H.F. _____ Section 1. NEW SECTION . 249O.1 Request for notice of 1 transfer or encumbrance of real property held by recipient of 2 medical assistance. 3 1. When a recipient of medical assistance as defined in 4 section 249A.2 is the titleholder of record to real property, 5 is the contract holder of record as the purchaser under a land 6 sale contract, or has any other legal or equitable interest 7 in real property, the department of human services may file 8 a request for notice of transfer or encumbrance of the real 9 property with the county recorder of the county in which the 10 real property is located. 11 2. If a request for notice of transfer or encumbrance 12 is filed by the department of human services pursuant to 13 subsection 1, a title examiner shall provide the department 14 with a notice of transfer or encumbrance pursuant to section 15 558.73. 16 3. If the department has filed a request for notice of 17 transfer or encumbrance under subsection 1, but determines that 18 it is no longer necessary or appropriate to monitor transfers 19 or encumbrances related to the real property, the department 20 shall file a termination of request for notice of transfer or 21 encumbrance with the county recorder of the county in which the 22 real property is located. 23 4. a. The department shall adopt by rule in accordance 24 with chapter 17A the requirements and the forms to be used for 25 the request for notice of transfer or encumbrance, the notice 26 of transfer or encumbrance, and the termination of request for 27 notice of transfer or encumbrance. At a minimum, the forms 28 shall contain all of the following: 29 (1) The name of the medical assistance recipient and a 30 state identification number that links the individual who is 31 the titleholder of record to the real property or the contract 32 holder of record as the purchaser under a land sale contract, 33 or who has any other legal or equitable interest in the 34 property, to the medical assistance recipient’s records. 35 -1- LSB 2451YC (3) 88 pf/jh 1/ 6

H.F. _____ (2) The legal description of the real property identified. 1 (3) A mailing address for the department to receive the 2 notice of transfer or encumbrance from a title examiner. 3 b. The rules shall require that the recordation of the forms 4 comply with the requirements specified in sections 558.41 and 5 558.42 for the recording of instruments affecting real estate. 6 5. The request for notice of transfer or encumbrance 7 described in this section does not affect the title to real 8 property and is not a lien on, or an encumbrance of, any 9 interest in the real property. 10 6. Except as provided in subsection 7, the department may 11 impose a lien against the property of any individual prior 12 to the person’s death due to medical assistance paid or to 13 be paid on the person’s behalf if either of the following is 14 applicable: 15 a. The lien is imposed pursuant to a judgment of a court 16 based on benefits incorrectly paid on behalf of such person. 17 b. In the case of the real property of a person who is a 18 resident of a nursing facility, an intermediate care facility 19 for persons with an intellectual disability, or a mental health 20 institute, if such person is required, as a condition of 21 receiving services in such institution, to spend for costs of 22 medical care all but a minimal amount of the person’s income 23 required for personal needs, and the department determines, 24 after notice and opportunity for a hearing, that the person 25 cannot reasonably be expected to be discharged from the nursing 26 facility, intermediate care facility for persons with an 27 intellectual disability, or mental health institute and return 28 to the person’s home. 29 7. A lien shall not be imposed under subsection 6 on 30 the home of a recipient of medical assistance if any of the 31 following persons is lawfully residing in the home: 32 a. The spouse of the recipient. 33 b. A child of the recipient who is under twenty-one years of 34 age, or is blind or permanently and totally disabled. 35 -2- LSB 2451YC (3) 88 pf/jh 2/ 6

H.F. _____ c. A sibling of the recipient who has an equity interest 1 in the home and who was residing in the home for a period of 2 at least one year immediately before the date of the medical 3 assistance recipient’s admission to the nursing facility, 4 intermediate care facility for persons with an intellectual 5 disability, or mental health institute. 6 8. Any lien imposed pursuant to subsection 6, paragraph 7 “b” , shall be discharged if the recipient is discharged from 8 the nursing facility, intermediate care facility for persons 9 with an intellectual disability, or mental health institute and 10 returns to the person’s home. 11 9. a. The department may file and enforce a lien against 12 the real property of a deceased recipient when there is no 13 estate subject to probate and no person specified in subsection 14 7 is lawfully residing in the home. 15 b. The lien shall be subject to all prior liens of record 16 and transfers for value to a bona fide purchaser of record. 17 c. The lien shall be filed in the county where the real 18 property is located within one year from the date of death of 19 the recipient and shall contain the legal description of all 20 real property in the county subject to the lien. 21 Sec. 2. NEW SECTION . 558.73 Notice to department of human 22 services —— transfer or encumbrance of real property and liens —— 23 medical assistance recipient. 24 1. If a title examiner discovers the presence of a request 25 for notice of transfer or encumbrance filed pursuant to section 26 249O.1 when performing a title search, the title examiner shall 27 do all of the following: 28 a. Provide the department with a notice of transfer or 29 encumbrance of the real property prior to the transfer or 30 encumbrance. 31 b. Report the request for notice of transfer or encumbrance 32 in any title opinion or other report preliminary to the sale of 33 the property. 34 2. If the department has recorded a termination of request 35 -3- LSB 2451YC (3) 88 pf/jh 3/ 6

H.F. _____ for notice of transfer or encumbrance, the examiner is not 1 required to provide the notice of transfer or encumbrance 2 otherwise required pursuant to subsection 1. 3 3. A title examiner shall use the notice of transfer or 4 encumbrance form approved by the department when notifying the 5 department pursuant to subsection 1, which the title examiner 6 is not required to record with the county recorder. 7 4. A request for notice of transfer or encumbrance, 8 termination of request for notice of transfer or encumbrance, 9 and any lien authorized by section 249O.1 shall be recorded 10 as otherwise provided in this chapter. The county recorder 11 shall charge and collect fees for the recordation of these 12 instruments as provided pursuant to section 558.58 to be paid 13 by the department. 14 EXPLANATION 15 The inclusion of this explanation does not constitute agreement with 16 the explanation’s substance by the members of the general assembly. 17 This bill relates to the transfer or encumbrance of real 18 property held by a recipient of medical assistance. 19 The bill provides that when a recipient of medical 20 assistance (Medicaid) is the titleholder of record to real 21 property, is the contract holder of record as the purchaser 22 under a land sale contract, or has any other legal or equitable 23 interest in real property, the department of human services 24 (DHS) may file a request for notice of transfer or encumbrance 25 of the real property with the county recorder of the county 26 in which the real property is located. If such a request 27 for notice of transfer or encumbrance is filed by DHS, a 28 title examiner shall provide DHS with a notice of transfer or 29 encumbrance as specified in the bill. If DHS files a request 30 for notice of transfer or encumbrance, but determines that it 31 is no longer necessary or appropriate to monitor transfers 32 or encumbrances related to the real property, the department 33 shall file a termination of request for notice of transfer or 34 encumbrance with the county recorder of the county in which the 35 -4- LSB 2451YC (3) 88 pf/jh 4/ 6

H.F. _____ real property is located. 1 The bill requires DHS to adopt administrative rules 2 regarding the requirements and the forms to be used for the 3 request for notice of transfer or encumbrance, the notice of 4 transfer or encumbrance, and the termination of request for 5 notice of transfer or encumbrance. 6 The bill provides that a request for notice of transfer or 7 encumbrance does not affect the title to real property and is 8 not a lien on, or an encumbrance of, any interest in the real 9 property. 10 Under the bill, DHS may impose a lien against the property 11 of any individual prior to the person’s death due to medical 12 assistance paid or to be paid on the person’s behalf if the 13 lien is imposed pursuant to a judgment of a court based on 14 benefits incorrectly paid on behalf of such person, or if 15 the person is a resident of a nursing facility, intermediate 16 care facility for persons with an intellectual disability, 17 or a mental health institute, if such person is required, 18 as a condition of receiving services in such institution, 19 to spend for costs of medical care all but a minimal amount 20 of the person’s income required for personal needs, and DHS 21 determines, after notice and opportunity for a hearing, that 22 the person cannot reasonably be expected to be discharged 23 from the facility or mental health institute and return to 24 the person’s home. However, a lien shall not be imposed on 25 the home of a recipient of medical assistance if certain 26 individuals including a spouse, certain children, or certain 27 siblings are lawfully residing in the home. The bill provides 28 for discharge of a lien imposed if the person does return to 29 the person’s home after being discharged from a facility or 30 mental health institute. 31 Under the bill, DHS may file and enforce a lien against 32 the real property of a deceased recipient when there is no 33 estate subject to probate and no person specified in the bill 34 is lawfully residing in the home. The lien shall be subject 35 -5- LSB 2451YC (3) 88 pf/jh 5/ 6

H.F. _____ to all prior liens of record and transfers for value to a bona 1 fide purchaser of record. The lien shall be filed in the 2 county where the real property is located within one year from 3 the date of death of the recipient and shall contain the legal 4 description of all real property in the county subject to the 5 lien. 6 The bill requires that if a title examiner discovers the 7 presence of a request for notice of transfer or encumbrance 8 when performing a title search, the title examiner shall 9 provide DHS with a notice of transfer or encumbrance of 10 the real property prior to the transfer or encumbrance, and 11 report the request for notice of transfer or encumbrance in 12 any title opinion or other report preliminary to the sale of 13 the property. However, if DHS has recorded a termination of 14 request for notice of transfer or encumbrance, the examiner is 15 not required to provide the notice of transfer or encumbrance 16 otherwise required. The title examiner is required to use the 17 notice of transfer or encumbrance form approved by DHS, but is 18 not required to record the notice with the county recorder. 19 The request for notice of transfer or encumbrance, termination 20 of request for notice of transfer or encumbrance, and any 21 lien authorized under the bill is required to be recorded, 22 and the county recorder shall charge and collect fees for the 23 recordation of these instruments as provided in existing law 24 to be paid by the department. 25 -6- LSB 2451YC (3) 88 pf/jh 6/ 6