249A.5 - RECOVERY OF PAYMENT.
249A.5 RECOVERY OF PAYMENT.
1. Medical assistance paid to, or on behalf of, a recipient or
paid to a provider of services is not recoverable, except as provided
in subsection 2, unless the assistance was incorrectly paid.
Assistance incorrectly paid is recoverable from the provider, or from
the recipient, while living, as a debt due the state and, upon the
recipient's death, as a claim classified with taxes having preference
under the laws of this state.
2. The provision of medical assistance to an individual who is
fifty-five years of age or older, or who is a resident of a nursing
facility, intermediate care facility for persons with mental
retardation, or mental health institute, who cannot reasonably be
expected to be discharged and return to the individual's home,
creates a debt due the department from the individual's estate for
all medical assistance provided on the individual's behalf, upon the
individual's death.
a. The department shall waive the collection of the debt
created under this subsection from the estate of a recipient of
medical assistance to the extent that collection of the debt would
result in either of the following:
(1) Reduction in the amount received from the recipient's estate
by a surviving spouse, or by a surviving child who was under age
twenty-one, blind, or permanently and totally disabled at the time of
the individual's death.
(2) Otherwise work an undue hardship as determined on the basis
of criteria established pursuant to 42 U.S.C. § 1396p(b)(3).
b. If the collection of all or part of a debt is waived
pursuant to subsection 2, paragraph "a", to the extent the
medical assistance recipient's estate was received by the following
persons, the amount waived shall be a debt due from one of the
following, as applicable:
(1) The estate of the medical assistance recipient's surviving
spouse or child who is blind or has a disability, upon the death of
such spouse or child.
(2) A surviving child who was under twenty-one years of age at
the time of the medical assistance recipient's death, upon the child
reaching the age of twenty-one or from the estate of the child if the
child dies prior to reaching the age of twenty-one.
(3) The estate of the recipient of the undue hardship waiver, at
the time of death of the hardship waiver recipient, or from the
hardship waiver recipient when the hardship no longer exists.
c. For purposes of this section, the estate of a medical
assistance recipient, surviving spouse, or surviving child includes
any real property, personal property, or other asset in which the
recipient, spouse, or child had any legal title or interest at the
time of the recipient's, spouse's, or child's death, to the extent of
such interests, including but not limited to interests in jointly
held property, retained life estates, and interests in trusts.
d. For purposes of collection of a debt created by this
subsection, all assets included in the estate of a medical assistance
recipient, surviving spouse, or surviving child pursuant to paragraph
"c" are subject to probate.
e. Interest shall accrue on a debt due under this subsection,
at the rate provided pursuant to section 535.3, beginning six months
after the death of a medical assistance recipient, surviving spouse,
or surviving child.
f. (1) If a debt is due under this subsection from the estate
of a recipient, the administrator of the nursing facility,
intermediate care facility for persons with mental retardation, or
mental health institute in which the recipient resided at the time of
the recipient's death, and the personal representative of the
recipient, if applicable, shall report the death to the department
within ten days of the death of the recipient.
(2) If a personal representative or executor of an estate makes a
distribution either in whole or in part of the property of an estate
to the heirs, next of kin, distributees, legatees, or devisees
without having executed the obligations pursuant to section 633.425,
the personal representative or executor may be held personally liable
for the amount of medical assistance paid on behalf of the recipient,
to the full value of any property belonging to the estate which may
have been in the custody or control of the personal representative or
executor.
(3) For the purposes of this paragraph, "executor" means
executor as defined in section 633.3, and "personal
representative" means a person who filed a medical assistance
application on behalf of the recipient or who manages the financial
affairs of the recipient. Section History: Early Form
[C62, 66, § 249A.13; C71, 73, 75, 77, 79, 81, § 249A.5] Section History: Recent Form
83 Acts, ch 153, § 14; 94 Acts, ch 1120, §10; 95 Acts, ch 68, § 2;
96 Acts, ch 1107, § 1; 96 Acts, ch 1129, § 65, 113; 2002 Acts, ch
1086, §2, 21; 2003 Acts, ch 62, §3
Referred to in § 523A.303, 561.19, 633.231, 633.304A, 633.356,
633.410, 633.425