10-144-332 Me. Code R. § 2-6

Current through 2024-51, December 18, 2024

Section 144-332-2-6 - ASSIGNMENT OF RIGHTS TO MEDICAL PAYMENTS

Certain individuals must assign their rights to payment for medical care from any third party to the Department of Health and Human Services and cooperate in obtaining these medical payments. This is done by a referral to the Third-Party Liability (TPL) Unit.

Section 6.1:Who Must Comply

I. Parents or caretaker relatives applying on behalf of themselves and their children;

II. Individuals age 18 or over who are applying on their own behalf; and

III. Individuals under age 18 who are applying on their own behalf who are married or in the military.

This provision does not apply to individuals who are pregnant, or those receiving only the Medicare Savings Program or one of the State funded benefits listed in Section 1 of this part.

Section 6.2:Third-Party Liability Requirements

I. Assign rights to payment for medical care;

II. Cooperate with the TPL Unit in obtaining medical payments; or

III. Relinquish medical payments received directly from a third-party resource that were intended to cover services paid by Medicaid.

IV. Items for prospective, current, and retroactive periods that must be reported include:

A. Any court ordered responsibility to pay medical bills by a parent, unless it can be demonstrated that contact with the parent by the TPL Unit or Division of Support Enforcement and Recovery (DSER) could cause harm;

B. Medical insurance (except Medicare) covering the applicant or recipient. This includes private medical group insurance, TRICARE (formerly CHAMPUS), and supplemental policies such as companion plans from Blue Cross/Blue Shield, major medical, and indemnity insurance. Reporting is required whether the cost of premiums is paid by the individual, employer, or another party;

C. The portion of Worker's Compensation benefits for medical services for which the recipient is applying, receiving, or which terminated during the retroactive eligibility period; and

D. Information regarding settled or pending lawsuits involving personal injury.

Section 6.3:Noncompliance

I. Individuals who fail to comply with assignment of rights to medical payments are not eligible for Medicaid. In cases where Medicaid is open at the time of the failure to comply, Medicaid will be closed. When parents or caretaker relatives are applying on behalf of themselves and their children, the parent or other caretaker relative applying on behalf of the child under age 18 is not eligible. The child remains eligible.

II. When an individual is not eligible for Medicaid due to non-compliance, the individual is counted in the assistance unit size and the individual's income and assets (when applicable) are used to determine eligibility for the assistance unit.

III. SSI-Related Only - When a stepparent must be sanctioned, the stepparent's income will be considered as if the stepparent chose to be excluded from the assistance unit. The assets owned solely by the stepparent are not considered available to the assistance unit. The stepparent is not considered a member of the assistance unit when determining eligibility under the appropriate Federal Poverty Level.

IV. SSI-Related Only - When a caretaker relative other than a parent or stepparent must be sanctioned, the specified relative's income and assets are considered in the same manner as a sanctioned parent's income and assets are considered. However, such sanctioned caretaker relative may choose to be excluded from the unit.

An individual may request good cause for non-compliance with TPL. See Section 8 of this part for specific information regarding good cause.

10-144 C.M.R. ch. 332, § 2-6