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All Medicaid Programs |
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Obsolete Policy |
Requirement for Applicants
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. Eligibility staff MUST give all applicants a copy of Form 19, Third Party and Insurance Information and answer any questions about good cause the person may have. (See section 225-4)
The TPL information may be gathered on the application form or on a Form 19. The applicant must complete the questions on one of these forms when applying for Medicaid or QMB. Refer to Medicaid Policy, section 900 for Primary Care Network applicants.
DO NOT approve Medicaid for any adult until he or she has provided information to complete the Third Party Liability questions and signed either the Form 19 or a Medicaid application that includes a completed TPL section in either paper or online format.
See Section 303 before opening DM assistance for Primary Care Network recipients who are approved for disability.
Requirement for Parent
An adult parent, or an emancipated minor parent must provide TPL information for his or her children who will receive Medicaid. 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 of Form 19 to ORS.
Requirement to Apply for Medicare Part B
Applicants and recipients who may be eligible for Part B Medicare benefits must apply for such benefits as an eligibility requirement for Medicaid. 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. 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.
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.