Under state and federal law, the Medicaid program is intended to be the payer of last resort for health-care costs. All other available third-party resources must meet their legal obligations to pay claims before the Medicaid program pays for the care of an individual eligible for Medicaid.
The Third Party Liability Unit (TPL) identifies Medicaid recipients who have other medical insurance or payment sources that must pay at least some of their health-care costs before they rely on Medicaid. These third-party sources may include health and liability insurance, court settlements, worker's compensation, and absent parents.
Individuals eligible for Medicaid assign their rights to third-party payments to the State Medicaid agency, which in Montana is the Department of Public Health and Human Services. Once the state has determined that a potentially liable third party exists, it is required either to "cost avoid" or "pay and chase" claims.
Cost avoidance is where the provider of services bills and collects from liable third parties before sending a claim to Medicaid. Pay and chase is used when the state Medicaid program pays the medical bills and then attempts to recover from liable third parties.
The Third Party Liability Unit comprises these programs:
When the State becomes aware of recoverable assets, it files a claim against the deceased recipient's estate. The personal representative or attorney handling the estate uses proceeds from the sale of estate property to repay the Medicaid Program for medical expenses paid on the decedent's behalf.
The State may also place a lien on a nursing home or institutionalized recipient's home when there is not a reasonable expectation that the recipient will return home within six months. Proceeds from the sale of the home are used to reimburse the Medicaid Program for medical expenses paid on the recipient's behalf.
Program Compliance Bureau Chief
Third Party Liability Supervisor
Page last updated: 02/11/2013