441—92.2 (249A,249J) Eligibility. IowaCare eligibility shall be determined according to the requirements of rules 441—75.2(249A) to 441—75.4(249A), 441—75.7(249A), 441—75.10(249A), and 441—75.12(249A) and the provisions of this rule.
	 92.2(1) Persons covered. Medical assistance under IowaCare shall be available to the following people as provided in this chapter:
	  a.   	 Persons 19 through 64 years of age who:
	 (1) 	 Are not eligible for medical assistance under 441—subrules 75.1(1) through 75.1(40) or 75.1(42), including persons unable to meet spenddown under 441—subrule 75.1(35); and
	 (2) 	 Have countable income at or below 200 percent of the federal poverty level.
	  b.   	 Pregnant women whose:
	 (1) 	 Gross countable income is below 300 percent of the federal poverty level; and
	 (2) 	 Allowable medical expenses reduce their countable income to 200 percent of the federal poverty level or below.
	  c.   	 Newborn children born to women defined in paragraph “b.”
	 92.2(2) Citizenship. To be eligible for IowaCare benefits, a person must meet the requirements in 441—paragraph 75.11(2)“a.” A person who claims a qualified alien status shall provide documentation of this status.
	 92.2(3) Other disqualification. A person who has been disqualified from Medicaid for reasons other than excess income, excess resources, or lack of categorical eligibility is not eligible for IowaCare benefits.
	 92.2(4) Group health insurance. A person who has access to group health insurance is not eligible for IowaCare. An applicant or member shall not be considered to have access to group health insurance if any of the following conditions exist:
	  a.   	 The applicant or member is not enrolled in the available group health plan and states that:
	 (1) 	 The coverage is unaffordable; or
	 (2) 	 Exclusions for preexisting conditions apply; or
	 (3) 	 The needed services are not services covered by the plan.
	  b.   	 The applicant or member is enrolled in a group health plan but states that:
	 (1) 	 Exclusions for preexisting conditions apply; or
	 (2) 	 The needed services are not covered by the plan; or
	 (3) 	 The limits of benefits under the plan have been reached; or
	 (4) 	 The plan includes only catastrophic health care coverage.
	 92.2(5) Payment of assessed premiums. As a condition of eligibility for IowaCare, an applicant or member must pay premiums in accordance with 441—92.7(249A,249J). Premiums incurred and unpaid from a previous certification period must be paid in full before an applicant can establish new eligibility under this chapter.
	 92.2(6) Availability of funds. Eligibility for IowaCare shall not be approved when the department has determined that there are insufficient funds available to pay for additional enrollment, in accordance with 441—92.14(249A,249J).