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Title 8: Medicaid Page 33 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Transfer of Assets Revised July 10, 2026 Transfers That Cause a Medicaid Penalty • The annuity has the state of Iowa named as the remainder beneficiary for at least the total amount of medical assistance paid on behalf of the annuitant or the annuitant’s spouse, if either is currently institutionalized. Iowa may be named as either:  The remainder beneficiary in the first position, or  The remainder beneficiary in the second position, after the community spouse, minor child or disabled child, and in the first position if the spouse or a representative of the child does dispose of the remainder for less than fair market value. NOTE: When an annuity has the state of Iowa named as a remainder beneficiary, complete form 470-4382, Notification Regarding Annuity Benefits and send it to the annuity company. • Purchase of an annuity on or after February 8, 2006, with the spouse of a Medicaid applicant or member as the annuitant, unless the annuity has the state of Iowa named as the remainder beneficiary for at least the total amount of medical assistance paid on behalf of the annuitant or the annuitant’s spouse, if either is currently institutionalized. Iowa may be named as either:  The remainder beneficiary in the first position, or  The remainder beneficiary in the second position, after the community spouse, minor child or disabled child, and in the first position if the spouse or a representative of the child does dispose of the remainder for less than fair market value. NOTE: When an annuity has the state of Iowa named as a remainder beneficiary, complete form 470-4382, Notification Regarding Annuity Benefits and send it to the annuity company.  Any purchase of a promissory note, loan, or mortgage made before February 8, 2006; or any purchase of a promissory note, loan, or mortgage made on or after February 8, 2006, unless the note, loan, or mortgage meets all of the following criteria: • It has a repayment term that is actuarially sound, as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration (see Loans and Promissory Notes); • It provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and • It prohibits the cancellation of the balance upon the death of the lender.