510 ASSIGNMENT OF RIGHTS

510 ASSIGNMENT OF RIGHTS

It is a requirement of the Medicaid program that each legally able recipient assign to the Department of Health, all rights to medical support and payments for medical care from any third party, including health insurance benefits available to the Medicaid recipient. The recipient must also cooperate with any third party liability ( TPL ) recovery efforts of the department. See Section 505 for policy on third party liability and recovery. The applicant’s signature on the application is a satisfactory showing of compliance with this provision.

510 A. DEFINITIONS

Assignment means the recipient has transferred the right to collect and retain third party and medical support payments to the extent that medical services are paid for under the Medicaid program.

Cooperation in Assignment of Medical Support means applicants and recipients must assist in securing medical support payments and third party payments. Cooperation also includes assisting in establishing paternity and establishing or modifying medical support orders and third party payments.

510 B. COOPERATION AND ASSIGNMENT REQUIREMENTS

The assignment of third party and medical support payments and the requirement for cooperation applies to all household members who are legally able to assign rights.

A specified relative who is a Medicaid recipient and who fails to cooperate in the assignment of medical support for an individual in their household when he or she can legally assign rights will be ineligible for any category of Medicaid, unless good cause is established. The specified relative remains ineligible for Medicaid until he or she cooperates in the assignment of medical support.

There is no minimum period of ineligibility for the ineligible specified relative. The ineligible specified relative may regain eligibility immediately upon cooperating.

510 C. EXCEPTIONS

The state must provide Medicaid to any person who cannot legally assign his or her rights and who would be eligible for Medicaid but for the refusal of the person legally able to assign those rights to cooperate. If a specified relative refuses to cooperate in assignment of medical rights, the specified relative must be denied Medicaid coverage; however, the children are eligible for Medicaid assuming they meet all other eligibility requirements.

Cooperation in assignment of medical support is not required for a pregnant woman, including a woman who is in the sixty-day post partum period. She is not required to cooperate in establishing paternity and in obtaining medical support for herself, as well as for any other person for whom she can legally assign rights.

However, a pregnant woman must cooperate in identifying and providing information in pursuing a third party ( TPL ) who may be liable to pay for care and services, unless good cause is established. See Section 505 K .

510 D. FUTURE THIRD PARTY AND MEDICAL SUPPORT RIGHTS

When Medicaid is terminated for a recipient, or for his or her child, the assignment of rights ends. However, the assignment remains in effect for the period during which the recipient’s child continues to receive Medicaid.

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