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Title 8: Medicaid Page 2 Iowa Department of Health and Human Services Employees’ Manual Chapter D: Resources Attribution of Resources Revised July 10, 2026

Complete the attribution using the resources the couple had as of the first day of the month that:  The institutionalized spouse enters a medical institution (on or after September 30, 1989) expecting to stay 30 consecutive days or more, or  The Medical Services Unit at the Iowa Medicaid or Managed Care Organization (MCO) determines that the Medicaid HCBS waiver or PACE applicant meets level of care. Information needed to attribute resources is included on the Medicaid application forms. Use form 470-2577, Resources Upon Entering a Medical Institution to attribute resources when:  The month of entry to the institution and the month of application are different, or  A married Medicaid member requests home- and community-based waiver or PACE services, or  Either the institutionalized spouse or the community spouse requests attribution but does not apply for Medicaid. Do not approve Medicaid until the attribution is completed. Complete the attribution within 45 calendar days. Complete only one attribution per community spouse per case. After an attribution has been completed, do not complete a new attribution if:  The institutionalized spouse is discharged after the 30 days but later reenters a medical institution.  The attribution was completed for a waiver or PACE application but the application was denied.  The attribution was completed for waiver or PACE services and the waiver or PACE spouse later enters a medical facility.  A person whose attribution was completed in another state applies for institutional care in Iowa. However, if that state has a lower minimum community spouse resource allowance, recalculate the attribution and assign Iowa’s minimum.