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415 (07/2026) Chapter 2:Eligibility • Section 6: Non-financial eligibility • Provide information for any third-party payments for medical care. This includes, but is not limited to:
Coverage under Medicare,
Coverage under Tri-Care, or
A claim for damages from personal injuries The penalty for failure to cooperate with medical coverage is ineligibility for the legally responsible adult. A person can be penalized only if they have the legal right to obtain the health insurance. This means that individuals who cannot enroll in cost-effective employer-sponsored insurance for themselves are not disqualified. For example, if a spouse is unable to enroll on their own behalf, the spouse is not disqualified. End the noncooperation penalty when the individual provides evidence that they are willing to cooperate. Good cause for failing to pursue health care coverage and medical support Good cause includes the following: • Complying would result in emotional or physical harm to the individual or anyone on whose behalf that individual’s cooperation is required. • A child was conceived as a result of incest or rape and cooperating would cause harm to the individual, the child or the spouse. • Legal proceedings are pending for an adoption of a child. • A parent is being helped by a social service agency to help decide if a child should be released for adoption. • The individual is pregnant. OSIPM As of June 3, 2025, individuals are not required to apply for other benefits to pursue assets, including SSA income or unemployment compensation. Individuals are still required to cooperate with the following: • Personal Injury Liens • Medical Assignment • Child and Cash Medical Support Note: As of July 1, 2026, actions taken to avoid receiving an asset an individual or their spouse is entitled to is considered a disqualifying transfer of assets for long-term care (LTC). See Chapter 2, Section 10 for more information on disqualifying transfers of assets. Assignment of third party liability (TPL) and support Medical assignment ODHS|OHA has the authority to collect reimbursement for medical expenses it paid for anyone receiving Medicaid that should have been paid by another party or resource. This is called assignment of medical benefits. ODHS|OHA has the authority to refuse to pay medical expenses for anyone receiving benefits when another party or resource should pay first. HSD MSP