---
kind: "range"
citation: "42 C.F.R. §§ 433.151–433.154"
title: "42"
from: "433.151"
to: "433.154"
count: 4
url: "https://uscodex.org/cfr/42/433.151..433.154"
---

# §433.151. Cooperative agreements and incentive payments—State plan requirements.


For medical assistance furnished on or after October 1, 1984—

- (a) A State plan must provide for entering into written cooperative agreements for enforcement of rights to and collection of third party benefits with at least one of the following entities: The State title IV-D agency, any appropriate agency of any State, and appropriate courts and law enforcement officials. The agreements must be in accordance with the provisions of [§ 433.152](/cfr/42/433.152.md).
- (b) A State plan must provide that the requirements for making incentive payments and for distributing third party collections specified in §§ [433.153](/cfr/42/433.153.md) and [433.154](/cfr/42/433.154.md) are met.

# §433.152. Requirements for cooperative agreements for third party collections.

- (a) Except as specified in [paragraph (b)](#b) of this section, the State agency may develop the specific terms of cooperative agreements with other agencies as it determines appropriate for individual circumstances.
- (b) Agreements with title IV-D agencies must specify that:
  - (1) The Medicaid agency may not refer a case for medical support enforcement when the following criteria have been met:
    - (i) The Medicaid referral is based solely upon health care services provided through an Indian Health Program (as defined at [25 U.S.C. 1603(12)](/usc/25/1603.md?p=12)), including through the Purchased/Referred Care program, to a child who is eligible for health care services from the Indian Health Service (IHS).
    - (ii) [Reserved]
  - (2) The Medicaid agency will provide reimbursement to the IV-D agency only for those child support services performed that are not reimbursable by the Office of Child Support Enforcement under title IV-D of the Act and that are necessary for the collection of amounts for the Medicaid program.

# §433.153. Incentive payments to States and political subdivisions.

- (a) **When payments are required.** The agency must make an incentive payment to a political subdivision, a legal entity of the subdivision such as a prosecuting or district attorney or a friend of the court, or another State that enforces and collects medical support and payments for the agency.
- (b) **Amount and source of payment.** The incentive payment must equal 15 percent of the amount collected, and must be made from the Federal share of that amount.
- (c) **Payment to two or more jurisdictions.** If more than one State or political subdivision is involved in enforcing and collecting support and payments:
  - (1) The agency must pay all of the incentive payment to the political subdivision, legal entity of the subdivision, or another State that collected medical support and payments at the request of the agency.
  - (2) The political subdivision, legal entity or other State that receives the incentive payment must then divide the incentive payment equally with any other political subdivisions, legal entities, or other States that assisted in the collection, unless an alternative allocation is agreed upon by all jurisdictions involved.

# §433.154. Distribution of collections.


The agency must distribute collections as follows—

- (a) To itself, an amount equal to State Medicaid expenditures for the individual on whose right the collection was based.
- (b) To the Federal Government, the Federal share of the State Medicaid expenditures, minus any incentive payment made in accordance with [§ 433.153](/cfr/42/433.153.md).
- (c) **To the beneficiary, any remaining amount.** This amount must be treated as income or resources under [part 435](/cfr/42/part435.md) or [part 436](/cfr/42/part436.md) of this subchapter, as appropriate.