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 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:
- UnitedHealthCare Plan of the River Valley Inc. (1-800-464-9484)
- Wellmark Health Plan of Iowa Blue Access (1-800-211-6797)
- Delta Dental (1-800-544-0718) and TDD at (1-888-287-7312).
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 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:
Outpatient hospital services
Well child visits
Vaccines and shots (immunizations)
Inpatient hospital services
Eye glasses and vision exams
Dental care and exams
Speech therapy and physical therapy
Nursing care services
Durable medical equipment
Home health care
Mental health/substance abuse care
Each plan provides 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. In all the plans, eye glasses are covered up to $100.00 per year.
You need to report changes that might affect eligibility to the third-party administrator within 10 working days of the change. The day of the change is counted as the first day of the 10 days.
- If your child who is getting hawk-i coverage becomes pregnant
- 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?
The third-party administrator is supposed to send you 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 should take a written letter to the DHS office in your county and tell them that you want to appeal the reduction, cancellation, or denial. DHS will then decide whether your appeal was filed in time. If it was filed in time, then DHS will set a hearing.
The time limit for filing an appeal is 30 days after the date on the notice that you want to appeal, OR before the effective date of action. For example, DHS might send you a notice dated July 10, 201208, that you will have to start paying more for a premium starting on September 1, 201208. In that case, you will have until August 31, 201208, to file an appeal (which is more than 30 days after the date on the notice).
If you file your request for appeal more than 30 days after the date on the notice, but less than 90 days after the date, then DHS will decide whether you had "good cause" for filing late.