Iowa Medicaid Estate Recovery

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

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

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

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

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

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

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

Medical Assistance Income Trusts and Special Needs Trusts aka Miller Trusts Special Needs Trusts Pooled Trusts