470 4339-2026

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The document is a form from the Iowa Department of Human Services regarding the Medical Assistance Debt Response, which outlines the information required for the Estate Recovery Program. It requests details about the deceased Medicaid member's assets, expenses, and marital status to assess any medical assistance debt owed. The form must be completed and returned within 30 days.

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Click ‘Get Form’ to open the 470 4339 in the editor.
Begin by entering the name of the deceased in the designated field at the top of the form.
Proceed to list allowed expenses of the deceased. Be thorough and include all relevant costs, such as court costs and attorney fees.
Next, provide details about the value of assets at the time of death. Attach any necessary statements that verify these amounts.
Fill in information regarding any debts owed, including taxes or mortgages. Ensure accuracy to avoid delays.
Indicate whether there were any life estates or other interests in real estate. If applicable, estimate their value.
Complete sections on nursing home payments and marital status, ensuring all fields are filled out correctly.
Finally, certify your information by signing and dating the form before submitting it back via fax or mail.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I avoid Medicaid estate recovery in Iowa?

In a married couple where only one spouse is on Medicaid, Estate Recovery often can be avoided by making sure all assets in the name of the spouse receiving Medicaid are transferred into the name of the community spouse.

How do I protect my assets from Medicaid in Iowa?

One strategy we often recommend is setting up an Irrevocable Trust. In Iowa, assets held in an irrevocable trust are generally not considered a part of the Medicaid applicants assets, providing they were transferred to the trust more than five years prior to applying for Medicaid.

Does Iowa Medicaid check your bank account?

Bank Account Checks: An Integral Part of Eligibility Medicaid eligibility in Iowa is largely determined by income and asset limitations. Therefore, bank account checks are an integral part of the process. Medicaid wants to ensure that recipients truly need the assistance.

What is the lookback period for Medicaid in Iowa?

Remember, when spending down assets, its important that one does not give away assets or sell them under market value. This is because in Iowa, Medicaid has a Look- Page 6 Back period of 60 months.

Do I have to pay back Medicaid in Iowa?

ing to federal and state law, the money that the Medicaid program pays on behalf of a Medicaid recipient, who was age 55 or older or in a long-term care facility, is a debt owed back to the state.

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Do you have to pay Medicaid back in Iowa?

When you receive medical benefits, including the capitation fees paid to the MCOs, and even if the plan did not pay for any services, the state of Iowa has the right to ask for money back from your estate following your death. The state will never ask for more money back than it was paid.