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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL Division of Welfare and Supportive Services C-610 Medical Assistance Manual GENERAL ELIGIBILITY REQUIREMENTS 23 Dec 22 MTL 07/23 NOTIFICATION OF THIRD PARTY LIABILITY Note: If insurance coverage is available through a source that is not part of the household, assistance is not denied or terminated if the policyholder refuses to cooperate. C-610.1 Verification Obtain verification for any household member who has medical/group health insurance coverage. Types of verification (not all inclusive): ● Insurance card ● Insurance policy ● Letter from insurance company C-615 TPL AND ACCIDENTS Households are required to immediately report any accident-related injuries requiring medical care or any accident-related unsettled legal claims. When the customer has an accident or job related injury, was injured while in the custody of a law enforcement agency, or received insurance reimbursements for Medicaid-paid bills, the Medical Subrogation Form 2511 must be completed providing details and any legal action involved. The worker may contact the customer to obtain the required information. If the worker is unable to contact the customer, the form will be sent and the case will be pended for 10 days and terminated if the required information is not received. Once completed, the SETT screen is completed and the form is forwarded along with any supporting information to the fiscal intermediary. Note: See Medical Subrogation Form 2511 for fiscal intermediary address. C-620 HEALTH INSURANCE PREMIUM PAYMENT (HIPP) PROGRAM FOR COST EFFECTIVE EMPLOYER GROUP HEALTH INSURANCE Section 4402 of OBRA 1990 added section 1906 of the Social Security Act which established authorization for States to offer the Health Insurance Premium Payment (HIPP) program. HIPP pays for the health care insurance premiums for eligible Medicaid recipients who have high cost medical claims and access to group health care insurance. The program intent is to defer the cost of high health care claims to other liable insurance. Upon enrollment into the HIPP program, Medicaid will pay the premium directly to the insurer, or reimburse the premium if deducted from wages so the Medicaid individual and any other family member included on the eligible group health care policy receives coverage provided it is cost effective for the State. Enrollment in the health plan is not a condition of eligibility