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Title 8: Medicaid Page 11 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Benefits Revised January 13, 2023 Recovery Recovery Legal reference: 42 CFR 435.930(b) and 455.12, Iowa Code Section 249A.53, 441 IAC 75.28(2) and 76 (Rules in Process) Policy: The Department is responsible for recovering overpayments from a member for all Medicaid funds incorrectly paid to or on behalf of the member. The Department also recovers overpayments from providers. Provider overpayments are processed by the Iowa Medicaid Enterprise (IME). The Department is also responsible for recovering medical assistance paid on behalf of the member from the estates of deceased Medicaid members. See 8-D, Estate Recovery, for information on when estate recovery applies. Comment: Member errors, agency errors, or administrative errors can result in incorrect expenditures. Examples of situations in which overpayments occur are: ▪ Services were incorrectly provided because the member was ineligible. ▪ The member loses an appeal, and assistance was continued pending the decision. Procedure: 1. Determine the period of time during which the overpayment occurred. ▪ When the overpayment is caused by an agency error, go back to the month the error was made and redetermine eligibility as it should have been determined from that point forward.

Mr. A receives his first check from XYZ Inc. on January 23. He reports the new job on January 25. The worker forgets to verify the income from the new job until the case is pulled for the annual review in July. The worker verifies the income at that time. The process that should have taken place is: The worker would have written a letter to Mr. A requesting verification of the new job and allowed ten days to return the verification. The due date would have been in early February. Once the verification was received, if there was a change in eligibility, it would have been effective March 1, allowing a ten-day notice for any negative action. If the worker had acted timely on the new job report, eligibility would not have been affected until March 1. Therefore, if an overpayment exists, it would begin effective March 1 because it was an agency error.