DHHS - Medicaid Policy Manual
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Medicaid Policy                                                                 

 

225-1 TPL Requirement of Applicants

Effective Date: April 1, 2019

Previous Policy

 

Requirement for Applicants

  1. To be eligible for Medicaid or QMB, (but not SLMB and QI-1), applicants must provide information about any possible third party who may be responsible to pay their medical expenses.  An applicant may claim good cause for not providing this information (225-4).  The applicant may provide TPL information verbally, on the application form or on a Form 19.  Verbal TPL information must be narrated in the case record.
  2. DO NOT approve Medicaid for any adult until he or she has provided the required TPL information.

Requirement for Parent

  1. An adult parent, or an emancipated minor parent must provide TPL information for his or her children who will receive Medicaid.  
  2. If the parent refuses without good cause, do not approve Medicaid for the parent.  Open Medicaid only for the eligible children.  Do not deny Medicaid to children because of a parent's failure to complete TPL requirements.

Refer the TPL information from the application or Form 19 to ORS.

Requirement to Apply for Medicare Part B

  1. Applicants and recipients who may be eligible for Part B Medicare benefits must apply for such benefits after they become eligible for Medicaid (223-2).  If eligible for Part B Medicare, the Medicaid agency will pay the monthly Part B premium for months the individual is eligible for Medicaid, QMB, SLMB or QI benefits.  

  1. The state automatically enrolls individuals in Part B Medicare after they become eligible for Medicaid if they are receiving Part A or have been on Part B in the past (223-2).  Do not require these individuals to do a Part B enrollment.

TPL Requirement when Review is Treated as an Application

An adult recipient's medical assistance will end if the recipient fails to complete their 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.