441—86.4 (514I) Coordination with Medicaid.
	 86.4(1) HAWK-I applicant appears eligible for Medicaid. At the time of initial application, if it appears the child may be eligible for Medicaid in accordance with the provisions of rule 441—75.1(249A), with the exception of meeting a spenddown under the medically needy program at 441—subrule 75.1(35), a referral shall be made by the third-party administrator to the department for a determination of Medicaid eligibility as follows:
	  a.   	 The original Healthy and Well Kids in Iowa (HAWK-I) Application, Form 470-3526, or Form 470-4016, HAWK-I Electronic Application Summary and Signature Page, and copies of any accompanying information and verification shall be forwarded to the department within 24 hours, or the next working day, whichever is sooner. The third-party administrator shall maintain a copy of all documentation sent to the department and a log to track the disposition of all referrals.
	  b.   	 The third-party administrator shall notify the family that the referral has been made. The third-party administrator shall return to the family any original verification and information that was submitted with the application and retain a copy in the file record.
	  c.   	 The referral shall be considered an application for Medicaid in accordance with the provisions of rule 441—76.1(249A). The time limit for processing the referred application begins with the date the Healthy and Well Kids in Iowa (HAWK-I) Application, Form 470-3526, or Form 470-4016, HAWK-I Electronic Application Summary and Signature Page, is date-stamped as being received by the third-party administrator.
	 86.4(2) HAWK-I enrollee appears eligible for Medicaid. At the time of the annual review, if it appears the child may be eligible for Medicaid in accordance with the provisions of rule 441—75.1(249A), with the exception of meeting a spenddown under the medically needy program at 441—subrule 75.1(35), the third-party administrator shall make a referral to the department for a determination of Medicaid eligibility as stated in subrule 86.4(1) above. However, the child shall remain eligible for the HAWK-I program pending the Medicaid eligibility determination unless the 12-month certification period expires first.
	 86.4(3) Medicaid applicant not eligible. If a child is not eligible for Medicaid under the provisions of rule 441—75.1(249A), with the exception of meeting a spenddown under the medically needy program at 441—subrule 75.1(35), or is voluntarily excluded from the Medicaid eligible group under the provisions of 441—75.59(249A) and meets the criteria specified at 86.2(5), the department shall make a referral to the third-party administrator for an eligibility determination under the HAWK-I program as follows:
	  a.   	 The department worker shall submit an electronic referral to the HAWK-I program or complete Form 470-3563, Referral to HAWK-I, and send the form and a copy of the Medicaid notice of decision to the third-party administrator.
	  b.   	 The third-party administrator shall date-stamp Form 470-3563 with the date the completed form is received.
	  c.   	 The third-party administrator shall notify the family of the referral and proceed with an eligibility determination under the HAWK-I program.
	  d.   	 The period for processing the referral begins with the day on which:
	 (1) 	 Form 470-3563, Referral to HAWK-I, is date-stamped as received by the third-party administrator; or
	 (2) 	 The third-party administrator receives the electronic referral file.
	 86.4(4) Medicaid member becomes ineligible. If a child becomes ineligible for Medicaid under the provisions of rule 441—75.1(249A), with the exception of meeting a spenddown under the medically needy program at 441—subrule 75.1(35), or is voluntarily excluded from the Medicaid eligible group under the provisions of rule 441—75.59(249A) and meets the criteria specified at subrule 86.2(5), the department shall make a referral to the third-party administrator for an eligibility determination under the HAWK-I program as follows:
	  a.   	 The department worker shall submit an electronic referral to the HAWK-I program or complete Form 470-3563, Referral to HAWK-I, and send the form and a copy of the Medicaid notice of decision to the third-party administrator.
	  b.   	 The third-party administrator shall:
	 (1) 	 Date-stamp Form 470-3563 with the date the completed form is received;
	 (2) 	 Notify the family of the referral; and
	 (3) 	 Proceed with an eligibility determination under the HAWK-I program.
	  c.   	 The period for processing the referral begins with the day on which:
	 (1) 	 Form 470-3563, Referral to HAWK-I, is date-stamped as received by the third-party administrator; or
	 (2) 	 The third-party administrator receives the electronic referral file.