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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 October 2013 Subchapter Subject Page ending with Page M0250 ASSIGNMENT OF RIGHTS AND PURSUIT OF SUPPORT M0250.200 2

M0250.200 PROCEDURES FOR ASSIGNMENT OF RIGHTS

A. Forms The assignment of rights information is incorporated into the online and paper applications for medical assistance (MA). By signing the application for MA, the individual assigns his/her own rights and the rights of anyone for whom the individual has applied and can assign rights. B. Refusal To Assign Rights Or Cooperate An individual who is able to assign rights but who refuses or fails to meet the assignment of rights requirements in this subchapter is not eligible for Medicaid. Deny or cancel Medicaid coverage to an individual who:

• refuses to assign his own rights if he applies for himself,

• refuses to assign the rights of any other applicant for whom he can make an assignment, or

• refuses to cooperate in identifying and providing liable third party information, unless cooperation has been waived for good cause. C. Cooperation – Assignment of Rights Cooperation in assisting the agency in securing medical support and payments includes requiring the individual to: • provide identifying information about liable third parties, such as the liable person’s insurance company and policy number, the medical services covered by the insurance policy, etc.;

• appear as a witness at a court or other proceeding; • provide information, or attest to lack of information, under penalty of perjury;

• pay to the agency any medical care funds received that are covered by the assignment of rights; and

• take any other reasonable steps to assist the state in pursuing any liable third party. Should DMAS or the local agency request information from the individual, including information about third party liability, or otherwise require cooperation with the pursuit of medical support and/or third party liability as outlined in M0250.200 C. above, the individual must cooperate with the pursuit of medical support in order for the individual’s eligibility to continue. 1. Waiver of Cooperation A waiver of the cooperation requirement in identifying and providing liable third party information is allowed if the agency finds that cooperation is against the best interests of the individual, or other person for whom he/she can assign rights, because the agency anticipates that cooperation will result in reprisal against or cause physical or emotional harm to the individual or other person.