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Title 8: Medicaid Page 12 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Benefits Revised January 13, 2023 Recovery ▪ When the overpayment is caused by a member error, go back to when the error occurred and redetermine eligibility as if the information was timely reported. If an overpayment exists, it begins the month following the month of the member error. EXCEPTION: When the member does not report the receipt of a lump-sum payment timely, the overpayment begins the month the lump sum was received.

1. The worker discovers at the annual review in July that Mr. B began a new job at XYZ Inc. the previous January and didn’t report it. Mr. B received his first check from XYZ Inc. on January 13. He did not report this income within ten days of receipt of his first check. If an overpayment exists, it would begin effective February 1. 2. Same as Example 1, except Mr. B received the first check on January 23 and did not report the receipt of his first check until March 1. If an overpayment exists, it would begin effective February 1. 2. If the reason for the Medicaid overpayment is because of any type of income for any household member, including “absent parent” in the home or an unreported spouse: ▪ Request income information and give them ten days to provide the information. ▪ Explain to the member that failure to provide the income information would: • Result in the Department not being able to determine eligibility, and • Result in a larger overpayment. 3. Send a letter requesting verification. If the member does not provide information, all benefits are subject to recoupment. 4. When income information is provided, determine if family members continue to be Medicaid eligible. Use the information that is now available to determine eligibility and the overpayment. 5. If family members are over income for Medicaid, determine the spenddown amount for Medically Needy for each certification period. This is not a matter of whether the person wants Medically Needy or not, but is a matter of calculating the correct overpayment amount. See Medically Needy Overpayment. 6. If the household received Medicaid but was ineligible, calculate an overpayment. 7. Complete the Initial Claim Entry on line. EXCEPTION: For overpayments before July 1, 1997, contact central office for assistance. 8. Wait to determine the amount of the Medicaid overpayment for six months after the “To Date” on the claim to allow time for claims to be submitted. (While providers have 12 months to submit a claim, the majority of Medicaid claims are submitted in the six-month period after service is given.) See Amount to Recoup. Comment: See 6-G for information about how to establish a claim for an overpayment, repayment options available to members, and types of collection actions.