to qualify for the Iowa Health and Wellness Plan:

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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Learn more in DB101's Iowa Health and Wellness Plan article.

2. Disability-Based Medicaid and Medicaid for Employed People with Disabilities (MEPD)

If you get SSI, you automatically get Medicaid and do not have to fill out an additional application. You can read more about how to qualify for SSI on the SSI Eligibility page.

If you have a disability, your resources or income are higher than SSI's limits, and you have paid work, you may instead qualify for Medicaid for Employed People with Disabilities (MEPD). With MEPD, you can keep your Medicaid coverage if you:

• Have $12,000 or less in resources ($24,000 or less if you're married), and
• Have countable family income at or below 250% of FPG for your family size. If you're single, that's $3,325 or less per month; for a family of four, that's $6,875 or less per month of family income.
  • MEPD counts your family's income the same way that SSI does: almost all of the family members' unearned income is counted, but less than half of their earned income is counted.

Learn more about MEPD.