Medicaid Third Party Liability Act This bill modifies requirements relating to Medicaid third-party liability. Current law generally requires legally liable third parties (e.g., health insurers) to pay claims before Medicaid. However, Medicaid must pay first (and seek reimbursement from liable third parties) for claims for (1) preventive pediatric care, and (2) services for an individual for whom child support enforcement is being conducted by the state. The bill repeals these exceptions. Current law also requires state Medicaid programs to take all reasonable measures to identify legally liable third parties. The bill specifically prohibits federal Medicaid payment for services to individuals for whom third-party insurance information was not obtained and verified by the state.
If passed, HB 497 would specifically alter the legal framework surrounding Medicaid reimbursements and third-party liabilities. Insurers would be required to take on more clearly defined roles regarding their liabilities while receiving medical assistance payments. One crucial update is the clarification that states can delegate their right to recover costs from third parties to health insurers, fostering collaboration between state agencies and private insurers.
House Bill 497, known as the Medicaid Third Party Liability Act, aims to amend Title XIX of the Social Security Act, clarifying the responsibilities of third-party payers related to medical assistance under the Medicaid program. The bill revises the rules governing how state agencies can recover costs from third-party insurers when Medicaid pays for medical services. This change is intended to enhance the efficiency of state Medicaid programs by ensuring that they can effectively recover funds from private insurers, which could lead to decreased state expenditures for Medicaid.
The bill could lead to differences in opinion among stakeholders. Proponents argue that streamlining recovery processes will benefit the overall efficiency of Medicaid funding, providing essential services to more people without increasing state costs. However, detractors might raise concerns about the implications for individual rights regarding insurance claims and the financial burden on insurers that may arise from expanded responsibilities under HB 497. Legislative debates may focus on protecting the interests of Medicaid recipients while balancing the financial responsibilities of insurers.