Effective Date: May 1, 2015

Previous Policy

Reporting Changes

Adult recipients and emancipated minor recipients of medical assistance must report all changes and additions in third party liability. They must also cooperate in the establishment and collection of third party claims. This includes cooperating in the establishment of paternity for born children. (See Section 225-3 )

Members must report TPL changes within 30 days of when the change occurs.

Members must provide updated TPL information at each eligibility review. Section 721-1 discusses the process for completing an eligibility review. If the recipient provided updated TPL information during the failed review process, do not request it again as part of the application process.

Cooperation

ORS will tell workers if the recipient is not cooperating. If a recipient who is not cooperating does not claim Good Cause, he or she will not be eligible for Medicaid again until ORS reports that the recipient is again cooperating. (See Section 225-5 for applying the sanction.)

TPL Resulting from Accidents or Legal Actions

Recipients must report when they are involved in a lawsuit or settlement involving injury, accident or medical claims such as a malpractice suit. Notify ORS of any pending settlements, and of any payments the member receives. ORS may seek recovery of any related Medicaid costs. Recipients must also report if they are involved in an accident or suffer an injury that insurance such as auto or homeowner's insurance may cover.