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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 21 · children with a disability must meet disability and level of care requirements · long term care applicants must meet level of care requirements 15 DE Reg. 202 (08/01/11) 14540 Estate Recovery Protections Effective with dates of service on or after January 1, 2010, medical assistance for Medicare cost-sharing is protected from estate recovery for certain categories of individuals who, collectively, are known as dual eligibles. The following categories of individuals are protected from estate recovery of Medicare cost-sharing: a) Qualified Medicare Beneficiaries b) Specified Low Income Medicare Beneficiaries c) Qualifying Individuals d) Qualified and Disabled Working Individuals e) Qualified Medicare Beneficiaries with full Medicaid f) Specified Low Income Medicare Beneficiaries with full Medicaid Medicare cost-sharing includes payments of Part A and Part B premiums, deductibles, coinsurance, and copayments. The date of service for premiums is the date DMMA paid the premium. The date of service for deductibles, coinsurance, and copayments is the date the request for payment is received by DMMA. The protection from estate recovery for Medicare cost sharing applies to mandatory and optional services under the State plan including nursing facility, home and community-based services, and related prescription drugs and hospital services. 15 DE Reg. 84 (07/01/11) 14600 Third-Party Liability Some Medicaid recipients are covered by other medical insurance plans. Examples of other resources are Medicare, employment related health insurance, Union Health & Welfare Funds, national Blue Cross and Blue Shield plans, Military Health Insurance For Active Duty, Retired Military, and their dependents, workmen's compensation, and no-fault automobile coverage. When a recipient receives payment from an insurance carrier, court settlement, etc. for any medical services paid by Medicaid, the recipient is obligated to reimburse the program for those related services. All such cases must be referred to the Third Party Liability Unit at the Medicaid State Office. 14610 Assignment Of Rights To Benefits As a condition of eligibility, each legally able applicant and recipient must: A. assign his or her rights and the rights of any other eligible individuals for whom the individual has the legal authority under State laws to assign such rights, to medical support or other third party payments to the agency. (for example, a parent assigns the rights of a child); B. cooperate in establishing paternity and obtaining medical support unless there is a finding of good cause (pregnant and post partum women do not have to meet this requirement); and C. cooperate, absent good cause, in identifying and providing information needed to pursue third parties who may be liable to pay for medical services covered by Medicaid. 14620 Rights Assigned The applicant or recipient must make a written assignment assigning his or her rights to any medical support available under an order of a court or an administrative agency. He or she must also assign to Medicaid any third party payments for medical care and payments for any other eligible individual for whom he or she has the legal authority under State law to make an assignment.