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Notes

42 C.F.R. §§ 433.145–433.148

4 sections in range

§433.145. Assignment of rights to benefits—State plan requirements.

42 C.F.R. § 433.145

(a)
A State plan must provide that, as a condition of eligibility, each legally able applicant or beneficiary is required to:
(1)
Assign to the Medicaid agency his or her rights, or the rights of any other individual eligible under the plan for whom he or she can legally make an assignment, to medical support and to payment for medical care from any third party;
(2)
Cooperate with the agency in establishing the identity of a child's parents and in obtaining medical support and payments, unless the individual establishes good cause for not cooperating, and except for individuals described in § 435.116 of this chapter (pregnant women), who are exempt from cooperating in establishing the identity of a child's parents and obtaining medical support and payments from, or derived from, the non-custodial parent of a child; and
(3)
Cooperate in identifying and providing information to assist the Medicaid agency in pursuing third parties who may be liable to pay for care and services under the plan, unless the individual establishes good cause for not cooperating.
(b)
A State plan must provide that the requirements for assignments, cooperation in establishing paternity and obtaining support, and cooperation in identifying and providing information to assist the State in pursuing any liable third party under §§ 433.146 through 433.148 are met.
(c)
A State plan must provide that the assignment of rights to benefits obtained from an applicant or beneficiary is effective only for services that are reimbursed by Medicaid.
Notes, amendments, and revision history

Amendments

[55 FR 48606, Nov. 21, 1990, as amended at 58 FR 4907, Jan. 19, 1993; 81 FR 86450, Nov. 30, 2016]

Source

Source: 45 FR 8984, Feb. 11, 1980, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45201, Sept. 29, 1978, unless otherwise noted.

Amendments

[55 FR 48606, Nov. 21, 1990, as amended at 58 FR 4907, Jan. 19, 1993; 81 FR 86450, Nov. 30, 2016]

§433.146. Rights assigned; assignment method.

42 C.F.R. § 433.146

(a)
Except as specified in paragraph (b) of this section, the agency must require the individual to assign to the State—
(1)
His own rights to any medical care support available under an order of a court or an administrative agency, and any third party payments for medical care; and
(2)
The rights of any other individual eligible under the plan, for whom he can legally make an assignment.
(b)
Assignment of rights to benefits may not include assignment of rights to Medicare benefits.
(c)
If assignment of rights to benefits is automatic because of State law, the agency may substitute such an assignment for an individual executed assignment, as long as the agency informs the individual of the terms and consequences of the State law.
Notes, amendments, and revision history

Source

Source: 45 FR 8984, Feb. 11, 1980, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45201, Sept. 29, 1978, unless otherwise noted.

§433.147. Cooperation in establishing the identity of a child's parents and in obtaining medical support and payments and in identifying and providing information to assist in pursuing third parties who may be liable to pay.

42 C.F.R. § 433.147

(a)
Scope of requirement. The agency must require the individual who assigns his or her rights to cooperate in—
(1)
Except as exempt under § 433.145(a)(2), establishing the identity of a child's parents and obtaining medical support and payments for himself or herself and any other person for whom the individual can legally assign rights; and
(2)
Identifying and providing information to assist the Medicaid agency in pursuing third parties who may be liable to pay for care and services under the plan.
(b)
Essentials of cooperation. As part of a cooperation, the agency may require an individual to—
(1)
Appear at a State or local office designated by the agency to provide information or evidence relevant to the case;
(2)
Appear as a witness at a court or other proceeding;
(3)
Provide information, or attest to lack of information, under penalty of perjury;
(4)
Pay to the agency any support or medical care funds received that are covered by the assignment of rights; and
(5)
Take any other reasonable steps to assist in establishing paternity and securing medical support and payments, and in identifying and providing information to assist the State in pursuing any liable third party.
(c)
Waiver of cooperation for good cause. The agency must waive the requirements in paragraphs (a) and (b) of this section if it determines that the individual has good cause for refusing to cooperate.
(1)
For establishing the identity of a child's parents or obtaining medical care support and payments, or identifying or providing information to assist the State in pursuing any liable third party for a child for whom the individual can legally assign rights, the agency must find that cooperation is against the best interests of the child.
(2)
With respect to obtaining medical care support and payments for an individual and identifying and providing information to assist in pursuing liable third parties in any case not covered by paragraph (c)(1) of this section, the agency must find that cooperation is against the best interests of the individual or the person to whom Medicaid is being furnished because it is anticipated that cooperation will result in reprisal against, and cause physical or emotional harm to, the individual or other person.
Notes, amendments, and revision history

Amendments

[45 FR 8984, Feb. 11, 1980, as amended at 55 FR 48606, Nov. 21, 1990; 58 FR 4907, Jan. 19, 1993; 81 FR 86450, Nov. 30, 2016]

Source

Source: 45 FR 8984, Feb. 11, 1980, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45201, Sept. 29, 1978, unless otherwise noted.

Amendments

[45 FR 8984, Feb. 11, 1980, as amended at 55 FR 48606, Nov. 21, 1990; 58 FR 4907, Jan. 19, 1993; 81 FR 86450, Nov. 30, 2016]

§433.148. Denial or termination of eligibility.

42 C.F.R. § 433.148

In administering the assignment of rights provision, the agency must:
(a)
Deny or terminate eligibility for any applicant or beneficiary who—
(1)
Refuses to assign his own rights or those of any other individual for whom he can legally make an assignment; or
(2)
In the case of an applicant, does not attest to willingness to cooperate, and in the case of a beneficiary, refuses to cooperate in establishing the identity of a child's parents, obtaining medical child support and pursuing liable third parties, as required under § 433.147(a) unless cooperation has been waived;
(b)
Provide Medicaid to any individual who—
(1)
Cannot legally assign his own rights; and
(2)
Would otherwise be eligible for Medicaid but for the refusal, by a person legally able to assign his rights, to assign his rights or to cooperate as required by this subpart; and
(c)
In denying or terminating eligibility, comply with the notice and hearing requirements of part 431, subpart E of this subchapter.
Notes, amendments, and revision history

Amendments

[45 FR 8984, Feb. 11, 1980, as amended at 81 FR 86450, Nov. 30, 2016]

Source

Source: 45 FR 8984, Feb. 11, 1980, unless otherwise noted.

Authority

Authority: 42 U.S.C. 1302.

Source

Source: 43 FR 45201, Sept. 29, 1978, unless otherwise noted.

Amendments

[45 FR 8984, Feb. 11, 1980, as amended at 81 FR 86450, Nov. 30, 2016]