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Title 8: Medicaid Page 13 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Benefits Revised January 13, 2023 Recovery Members usually repay the Department directly. In the case of overpayment due to incorrect calculation of client participation for a member in a nursing facility, PMIC, ICF/ID, or mental health institute, the member repays the facility. The Department then recovers the funds from the facility through a vendor adjustment. See 8-I, Client Participation. Amount to Recoup Policy: Consider the following when determining the Medicaid claim amount:

When: Recoup: The overpayment was a member error, and the member is completely ineligible for Medicaid… All Medicaid claims paid, including capitation fees. The overpayment was an agency error… All Medicaid claims paid except for capitation fees. The member is ineligible for full Medicaid but continues to be eligible for Qualified Medicare Beneficiary (QMB)… All Medicaid claims, including capitation fees. Do not include Medicare Part A or Part B premiums, Medicare deductibles, Medicare copayments or co- insurance. The member is ineligible for full Medicaid but continues to be eligible for Specified Low-Income Medicare Beneficiary (SLMB)… All Medicaid claims, including capitation fees. Do not include Medicare Part B premiums. The member is ineligible for HCBS waiver services but continues to be eligible for Medicaid… Claims paid for HCBS waiver services only. The member is ineligible for nursing facility services but continues to be eligible for Medicaid… Claims paid for nursing facility services only. The member is not eligible for full Medicaid, but would be eligible for Medically Needy with a spenddown… Medicaid claims paid up to the spenddown amount, plus claims paid for any waiver or any nursing facility services. If the member continues to: ▪ Be eligible for QMB do not include Medicare Part A or Part B premiums, Medicare deductibles, Medicare co-payments or co- insurance. ▪ Be eligible for SLMB do not include Medicare Part B premiums. See Medically Needy Overpayment for more information. The member is ineligible because the member is an inmate in a public institution… All Medicaid claims paid including capitation fee. Do not include inpatient hospital services that are provided at a nonpenal institution. The member is eligible for Medicaid but not eligible for residential care facility assistance… Claims paid for State Supplementary Assistance only.