# Plain Language Summary: Medicaid Third Party Liability Act

This bill changes how states handle situations where someone has both Medicaid and other health insurance. Right now, when Medicaid pays for your medical care, the government has the right to recover that money from your other insurance company if that company should have paid instead. This bill clarifies and expands how states can manage this process, particularly when they hire private insurance companies to handle Medicaid coverage.

The main change is that states can now delegate their recovery rights to private health insurers—meaning if you have both Medicaid and private insurance, the private insurance company can pursue getting reimbursed from other responsible parties instead of the state doing it. The bill also requires states to be clearer about what rights they're giving to these private insurers. Additionally, starting January 1, 2024, states must verify whether people applying for Medicaid have other insurance coverage, and they won't get federal funding for Medicaid claims if they haven't checked for other insurance first.

For most Medicaid recipients, this won't directly change your benefits or coverage. However, it could affect how quickly claims get processed and resolved, since private insurers may handle recovery differently than state agencies. The bill essentially streamlines the system by allowing states to use private companies to manage the complicated task of figuring out who should actually pay for medical services when multiple insurance options exist. States have until their next legislative session to update their rules to comply with these new requirements.

Medicaid Third Party Liability Act

Burgess, Michael C.

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.