249FTRANSFER OF ASSETS — MEDICAL ASSISTANCE DEBT249F.1Definitions.As used in this chapter, unless the context otherwise requires:1“Department” means the department of health and human services.2“Medical assistance” means “mandatory medical assistance”, “optional medical assistance”, “discretionary medical assistance”, or “Medicare cost sharing” as each is defined in section 249A.2 which is provided to an individual pursuant to chapter 249A and Tit. XIX of the federal Social Security Act.3a“Transfer of assets” means any transfer or assignment of a legal or equitable interest in property, as defined in section 702.14, from a transferor to a transferee for less than fair consideration, made while the transferor is receiving medical assistance or within five years prior to application for medical assistance by the transferor. Any such transfer or assignment is presumed to be made with the intent, on the part of the transferee; transferor; or another person acting on behalf of a transferor who is an actual or implied agent, guardian, attorney-in-fact, or person acting as a fiduciary, of enabling the transferor to obtain or maintain eligibility for medical assistance or of impacting the recovery or payment of a medical assistance debt. This presumption is rebuttable only by clear and convincing evidence that the transferor’s eligibility or potential eligibility for medical assistance or the impact on the recovery or payment of a medical assistance debt was no part of the reason of the transferee; transferor; or other person acting on behalf of a transferor who is an actual or implied agent, guardian, attorney-in-fact, or person acting as a fiduciary for making or accepting the transfer or assignment. A transfer of assets includes a transfer of an interest in the transferor’s home, domicile, or land appertaining to such home or domicile while the transferor is receiving medical assistance, unless otherwise exempt under paragraph “b”.bHowever, transfer of assets does not include the following:1Transfers to or for the sole benefit of the transferor’s spouse, including a transfer to a spouse by an institutionalized spouse pursuant to section 1924(f)(1) of the federal Social Security Act.2Transfers to or for the sole benefit of the transferor’s child who is blind or has a disability as defined in section 1614 of the federal Social Security Act.3Transfer of a dwelling, which serves as the transferor’s home as defined in 20 C.F.R. §416.1212, to a child of the transferor under twenty-one years of age.4Transfer of a dwelling, which serves as the transferor’s home as defined in 20 C.F.R. §416.1212, after the transferor is institutionalized, to either of the following:aA sibling of the transferor who has an equity interest in the dwelling and who was residing in the dwelling for a period of at least one year immediately prior to the date the transferor became institutionalized.bA child of the transferor who was residing in the dwelling for a period of at least two years immediately prior to the date the transferor became institutionalized and who provided care to the transferor which permitted the transferor to reside at the dwelling rather than in an institution or facility.5Transfers of less than two thousand dollars. However, all transfers by the same transferor during the five-year period prior to application for medical assistance by the transferor shall be aggregated. If a transferor transfers property to more than one transferee during the five-year period prior to application for medical assistance by the transferor, the two thousand dollar exemption shall be divided equally between the transferees.6Transfers of assets that would, at the time of the transferor’s application for medical assistance, have been exempt from consideration as a resource if retained by the transferor, pursuant to 42 U.S.C. §1382b(a), as implemented by regulations adopted by the secretary of the United States department of health and human services, excluding the home and land appertaining to the home.7Transfers to a trust established solely for the benefit of the transferor’s child who is blind or permanently and totally disabled as defined in the federal Social Security Act, section 1614, as codified in 42 U.S.C. §1382c.8Transfers to a trust established solely for the benefit of an individual under sixty-five years of age who is disabled, as defined in the federal Social Security Act, section 1614, as codified in 42 U.S.C. §1382c.4“Transferee” means the person who receives a transfer of assets.5“Transferor” means the person who makes a transfer of assets.93 Acts, ch 106, §1; 96 Acts, ch 1107, §3; 96 Acts, ch 1129, §66; 97 Acts, ch 23, §23; 2000 Acts, ch 1060, §4, 5; 2010 Acts, ch 1031, §352, 353; 2010 Acts, ch 1061, §180; 2013 Acts, ch 138, §74; 2014 Acts, ch 1092, §175; 2023 Acts, ch 19, §814249F.2Creation of debt.A transfer of assets creates a debt due and owing to the department from the transferee in an amount equal to medical assistance provided to or on behalf of the transferor, on or after the date of the transfer of assets, but not exceeding the fair market value of the assets at the time of the transfer.93 Acts, ch 106, §2; 96 Acts, ch 1107, §42023 Acts, ch 19, §815249F.3Notice of debt failure to respond hearing order.1The department may issue a notice establishing and demanding payment of an accrued or accruing debt due and owing to the department as provided in section 249F.2. The notice shall be sent by restricted certified mail as defined in section 618.15, to the transferee at the transferee’s last known address. If service of the notice is unable to be completed by restricted certified mail, the notice shall be served upon the transferee in accordance with the rules of civil procedure. The notice shall include all of the following:aThe amount of medical assistance provided to the transferor to date which creates the debt.bA computation of the debt due and owing.cA demand for immediate payment of the debt.d1A statement that if the transferee desires to discuss the notice, the transferee, within ten days after being served, may contact the department and request an informal conference.2A statement that if a conference is requested, the transferee has until ten days after the date set for the conference or until twenty days after the date of service of the original notice, whichever is later, to send a request for a hearing to the department.3A statement that after the holding of the conference, the department may issue a new notice to be sent to the transferee by first-class mail addressed to the transferee at the transferee’s last known address, or if applicable, to the transferee’s attorney at the last known address of the transferee’s attorney.4A statement that if the department issues a new notice, the transferee has until ten days after the date of mailing of the new notice or until twenty days after the date of service of the original notice, whichever is later, to send a request for a hearing to the department.eA statement that if the transferee objects to all or any part of the original notice and no conference is requested, the transferee has until twenty days after the date of service of the original notice to send a written response setting forth any objections and requesting a hearing to the department.fA statement that if a timely written request for a hearing is received by the department, the transferee has the right to a hearing to be held in district court as provided in section 249F.4; and that if no timely written request for hearing is received, the department will enter an order in accordance with the latest notice.gA statement that as soon as the order is entered, the property of the transferee is subject to collection action, including but not limited to wage withholding, garnishment, attachment of a lien, or execution.hA statement that the transferee must notify the department of any change of address or employment.iA statement that if the transferee has any questions concerning the transfer of assets, the transferee should contact the department or consult an attorney.jOther information as the department finds appropriate.2If a timely written request for hearing is received by the department, a hearing shall be held in district court.3If a timely written request for hearing is not received by the department, the department may enter an order in accordance with the latest notice, and the order shall specify all of the following:aThe amount to be paid with directions as to the manner of payment.bThe amount of the debt accrued and accruing in favor of the department.cNotice that the property of the transferee is subject to collection action, including but not limited to wage withholding, garnishment, attachment of a lien, and execution.4The transferee shall be sent a copy of the order by first-class mail addressed to the transferee at the transferee’s last known address, or if applicable, to the transferee’s attorney at the last known address of the transferee’s attorney. The order is final, and action by the department to enforce and collect upon the order may be taken from the date of the issuance of the order.93 Acts, ch 106, §3; 99 Acts, ch 52, §12023 Acts, ch 19, §816249F.4Certification to court — hearing — default.1If a timely written request for a hearing is received, the department shall certify the matter to the district court in the county where the transferee resides.2The certification shall include true copies of the original notice, the return of service, if applicable, any request for an informal conference, any subsequent notices, the written request for hearing, and true copies of any administrative orders previously entered.3The department may also request a hearing on its own motion regarding the determination of a debt, at any time prior to entry of an administrative order.4The district court shall set the matter for hearing and notify the parties of the time and place of hearing.5If a party fails to appear at the hearing, upon a showing of proper notice to the party, the district court may find the party in default and enter an appropriate order.93 Acts, ch 106, §4; 99 Acts, ch 52, §22023 Acts, ch 19, §817249F.5Filing and docketing of order — order effective as court decree.1A true copy of an order entered by the department pursuant to this chapter, along with a true copy of the return of service, if applicable, may be filed in the office of the clerk of the district court in the county in which the transferee resides or, if the transferee resides in another state, in the office of the district court in the county in which the transferor resides.2The department order shall be presented, ex parte, to the district court for review and approval. Unless defects appear on the face of the order or on the attachments, the district court shall approve the order. The approved order shall have all force, effect, and attributes of a docketed order or decree of the district court.3Upon filing, the clerk shall enter the order in the judgment docket.93 Acts, ch 106, §52023 Acts, ch 19, §818249F.6Security for payment of debt — forfeiture.Upon entry of a court order or upon the failure of a transferee to make payments pursuant to a court order, the court may require the transferee to provide security, a bond, or other guarantee which the court determines is satisfactory to secure the payment of the debt under the court order. If the transferee fails to make payments pursuant to the court order, the court may declare the security, bond, or other guarantee forfeited.93 Acts, ch 106, §6249F.6AExemption from chapter 17A.Actions initiated under this chapter are not subject to chapter 17A. Review by the district court shall be an original hearing before the district court.2000 Acts, ch 1060, §6249F.7Administration.As provided in this chapter, the establishment of a debt for medical assistance due to transfer of assets shall be administered by the department. All administrative discretion in the administration of this chapter shall be exercised by the department, and any state administrative rules implementing or interpreting this chapter shall be adopted by the department.93 Acts, ch 106, §72023 Acts, ch 19, §819249F.8Inconsistency with federal laws.If it is determined by the attorney general that any provision of this chapter would cause denial of funds from the United States government under Tit. XIX of the federal Social Security Act, or would otherwise be inconsistent or conflict with the requirements of federal law for state participation in the Tit. XIX program, such provision shall be suspended, but only to the extent necessary to prevent denial of such funds or to eliminate the inconsistency or conflict with the requirements of federal law. If the attorney general makes such a suspension determination, the attorney general shall report it to the general assembly at its next session. This report shall include any recommendations in regard to corrective legislation needed to conform this chapter with federal law.93 Acts, ch 106, §8; 2010 Acts, ch 1061, §180