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Form 470-5170 - Iowa Department of Human Services - Iowa.gov - dhs state ia-2026

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The document is an application form from the Iowa Department of Human Services for health coverage and financial assistance with medical costs. It outlines eligibility criteria for various health insurance options, including private plans, Medicaid, and CHIP, emphasizing that families can apply regardless of income levels or existing coverage. The application process is detailed, including required information about family members, income, and current health insurance. Assistance options are provided for completing the application, and it assures confidentiality of personal information.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out your personal information in Step 1. Include your first name, last name, address, and contact details. Ensure accuracy as this will be used for communication regarding your application.
In Step 2, provide details about all family members living with you. List their names, relationships, and relevant information such as Social Security Numbers if applicable.
Continue through the form by answering questions related to income and employment for each family member. Be thorough to ensure eligibility for health coverage options.
Once all sections are completed, review your entries for accuracy before signing the application on the designated page.
Finally, submit your completed application by mailing it to the address provided at the end of the form.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (40 Votes)
2016	1 Satisfied (14257 Votes)
2015	4.3 Satisfied (46 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to fill out a Medicaid application?

Call our toll-free Provider Services number at 833-404-1061 from any touch-tone phone and follow the appropriate menu options to docHub our automated member eligibility-verification system 24 hours a day. The automated system will prompt you to enter the member Medicaid ID and the month of service to check eligibility.

How do I verify my Medicaid eligibility in Iowa?

The Iowa Departments of Public Health (IDPH) and Human Services (DHS) are becoming one, single, department. IDPH and DHS will fully transition into the Iowa Department of Health and Human Services (HHS) by July 1, 2023.

What is the maximum amount you can make to qualify for Medicaid?

For the state of Iowa, adults who are under the age of 65 and have incomes 138% of the federal poverty level (FPL) or lower are eligible for Medicaid. For children under age one, Medicaid eligibility is possible so long as the family doesnt make more than 220% of the FPL.

What is the eligibility status for Iowa Medicaid?

Income is verified through federal and state data sources. If the result is compatible, eligibility is approved.

What is the maximum income to qualify for Medicaid in Iowa?

Adults (Ages 19-64) Persons in householdIncome limit 1 $20,030 2 $27,185 3 $34,341 4 $41,4965 more rows

dhs iowa gov forms

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What is the income limit to get Medicaid in Iowa?

Your state Medicaid agency may ask for: Your name and date of birth. Your Social Security number. Your monthly payment amounts for rent, mortgage, or utilities. Proof of citizenship or immigration status. Proof of income, like paystubs or W-2s. A verification of what other government benefits you receive.