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 payer 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 DHCS Division of Health Care Services .  The recipient must cooperate in any TPL Third Party Liability recovery efforts by the Division of Health Care Services 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)