Iowa Medicaid Estate Recovery

1. Iowa Medicaid Estate Recovery

2. Processes • Outreach and Referrals • Obtaining Debt Information • Contacts with Personal Representatives • Probate (Filing claims) Iowa Code 633.231; 633.304A, 633.410, and 635.13 • Non-probate (Letters) • Probate administration • TEFRA liens – not available in Iowa • Responses and Follow-up • Deposits to Medicaid Fund • Consistency of Revenue to the State

3. What to collect • As authorized under 42 USC 1396p(b), all Medicaid services provided, as limited by MIPPA • HMO’s and capitation fees • Buy-in (Medicare premiums) • Interest

4. From which estates? • Age requirement – 55 and over • Long term care requirement (under 55) • Liability for personal representatives who distribute funds without paying medical assistance debt

5. Waivers and Exemptions • Spouse, Disabled children, Minor children • Hardship waivers • Homestead exemption not applicable per se (See Iowa Code 561.19), but hardship waiver may apply

6. Probate Assets • Bank accounts • Real estate • Excess burial funds and life insurance • Household goods • Litigation • Vehicles • Stocks, bonds, and mineral interests

7. Expanded Probate Assets • Joint property -- Estate of Serovy, Estate of Kirk • Life estates -- Estate of Laughead • Trusts -- Trust of Barkema and Iowa Code 633.2301 et seq. • Annuities • Pay on death (POD’s), Transfer on death (TOD’s) and other assets with beneficiary designations

8. Higher priority expenses • Court costs and costs of administration • Funeral expenses • Medical bills of last illness • Taxes (federal and state) • Higher priority expenses do not apply to Income Trusts, SNT’s, and Pooled Trusts • Other

9. Medical Assistance Income Trusts and Special Needs Trusts • Medical Assistance Income Trusts aka Miller Trusts • Special Needs Trusts • Pooled Trusts