Medicaid Policy                                                                 

421-4 When to Report Lump Sum Payments to ORS

Effective Date: November 1, 2021

Previous Policy (421-4 was previously found in section 407-4 until November 1, 2021)

1.    Report all lump sum payments to the Office of Recovery Services, Medical Section if the payment could possibly be considered a third party liability payment. 

a.    ORS will evaluate the payment for possible recoupment.

b.    Examples of such lump sum payments are insurance settlements, payments from trusts set up for medical support, settlements on personal injury suits, or reimbursements from a health insurance plan.

2.    When an individual establishes a trust and places the funds from a lump sum into the trust, review trust policy in 512 for availability of the trust funds.

·   If needed, send the trust and supporting documentation to the OEP Program Specialist to review for availability.  (See 512)