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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL Division of Welfare and Supportive Services C-505.2 Medical Assistance Manual GENERAL ELIGIBILITY REQUIREMENTS 23 Dec 22 MTL 07/23 NOT REQUIRED C-505.2 Not Required SSI application and determination by SSA is not required for: a. deceased individuals who were institutionalized during the period Medicaid is requested. b. applications requesting only prior Medicaid eligibility as long as the customer does not have an outstanding pending SSI determination for those months. c. institutionalized individuals with total net countable income of $30 or more. C-600 THIRD PARTY LIABILITY (TPL) (435.610) TPL is any individual, entity, or program that is, or may be, liable to pay all or part of the medical cost for medical assistance furnished to a Medicaid recipient. Nevada Check Up monitors previous insurance coverage to prevent the substitution of group health coverage or other commercial health insurance with public funded coverage. Enter current medical insurance information on the MINS and MEDI screen. The purpose of TPL is to reduce erroneous expenditures by maximizing use of third party resources. Medicaid is the payer of last resort whenever another resource is available, with the exception of Children with Special Health Care Needs, Indian Public Health Service (IHS) or Victims of Crime. Do not enter a MINS screens for IHS. Income maintenance insurance policies not related to actual medical expenses are not third-party liability resources unless the policy is assignable to a hospital or other medical provider. Note: If the case manager becomes aware of the pregnant woman being a surrogate, request a copy of the contract and notify the TPL Unit at DHCFP. When insurance coverage is available at no cost to the customer (e.g., through employment or Tricare, or as a veteran through the Veterans Administration), request the customer to enroll. Assistance will be denied or terminated if the customer refuses to apply for, pursue, or provide information necessary to establish insurance coverage/claims and/or fails to cooperate in the collection process from a third party. Exception: Do not deny coverage for a child if the parent refused to provide insurance information. C-605 MEDICARE AS TPL Medicare is Social Security's health insurance program. Medicare has two types of coverage; Part A - Hospital Insurance and Part B-Supplementary Medical Insurance.