1. Iowa Medicaid Estate Recovery

2. Processes Outreach and Referrals Obtaining Debt Information
Contacts with Personal Representatives
Probate (Filing claims)
Iowa Code ; A, , and
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 ), 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 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
aka Miller Trusts
Special Needs Trusts
Pooled Trusts