The 470 4339 form is a core component of Iowa's Estate Recovery Program, authorized under Iowa Code Section 249A.5(2). It requests detailed financial information from the estates of deceased Iowa Medicaid members so the Iowa Department of Human Services can determine how much Medicaid paid during the person's lifetime and whether any funds are recoverable from the estate.
Executors, estate administrators, and family members responsible for a deceased Iowa Medicaid recipient's estate must complete this form. You will need to report savings and checking account balances, real estate holdings, vehicle values, and other assets. The form also asks about obligations such as funeral expenses and final illness medical bills.
The Iowa HHS compares total estate assets against reported expenses to determine if Medicaid reimbursement is warranted. If assets exceed allowable deductions, the state may file a claim against the estate. Completing this form accurately protects the executor and ensures compliance with Iowa state law and Medicaid rules.
Families settling an Iowa estate may also need the Iowa Small Estate Affidavit for smaller estates that qualify for simplified administration. If the deceased left a cremation request, the Iowa Cremation Authorization Form is also required. For other Iowa HHS documents, see Iowa Form 470-4202.
| Question | Answer |
|---|---|
| Form Name | 470 4339 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | iowa dhs medical debt response, form 470 debt, 470 4339 rev 12 10, iowa medical assistance debt response |