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MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |82 Effective Month: July 2025 By signing the Application for Health Benefits and/or the Medicaid Aged, Blind and Disabled application form, each applicant/recipient is deemed to have made an assignment to the Medicaid Program of his rights to medical support or any third party benefits, including hospitalization, accident, medical or health benefits owed to the individual, as well as rights to such benefits owed by any third party to the children or any other person for whom the applicant/recipient has legal authority to execute such an assignment. Requirements As a condition of eligibility each applicant/recipient must: • Disclose all potential third-party liability sources; • Assign to the state his individual rights to medical support and other third-party payments, and such rights of any other eligible individuals for whom he has legal authority; • Cooperate in establishing paternity and obtaining medical support or payments, when applicable, and • Cooperate in identifying and providing information to obtain third party payments. Automatic Assignment of Third-Party Rights Although assignment of third-party rights is automatic, the applicant/recipient must be informed of the requirement. The ABD and MAGI application forms contain the mandatory assignment of rights statement in the section of the form requiring the signature of the applicant, recipient, head of household or designated representative. If an in-person interview is completed, explain the mandatory assignment of rights provision. The individual’s signature on the application form at initial application and each redetermination of eligibility acknowledges the automatic assignment of all third- party rights. Failure to Cooperate with Third Party Assignment The Third-Party Recovery (TPR) Unit has the responsibility for determining if an individual has failed, without good cause, to cooperate with assignment of third-party rights. If the TPR Unit determines there was good cause for failure to cooperate, the individual will be exempted from the cooperation requirement. However, a determination