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Title 8: Medicaid Table of Contents Chapter D: Resources Revised September 13, 2024 Page 1 Page Iowa Department of Health and Human Services Employees’ Manual Overview .................................................................................................................................... 1 Attribution of Resources .......................................................................................................... 1 Resources Excluded from Attribution ................................................................................. 4 Calculating the Amount to Attribute to the Community Spouse .......................................... 5 If the Applicant Appeals the Attribution Amount.......................................................... 7 Increase in the Minimum and Maximum Allowance for Community Spouse ............ 15 Processing a Medicaid Application After Attribution ......................................................... 16 When Spouses Are Estranged ................................................................................. 19 Assignment of Support Rights .................................................................................. 19 Transfers to Establish Ongoing Eligibility ................................................................. 20 Summary Examples ......................................................................................................... 22 Estate Recovery ...................................................................................................................... 24 Establishing Whether a Member Under Age 55 Can Return Home .................................. 25 Estate Recovery Agent ..................................................................................................... 26 Amount Due ..................................................................................................................... 27 When Estate Recovery Is Waived .................................................................................... 28 Transfer of Assets .................................................................................................................. 29 Transfers That Cause a Medicaid Penalty ........................................................................ 31 Purchases Considered Transfers for Less Than Fair Market Value ......................... 31 Transfers That Do Not Cause a Penalty ........................................................................... 34 Rebuttal of Transfer of Assets .......................................................................................... 39 Penalties for Transferring Assets ..................................................................................... 42 Multiple Transfers ............................................................................................................. 48 Transfers Before February 8, 2006 ........................................................................... 48 Transfers on or After February 8, 2006 .................................................................... 48 Return or Partial Return of the Transferred Asset .................................................... 50 Trusts....................................................................................................................................... 51 Trust Definitions ............................................................................................................... 52 Evaluating a Trust............................................................................................................. 54 Treatment of Resources in a Trust ................................................................................... 56 Trusts Established with Assets Not Owned by Beneficiary ............................................... 62 Medicaid Qualifying Trusts ............................................................................................... 63 Counting Income or Resources ................................................................................ 64 Client Participation .................................................................................................... 66 Trusts Established After August 10, 1993 ........................................................................ 67 Revocable Trusts ...................................................................................................... 67 Irrevocable Trusts ..................................................................................................... 68 Special Needs Trust for Persons Under 65 Years Old ............................................. 69 Medical Assistance Income Trust (MAIT) ................................................................. 70 Special Needs Trust (Pooled Trust) .......................................................................... 70