Fiscal Note
Fiscal Services Division
HF 2135 – Medical Income Assistance Trusts, Fees (LSB5430HV)
Staff Contact: Eric Richardson (515.281.6767) eric.richardson@legis.iowa.gov
Fiscal Note Version – New
Description
House File 2135 increases the amount to be paid or set aside each month for administration of
a Medical Income Assistance Trust, from no more than $10 per month to no more than $50 per
month without court approval.
Background
Iowa Code section 633C.3 currently allows for a maximum of $10 per month to be set aside for
the expenses of a Medical Income Assistance Trust for Medicaid beneficiaries. A Medical
Income Assistance Trust, or Miller Trust, allows a beneficiary to qualify for Medicaid who would
otherwise have too much in assets or income to qualify for Medicaid, provided that a certain
amount of pension or Social Security income is placed into the Trust. A spouse may be eligible
to receive funds from the Trust. If the beneficiary does not have a spouse, the balance of the
Trust, beyond a monthly allowance for the beneficiary and the cost of administering the Trust, is
paid to a nursing facility to cover the costs of nursing care. Any payments to nursing facilities to
cover the cost of care for a beneficiary decrease the amount of State and federal dollars paid by
Medicaid.
Assumptions
• Any decreases in the amount of income available from a qualified beneficiary for the cost of
nursing care are costs borne by Medicaid.
• According to the Iowa Department of Health and Human Services (HHS), the Bill affects
1,642 beneficiaries annually.
• An increase of $40 monthly due to increasing the maximum allowable administrative cost in
the Bill will increase annual Medicaid costs for nursing facilities by approximately $788,000
beginning in FY 2025.
• The State will pay 36.75% of Medicaid costs for nursing facilities, while the federal
government will pay 63.25%, the same as Iowa’s FY 2025 Federal Medicaid Assistance
Percentage (FMAP). The FMAP rate in FY 2026 is assumed to equal the FY 2025 rate.
• According to the HHS, a one-time information technology (IT) implementation will be
necessary at a cost of $310,000 in FY 2025. The State will pay 25.0% of costs for IT
implementation, while the federal government will pay 75.0%.
• Any increase in State costs is expected to be funded from the HHS’s General Fund
Medicaid appropriation.
Fiscal Impact
House File 2135 is estimated to increase costs to the State by approximately $365,000 in
FY 2025 and $290,000 annually beginning in FY 2026.
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 Figure 1 — Estimated Cost of Increasing Medical Assistance Trust Fees
FY 2025 FY 2026
Expense Category
Total State Total State
Nursing Facilities $ 788,000 $ 288,000 $ 788,000 $ 290,000
Information Technology (IT) 310,000 77,000 0 0
Total Costs $ 1,098,000 $ 365,000 $ 788,000 $ 290,000
Sources
Department of Health and Human Services
LSA analysis
/s/ Jennifer Acton
February 16, 2024
Doc ID 1445142
The fiscal note for this Bill was prepared pursuant to Joint Rule 17 and the Iowa Code. Data used in
developing this fiscal note is available from the Fiscal Services Division of the Legislative Services
Agency upon request.
www.legis.iowa.gov
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Statutes affected:
Introduced: 633C.3