Page 16

Title 8: Medicaid Page 14 Iowa Department of Health and Human Services Employees’ Manual Chapter A: Administration Benefits Revised January 13, 2023 Recovery Medically Needy Overpayment Policy: When income information is provided, the amount of the overpayment shall not exceed the amount of the Medically Needy spenddown. When income information is not provided, the spenddown amounts for Medically Needy cannot be determined and the full amount of Medicaid claims paid must be recouped. Procedure: 1. When the Medicaid overpayment is because the person is over the resource limit for Medicaid, determine if the person’s resources are within the resource limits for other coverage groups, i.e., the Medicare Savings Programs, Medically Needy, MEPD. 2. Give the member the opportunity to provide the income information and explain that the overpayment will not exceed the spenddown amounts. If the member appeals and has not been provided this opportunity, the Department may lose the appeal and the ability to collect on the overpayment. 3. When income is provided, determine the amount of the Medically Needy spenddown for each certification period of the overpayment. ▪ Use only a three-month certification period for retroactive months. ▪ A one-month certification period may be used for overpayments when there is not a second month in the certification period for the overpayment or there is only one month in the retroactive period.

1. Ms. A, a pregnant woman, applies April 1. The Medicaid application is approved with three months of retroactive eligibility. It is later determined that Ms. A was over income for the months of January through June. Ms. A does provide income verification.

Spenddown amounts are determined for the following certification periods: ▪ January, February, and March (retroactive months) ▪ April and May ▪ June