Adult Medicaid Manual MA-2400 THIRD PARTY RECOVERY

REISSUED 01/01/11 – CHANGE NO. 24-10

I. POLICY RULES

A. The county department of social services must make every reasonable effort to identify all legally liable third party resources to pay for medical care and services arising out of injury, disease, or disability for any individual who applies for or receives Medicaid. This includes indemnity coverage.

B. In order for Medicaid claims to process correctly, ensure that TPR data in EIS accurately reflects the recipient’s insurance coverage. Terminate insurance coverage in EIS only when the individual is no longer covered by the insurance.

C. An individual who applies for or receives Medicaid must provide all known information regarding third party resources for medical coverage for every member of the assistance unit.

D. An individual who applies for or receives Medicaid agrees to assign rights to medical support or other third party payments for medical services to the Division of Medical Assistance as provided in N.C.G.S. 108A-59. Terminate or deny individuals who fail to meet the assignment of rights provisions.

E. A caretaker who applies for or receives Medicaid for himself must cooperate in obtaining medical support or payments for any minor child in his care for whom assistance is requested. Refer to MA-2375, Procedures For Child Support Enforcement.

F. Medicaid is the payer of last resort, except when certain programs are involved. Refer to V.B., below, for a listing of these programs.