50 State Primer on Medicaid Recovery Laws

1 50 State Primer on Medicaid Recovery Laws HINSHAW & CULBERTSON LLP ON THE LAW SERIES Volume 2 Second Edition July 2019 Hinshaw & Culbertson LLP is a based law firm with offices in 11 states and London. The firm s national reputation spans the insurance industry, the professional services sector including representation of law firms and lawyers and other highly regulated industries, such as banking and finance and the debt collection sector. Hinshaw also provides a series of closely coordinated litigation, business advisory and transactional services to clients of all sizes as well as governmental and public sector entities.

2 Visit for more information and follow @Hinshaw on LinkedIn and Twitter. Hinshaw & Culbertson LLP 151 North Franklin Street, Suite 2500 Chicago, IL 60606 312-704-3000 This Primer is part of a series of guides prepared by Hinshaw & Culbertson LLP for legal and insurance professionals. This publication is provided for informational purposes only. It is not intended to constitute, and shall not be construed as, the rendering of legal, accounting, or business advice or opinion or professional services of any type. Nothing herein constitutes the views of the firm or its clients or the endorsement of any particular case, principle, or proposition.

3 The contents of this publication should not be viewed as a substitute for the guidance, advice, or recommendations of a retained professional. 2019 Hinshaw & Culbertson LLP. All rights Reserved. No part of this publication may be reproduced in any form or by any means without express, written permission from Hinshaw & Culbertson LLP 50 State Primer on Medicaid Recovery Laws Table of Contents Page INTRODUCTION TO Medicaid AND State AGENCY Recovery RIGHTS .. 1 ALABAMA .. 4 ALASKA .. 6 8 ARKANSAS .. 9 CALIFORNIA .. 11 COLORADO.

4 13 CONNECTICUT .. 14 DELAWARE .. 15 FLORIDA .. 16 18 HAWAII .. 19 IDAHO .. 20 ILLINOIS .. 21 INDIANA .. 22 IOWA .. 24 25 26 LOUISIANA .. 28 MAINE .. 31 MARYLAND .. 34 36 MICHIGAN .. 38 MINNESOTA .. 42 MISSISSIPPI .. 43 50 State Primer on Medicaid Recovery Laws MISSOURI .. 45 MONTANA .. 47 NEBRASKA .. 50 NEVADA .. 52 NEW HAMPSHIRE .. 54 NEW JERSEY .. 56 NEW MEXICO .. 58 NEW YORK .. 60 NORTH CAROLINA .. 61 NORTH DAKOTA .. 64 66 OKLAHOMA .. 68 OREGON .. 71 PENNSYLVANIA .. 74 RHODE ISLAND .. 79 SOUTH 80 SOUTH DAKOTA.

5 83 TENNESSEE .. 84 TEXAS .. 88 UTAH .. 89 VERMONT .. 96 VIRGINIA .. 99 WASHINGTON .. 101 WEST VIRGINIA .. 104 WISCONSIN .. 107 WYOMING .. 108 50 State Primer on Medicaid Recovery Laws 1 50 State Primer on Medicaid Recovery Laws This Primer is intended to provide a brief introduction to Medicaid Recovery laws and act as a practical reference guide for insurance, legal, or medical service providers on Medicaid reimbursement or subrogation claims, or Medicaid compliance issues. In this highly regulated industry, it is essential to understand the individual State laws that affect reimbursement and subrogation claims.

6 In March 2017, we brought you the 1st Edition of the 50 State Primer on Medicaid Recovery Laws. We are pleased to offer this 2nd Edition which includes updates to individual State laws, including Iowa, Kansas, Kentucky, Maine, Michigan, North Dakota, Tennessee, Texas, Utah, Virginia, and Washington. We have used bold underlined typeface to indicate changes to State laws since the 1st E dition. INTRODUCTION TO Medicaid AND State AGENCY Recovery RIGHTS Medicaid is the single largest health plan in the United States with enrollment of more than 72 million individuals.

7 Medicaid is separate and distinct from Medicare, which is a federal health plan based on age and certain disabilities. Medicaid is a joint federal and State program that funds medical care. Low income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory Medicaid eligible groups, whereas other groups are provided optional coverage at the State 's discretion such as individuals receiving home and community based services and children in foster care who are not otherwise eligible.

8 States are not required to participate in Medicaid ; however, all States have opted to do so. The federal government covers a percentage of the medical costs that are paid by the States. In return, States must pay their portion of medical costs as well as follow the requirements the federal government has set in place for Medicaid . State participation requirements include the following: setting requirements for eligibility determinations; collecting and maintaining information; and administering the program.

9 If the State recovers from a liable third party, then the federal government does not have to reimburse the State . See FFP and Repayment of Federal Share, 42 (a)(2)(2005). To receive federal Medicaid funding, States must include a provision in their Medicaid plans for recouping funds spent on behalf of Medicaid recipients from liable third parties. 42 1396a(a)(25)(A). States must take all reasonable measures to find third parties that are liable for the coverage of a Medicaid recipient's medical costs.

10 Id. States must include a provision that requires Medicaid participants to sign over their rights to seek and collect payment for medical care from a liable third party to the State . 42 1396a(a)(25)(H). Recipients of Medicaid have a duty to cooperate when the proceeding is initiated by the State . 42 Introduction to Medicaid and State Agency Recovery Rights 50 State Primer on Medicaid Recovery Laws 2 1396k(a)(1)(C). Recipients must help identify and provide information that will help the State to pursue third parties.