5070            THIRD PARTY RESOURCES (TPL Third Party Liability) RECOVERY

By law, Medicaid funds are to be expended only after all other available resources have been used.  This refers to third party resources, which assume liability for payment because a person has received medical care and services (See section 5065).  Medicaid is the payor of last resort, except for IHS Indian Health Service.  Any recipient who has access to IHS Indian Health Service facilities may choose between those facilities and Medicaid.

Any injury caused negligently or intentionally to a Medicaid recipient by another person, business, or organization should be reported promptly to DMA.  The recipient must cooperate in any TPL recovery efforts by the Division of Medical Assistance as a condition of initial or continued Medicaid eligibility.   If the applicant/recipient refuses to cooperate, that person is ineligible to receive Medicaid benefits (see caseworker responsibilities section 5065-E)