7 AAC 100.034 - Assignment of rights to third-party payment

(a) To be eligible for Medicaid, an applicant or recipient must

(1) cooperate with the department in obtaining or identifying third-party resources that may be available to pay for medical care for which Medicaid coverage is sought; and

(2) assign to the department the applicant's or recipient's rights to payment for medical care from a third party for which Medicaid coverage is sought.

(b) Signing an application for Medicaid on a form provided by the department constitutes assignment of the applicant's rights to third-party payment for medical care for which Medicaid coverage is sought.

(c) An assignment of rights under this section ends when the recipient's eligibility for Medicaid ends.

(d) The department will deny or terminate an applicant's or recipient's Medicaid eligibility if the applicant or recipient fails to assign rights or cooperate in obtaining or identifying a third-party resource, except that the department will not deny or terminate Medicaid eligibility for a child under 18 years of age if

(1) a parent or other adult applying on the child's behalf fails to cooperate in identifying or obtaining a third party resource, or

(2) a parent or legal guardian fails to assign the child's rights to a third-party payment for medical care.

(e) A third-party resource is an entity, individual, or program that is, or may be, liable to pay all or part of an applicant's or recipient's medical care for which Medicaid coverage is sought. A third-party resource includes

(1) private, group, or employment-related health insurance;

(2) Medicare;

(3) pre-paid medical plans;

(4) indemnity policies;

(5) an absent parent with a duty to provide medical support;

(6) self-insured and self-funded medical plans or trusts;

(7) automobile or homeowner liability insurance;

(8) tenant or landlord insurance;

(9) a person liable under a court judgment or settlement from a liability insurer, malpractice, wrongful injury, or civil assault lawsuit;

(10) workers' compensation under AS 23.30;

(11) an estate from which a first-party probate recovery is available;

(12) TRICARE under 10 U.S.C. 1071 - 1110;

(13) veteran's benefits under 38 U.S.C. 101 - 8528; and

(14) other federal programs, except as provided in (f) of this section.

(f) Health care available to American Indians, Alaska Natives, and other beneficiaries of the United States Department of Health and Human Services, Indian Health Service, whether provided by the Indian Health Service or through tribal organizations funded in whole or in part by the Indian Health Service, is not a third-party resource for purposes of this section.

(g) An applicant or recipient may claim good cause for not cooperating with the assignment and cooperation requirements of this section by showing that, if required to cooperate, any individual for whom the applicant or recipient can assign rights could be subject to physical or emotional harm.

Notes

7 AAC 100.034

Eff. 7/20/2007, Register 183

Authority:AS 47.05.010

AS 47.07.025

AS 47.07.040