Medicaid Estate Recovery in Iowa

Medicaid Estate Recovery in Iowa: key facts

Recovery scope

All medical assistance provided on the recipient's behalf (Iowa Code 249A.53(2)), including capitation fees paid to a managed care organization even if the plan paid for no services. Medical assistance paid for Medicare cost sharing, or for benefits described in Section 1902(a)(10)(E) of the Social Security Act, is not subject to recovery, effective January 1, 2010 (Iowa Admin. Code r. 441-75.28(7)).

Who is subject

Recipients age 55 or older when assistance was provided, and residents of a nursing facility, ICF, or mental health institute who could not reasonably be expected to return home.

Estate reached

Real property, personal property, and any asset in which the recipient held legal title or interest at death, including jointly held property, retained life estates, and interests in trusts (Iowa Code 249A.53(2)(c)).

Recovery waived or deferred

For amounts that would reduce what a surviving spouse, or a surviving child who was under 21, blind, or permanently and totally disabled at death, receives from the estate; and for undue hardship under 42 U.S.C. 1396p(b)(3).

Hardship waiver test

Household income under 200% of the federal poverty level, household resources of $10,000 or less, and recovery would deprive the household of food, clothing, shelter, or medical care such that life or health would be endangered. The written request is due within 30 days of the estate recovery notice (Iowa Admin. Code r. 441-75.28(7)"g").

Governing law: Iowa Code 249A.53; Iowa Admin. Code r. 441-75.28(7)

Steps to take when someone dies

1. Determine whether the deceased received Medicaid at age 55 or older, or as a long-term care facility resident who could not be expected to return home.
2. Report the death to the Iowa HHS Estate Recovery Program; a facility administrator and the personal representative must report within ten days of death (Iowa Code 249A.53(2)(f)).
3. Provide the requested information about the deceased's assets so the program can determine the amount of the claim.
4. Address the recovery claim as a debt of the estate, classified with taxes having preference, before distributing assets to heirs.
5. Apply for a hardship waiver within 30 days of the estate recovery notice if recovery would deny the household food, clothing, shelter, or medical care and the household is under 200% of the federal poverty level with resources of $10,000 or less (Iowa Admin. Code r. 441-75.28(7)"g").

Frequently asked questions