Hawki Insurance for Children

Hawki is a health insurance program for children in Iowa. It covers some children whose household income is too high for Medicaid (also known as Title 19). 

Hawki is short for Healthy and Well Kids in Iowa. It is Iowa's version of the federal program, SCHIP. SCHIP is short for States Children's Health Insurance Program.

In Iowa, the Hawki program covers children whose household income is as high as 300% of the federal poverty level.

For many eligible households, there is no premium, so the cost is zero. For others, the cost is $10 per child per month with a cap of $20 per month. For other households, the cost is $20 per child per month with a cap of $40 per month. No family will pay more than $40 per month for Hawk-I coverage for the children in their household. 

Right now, the only co-pay is a $25 co-payment for an emergency room visit if the child's medical condition does not meet the definition of emergency medical condition. The ER co-payment does not apply to children whose family income is less than 181% of the federal poverty level or to children who are eligible American Indians or Alaskan Natives.

In order to be eligible for the Hawki program, a child must not be covered by other insurance. A child who is currently enrolled in a health plan may not be eligible. 

If your child is covered by health insurance, but not dental insurance, then your child can still receive dental insurance through Hawki.

Your child needs to be a resident of Iowa. Your child also needs to be either a U.S. Citizen or lawfully-admitted alien (immigrant). The parent or responsible person does not need to be a U.S. Citizen or lawfully-admitted alien (immigrant). 

If your child is eligible for Medicaid, then your child is not eligible for Hawki. In fact, when Hawki gets an application for a child, they screen it for Medicaid eligibility. If the child would be eligible for Medicaid, the Hawki program refers the family to HHS, which will contact the family to see if they wish to receive Medicaid benefits. 

You will get a written decision telling you that your child has been approved. 

There are 3  companies (called managed care organizations or MCO) that provide insurance through the hawk-i program. Each company's coverage is a little bit different, but they all have to provide basic health insurance.

The companies are: 

• Amerigroup Iowa, Inc
• Iowa Total Care
• Molina Healthcare of Iowa

Delta Dental is the administrator of the dental program.

The child will be assigned to an MCO and can then request to change to a different plan within 90 days of the initial enrollment for any reason. After 90 days, you can only switch to a different plan if you have a good reason, such as poor quality of care, lack of access to covered services under the plan, or lack of access to providers who are experienced in dealing with the child’s health care needs. 

Under the Hawki program, these MCOs provide the insurance, and you will receive an insurance card with the program's name and information on coverage. Under the Hawki program, each plan must cover the following:

Doctor visits 

Primary Care Provider

Specialists

Immunizations (shots)

Check-ups

Hospital care

Surgery

Emergencies

Non-emergency use of the ER

Out-of-network coverage

Eye exams

Eye glasses and contact lenses

Prescriptions

Mental health services

Substance use disorder

Dental health care and exams

Ambulance services

Physical therapy, speech therapy, and occupational therapy

 

You need to report changes that might affect eligibility to the third-party administrator promptly. 

• If your child who is getting Hawki coverage enters a non medical public institution (like a jail) 
• If your child who is getting Hawki coverage moves to another state 
• If your child who is getting Hawki coverage is enrolled in other health insurance coverage 
• If you (the child's parent) start working for the state of Iowa 
• If your income (the income of the child's family) decreases (so that your premium may be decreased)

Once your child has been approved for Hawki, the enrollment lasts for 12 months. If the family's income increases during those 12 months, that change will not affect the child's eligibility.

There will be a review of eligibility every 12 months. At that time, you should report if your income has increased. 

 

Will I be notified if something happens and I will have to pay more or my child's enrollment will be cancelled or denied?

You will receive a written notice when you are approved, AND if there are any changes that adversely affect you or your child. 

You have a right to appeal. If eligibility for Hawki is terminated or the assigned premium changes, then you will need to file an appeal with DHS. If the MCO denies coverage for a service, then you need to file an appeal with the MCO.

Iowa Legal Aid provides help to low-income Iowans. 

To apply for help from Iowa Legal Aid:

• Call 800-532-1275.
• Iowans age 60 and over, call 800-992-8161.
• Apply online at iowalegalaid.org