These matches can identify Medicaid enrollees that have sustained injuries which may be covered through workers' compensation or through an automobile insurance policy.From the bar graph and statistical data above we can conclude that… States also match with workers' compensation and state motor vehicle accident files. For example, states conduct data matches with public entities, such as the Department of Defense, to identify Medicaid enrollees and/or their dependents that have coverage through the Military Health Services system and the TRICARE program. States must have laws in place that require health insurers to provide their plan eligibility and coverage information to Medicaid programs. States conduct data matches to identify third party resources. This information is periodically updated whenever a Medicaid enrollee's eligibility is renewed. States gather information regarding potentially liable third parties, including information about other sources of health coverage, when individuals apply for medical assistance. Other state or Federal coverage programs (unless specifically excluded by law).Individuals eligible for Medicaid assign their rights to third party payments to the State Medicaid Agency.Įxamples of third parties which may be liable to pay for services: Coordination of BenefitsĬoordination of Benefits (COB) refers to the activities involved in determining Medicaid benefits when an enrollee has coverage through an individual, entity, insurance, or program that is liable to pay for health care services. For detailed information about COB/TPL policies, see our 2020 COB/TPL Handbook. For more information on Medicaid TPL and COB, see our Frequently Asked Questions. The Deficit Reduction Act of 2005 included several additional provisions related to TPL and coordination of benefits for Medicaid beneficiaries. States are required to take all reasonable measures to ascertain the legal liability of third parties to pay for care and services that are available under the Medicaid state plan. By law, all other available third party resources must meet their legal obligation to pay claims before the Medicaid program pays for the care of an individual eligible for Medicaid. Third Party Liability (TPL) refers to the legal obligation of third parties (for example, certain individuals, entities, insurers, or programs) to pay part or all of the expenditures for medical assistance furnished under a Medicaid state plan. It is possible for Medicaid beneficiaries to have one or more additional sources of coverage for health care services. Medicaid MAGI & CHIP Application Processing Time.Testing Experience & Functional Tools demonstration.Alternatives to Psychiatric Residential Treatment Facilities Demonstration.Balancing Long Term Services & Supports.Person-Centered Hospital Discharge Model.Vision and Hearing Screening Services for Children and Adolescents.Early and Periodic Screening, Diagnostic, and Treatment.State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services.SUPPORT Act Provider Capacity Demonstration.
SUPPORT Act Innovative State Initiatives and Strategies.Medicaid Information Technology Architecture.Section 223 Demonstration Program to Improve Community Mental Health Services.
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