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Title 8: Medicaid Page 31 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Transfer of Assets Revised September 13, 2024 Transfers That Cause a Medicaid Penalty Transfers That Cause a Medicaid Penalty Legal reference: 441 IAC 75.23(249A), P. L. 100-360 Transfers that currently may result in a Medicaid penalty being applied are:  Transfers by an applicant or an applicant’s spouse to someone other than a spouse that are made on or after February 8, 2006, and within 60 months before the Medicaid application is filed or on or after the date of application. This includes: • The disclaimer of an inheritance, and • Failure to take a share of an estate as a surviving spouse (also known as “taking against a will”) if the value received by taking against the will would exceed the inheritance received under the will  Transfers by an applicant or an applicant’s spouse involving funds in a trust that are made after August 10, 1993, and during the 60 months before the Medicaid application is filed and after institutionalization. Purchases Considered Transfers for Less Than Fair Market Value Legal reference: 441 IAC 75.23(9), (10), and (11) A transfer of assets for less than fair market value includes, but is not limited to, the following actions:  Purchase of an annuity before February 8, 2006, if the expected return on the annuity is not commensurate with a reasonable estimate of life expectancy, also referred to as “actuarially sound.” When an annuity purchased before February 8, 2006, is “actuarially sound,” then it is not considered a transfer of assets for less than fair market value. The annuitant has just converted the resources to income. To determine whether the annuity is “actuarially sound,” use the life expectancy tables compiled from information published by the Office of the Chief Actuary of the Social Security Administration. These tables may be accessed at http://www.ssa.gov/OACT/STATS/table4c6.html. The average number of years of expected life remaining for the annuitant must coincide with the life of the annuity. If the annuitant is not reasonably expected to live as long as or longer than the guarantee period of the annuity, the annuitant will not receive fair market value for the annuity based on the projected return.