hawk-i Insurance for Children
Authored By: Iowa Legal Aid
Hawk-i 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).
Hawk-i 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 hawk-i 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 and no more than a total of $20 per month per child, and no family will pay more than $40 per month.
Right now, the only co-pay is a $25 co-payment for each 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 150% of the federal poverty level for a family of the same size. The co-pay doesn't apply when the child is an eligible American Indian or Alaskan Native.
In order to be eligible for the hawk-i 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 hawk-i.
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 hawk-i. In fact, when hawk-i gets an application for a child, they screen it for Medicaid eligibility. If the child would be eligible for Medicaid, the hawk-i program refers the family to DHS, which will contact the family to see if they wish to receive Medicaid benefits.
What happens when my child is approved for hawk-i?
You will get a written decision telling you that your child has been approved.
There are 2 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
Delta Dental is the administrator of the dental program.
If more than one plan is available to you, then you will be asked to choose a plan. If you do not choose a plan within 10 working days, then the third-party administrator will choose a plan for you and notify you of enrollment in that plan.
Under the hawk-i program, these MCOs 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:
Primary Care Provider
Non-emergency use of the ER
Eye glasses and contact lenses
Mental health services
Substance use disorder
Dental health care and exams
You need to report changes that might affect eligibility to the third-party administrator promptly.
- If your child who is getting hawk-i coverage enters a non medical public institution (like a jail)
- If your child who is getting hawk-i coverage moves to another state
- If your child who is getting hawk-i 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 hawk-i, 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. You will need to file an appeal with your managed care organization before you can file an appeal with DHS.
Iowa Legal Aid provides help to low-income Iowans.
To apply for help from Iowa Legal Aid:
- Iowans age 60 and over, call 800-992-8161.
- Apply online at iowalegalaid.org