|
All Medicaid Programs |
|
Obsolete Policy |
Contact DWS Program Specialist for previous policy
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)
Clients must report TPL changes within 30 days of when the change occurs.
Clients must provide updated TPL information at each eligibility review. A recipient's medical assistance will end if the recipient fails to complete their review. When this happens, they may reapply in the month immediately following the effective closure date by responding to the review, providing all requested verification, or filing a new application form. The eligibility agency treats the response as a new application. If the client provided updated TPL information during the failed review process, they do not have to provide it again as part of this application process.
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.)
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 client 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.