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COMBINED MEDICAID 304-1 Health Coverage Overview Supersedes: FMA 307-1 (01/01/07); MA 305-1 (01/01/07) Reference: 42 CFR 433.136, .137-.140, .145-.148; ARM 37.82.101, .424, 37.85.407 Overview: As a condition of the adult’s eligibility, all adult Medicaid clients and parents/adult caretakers in child-only Medicaid households must cooperate with the Third Party Liability (TPL) Unit regarding trauma questionnaires, by providing health insurance information to be used to identify legally liable third parties for Medicaid payable services and by maintaining group health insurance that has been determined to be cost-effective through HIPPS. When a questionnaire regarding a specific injury is sent to a Medicaid recipient, the requested information from the questionnaire must be submitted as directed on the questionnaire within the specified time frame. If the information is not received within the time frame, the TPL Unit will enter the appropriate system non-compliance. Health insurance information must be provided for all Medicaid clients during the application and redetermination processes, or upon specific request. Cooperation in providing health insurance information may include establishing paternity, pursuing medical support or payments, and cooperation in identifying and providing information to assist the agency in pursuing any liable third parties. All current health insurance must be entered into the eligibility system, regardless of who pays the premiums, unless otherwise noted. Adult Medicaid clients and 18 year olds who are not living with a parent/specified caretaker loses or is denied Medicaid eligibility until: 1. The TPL unit receives the completed trauma questionnaire. 2. Health insurance information is provided to the requestor (which may be the OPA, TPL Unit or CSED) or 3. The individual re-enrolls in cost-effective group health insurance (typically at the next open enrollment period). When the Medicaid client is a child, the following adults lose Medicaid eligibility due to non-cooperation until the required information is provided: 1. The child’s parent residing in the same household as the child, regardless of whether the parent is receiving Medicaid under the same coverage group as the child;