Medicaid Estate Recovery in Iowa

What is recovered

Iowa Code 249A.53(2) makes all medical assistance provided on the recipient's behalf a debt due from the estate.¹

Rule 441-75.28(7) includes the capitation fees the state paid to a managed care organization, even if the plan paid for no services.²

Effective January 1, 2010, 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 (Rule 441-75.28(7)).^{2, 3}

Who is subject to recovery

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.^{1, 2}

What counts as the estate

Iowa Code 249A.53(2)(c) reaches 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.¹

When recovery is deferred or barred

Iowa waives recovery to the extent it 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.³

The waived amount can become a debt due later from the spouse's or child's estate.³

Undue-hardship waiver

Iowa also waives recovery where it would work an undue hardship under 42 U.S.C. 1396p(b)(3).³

Rule 441-75.28(7)"g" finds undue hardship when household income is under 200% of the federal poverty level, household resources are $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.²

The waiver request is a written statement with verification, due within 30 days of the notice of estate recovery.²

How the state files its claim

Iowa Code 249A.53(2)(f) requires a facility administrator and the personal representative to report the death to the Estate Recovery Program within ten days of death.¹

The recovery claim is a debt of the estate, classified with taxes having preference.³

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

Report of the death to the Estate Recovery Program by a facility administrator and the personal representative

ten days after the date of death¹

Written request for an undue-hardship waiver, with verification

within 30 days of the notice of estate recovery²

1. 1.Iowa Code 249A.53
2. 2.Iowa Admin. Code r. 441-75.28
3. 3.Estate Recovery (Iowa Health and Human Services)