Table of Contents

State/Territory Name: IA

State Plan Amendment (SPA) #: 20-0003

This file contains the following documents in the order listed:

1) Approval Letter2) Summary Form (with 179-like data)3) Approved SPA Page

DEPARTMENTOFHEALTH & HUMANSERVICESCentersforMedicare & MedicaidServices601East12thStreet, Suite355KansasCity, Missouri64106-2898

MedicaidandCHIPOperationsGroup

June15, 2020

MichaelRandol, MedicaidDirectorDivisionofMedicalServicesDepartmentofHumanServicesIowaMedicaidEnterprise611FifthAvenueDesMoines, IA50309

DearMr. Randol:

TheCentersforMedicareandMedicaidServices (CMS) hascompleteditsreviewofIowa’sStatePlanAmendment (SPA) #20-0003, whichwassubmittedonMarch31, 2020. ThepurposeofSPA #20-0003istoincreasethepremiumsassessedtoindividualsenrolledintheeligibilitygroupundersection1902(a)(10)(A)(ii)(XIII) oftheSocialSecurityActbeginningonAugust1, 2020. Thisisanannualadjustment. CMSisapprovingthisSPAsubjecttocertainlimitations, whichareexplainedinfurtherdetailbelow.

OnMarch18, 2020, theFamiliesFirstCoronavirusResponseAct (FFCRA) wassignedintolawPub. L. 116-127). TheFFCRAauthorizesatemporary6.2percentagepointincreasetoeach

qualifyingstateFederalMedicalAssistancePercentage (FMAP) undersection1905(b) oftheSocialSecurityAct. StatesmayclaimthisenhancedFMAPforexpendituresbeginningJanuary1, 2020andextendingthroughthelastdayofthecalendarquarterinwhichthepublichealthemergencyisdeclaredbytheSecretaryofHealthandHumanServices.

InordertoqualifyfortheenhancedFMAP, statesneedtomeetcertainrequirementsinsection6008oftheFFCRA. Whilestatesmaycontinuetocollectpremiumsduringthepublichealthemergencyperiod, undersection6008(b)(2) oftheFFCRA, statesmaynotincreasepremiumstoanamounthigherthanthatassessedonJanuary1, 2020. Assuch, ifthepublichealthemergencyhasnotendedbyAugust1, 2020, thestatehasagreednottoimplementthepremiumincreaseauthorizedinSPA20-003inordertocomplywiththeFFCRA. Instead, thestatewillsuspendallpremiumsforthiseligibilitygroup, perthestate’sdisasterSPA, #20-0008. OnceCMSnotifiesthestatesthatthepublichealthemergencyhasendedandstatescannolongerclaimenhancedFMAP, thenthestatecanresumepremiumassessmentsforthiseligibilitygroupandincreasethepremiumspertheamendedscheduleafterthestate’srulemakingprocesshasclosed.

CMSapprovedthisSPAonMay21, 2020, withaneffectivedateofAugust1, 2020, pursuanttothelimitationsoutlinedabove. EnclosedisacopyoftheCMS-179summaryform, aswellastheapprovedpageforincorporationintotheIowaStatePlan.

Page2 – MichaelRandol, MedicaidDirector

Ifyouhaveanyquestionsaboutthisletterorrequireanyfurtherassistance, pleasecontactLauraD’Angeloat (816) 426-6425, orLaura.DAngelo1@cms.hhs.gov.

Sincerely,

X JamesG. Scott, DirectorDivisionofProgramOperations

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ATTACHMENT2.6-APage12c

State: Iowa

CitationConditionorRequirement

Thedefinitionof “family” forpurposesofthe250% familyincomeeligibilitytestincludes:

Fordisabledindividualsunder18andunmarried: theindividual, parentslivingwiththeindividual, unmarriedsiblingsunder18livingwiththeindividual, andchildrenoftheindividualwholivewiththeindividual.

Fordisabledindividuals18orolderormarried: theindividual, theindividual’sspouselivingwiththeindividual, andanyunmarriedchildrenunder18whoarelivingwiththeindividual.

Incomparingfamilyincometo250%, SSIincomedisregardsandexemptionsareapplied. Indeterminingwhetherthe250% familyincomeeligibilitytestismet, disregardtheamountofincomeequaltothesocialsecuritycost-of-livingadjustmentfortheyearuntilthefederalpovertylevelincreasegoesintoeffectfortheyear.

Premiumswillbechargedforrecipientswithgrossincomeinexcessof150% ofthefederalpovertylevelandwillbeadjustedannuallybasedonchangesintheaveragestateemployeehealthinsurancepremium. Thepremiumisdeterminedaccordingtoaslidingscalebasedonincome, withthemaximumpremium, basedontheaveragestateemployee’shealthinsurancepremium, chargedonlywhennotmorethan5% ofgrossincome.

MonthlypremiumamountsestablishedAugust1, 2020; beginat $35withgrossincomegreaterthan150% ofthefederalpovertylevelandincreasetoamaximumof $829withgrossincomegreaterthan1550% ofthefederalpovertylevel. Noothercost-sharingchargesapplytothisgroup, exceptforotherwiseapplicableIowaMedicaidco-payments, subjecttotheaggregatelimitsdescribedin42C.F.R. §447.56(f).

Indeterminingthemonthlypremiumamount, thegrossincomefigureusedincalculationofthemonthlypremiumwillnotincludethecost-of-livingadjustmentfortheyearuntilthefederalpovertylevelfortheyeargoesintoeffect.

TNNo. IA-20-003SupersedesApprovalDateEffectiveDateTNNo. IA-19-005