37.82.416    ASSIGNMENT OF RIGHTS TO BENEFITS, COOPERATION WITH CHILD SUPPORT SERVICES REQUIREMENTS

(1) As a condition of eligibility for Medicaid, each legally able applicant and recipient must assign his rights to medical support or other third party payments to the department and must cooperate with the department in obtaining medical support or payments, except as provided in (4)(a) through (4)(e).

(2) Assignment method and rights assigned:

(a) Under 53-2-612 , MCA, the department has a lien upon all money paid by a third party or his insurer in satisfaction of a judgment or settlement arising from a recipient's claim for damages or compensation for personal injury, disease, illness, or disability. Under 53-2-613 , MCA, by signing the department-prescribed application form for Medicaid, an applicant for or recipient of Medicaid assigns to the department:

(i) his own rights to any medical care support under an order of a court or an administrative agency, and any third party payments for medical care; and

(ii) the rights of any other eligible individual in the family for whom he can legally make an assignment.

(b) Assignment of rights to benefits does not include assignment of rights to Medicare benefits.

(3) Cooperation in establishing paternity and obtaining support:

(a) The individual whose rights are assigned as provided in (2) must cooperate in:

(i) establishing paternity of a child born out of wedlock for whom he can legally assign rights; and

(ii) obtaining medical care support and payments for himself and any other individual for whom he can legally assign rights.

(b) As a part of cooperation, the department may require an individual to:

(i) appear at the state or county office to provide information or evidence relevant to the case;

(ii) appear as a witness at a court or other proceeding;

(iii) provide information, or attest to lack of information, under penalty of perjury;

(iv) pay to the department any support or medical care funds received that are covered by the assignment of rights; and

(v) take any other reasonable steps to assist in establishing paternity and securing medical support and payments.

(c) The department will waive the requirements in (a) and (b) if it determines that the individual has good cause for refusing to cooperate.

(i) With respect to establishing paternity of a child born out of wedlock or obtaining medical care support and payments for a child for whom the individual can legally assign rights, good cause is as defined in ARM 37.78.215.

(ii) With respect to obtaining medical care support and payments for an individual in any case not covered by (3)(c)(i), the department will waive cooperation if the department determines that cooperation is against the best interests of the individual or other 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.

(d) The procedure for waiving cooperation is as provided in ARM 37.78.215.

(4) Individuals receiving medical assistance only in any of the following coverage groups are not required to assign their rights to medical support or cooperate with the Child Support Services Division in establishing paternity and obtaining medical support:

(a) automatic newborn assistance;

(b) poverty level child assistance;

(c) poverty level pregnant woman assistance;

(d) poverty six child assistance; and

(e) Ribicoff child assistance.

(5) Medicaid eligibility will be denied or terminated for any applicant or recipient who fails or refuses without good cause to comply with the requirements of this rule regarding assignment of rights and/or cooperation in establishing paternity and obtaining support.

(a) However, Medicaid will be provided to a minor child or other individual who cannot legally assign rights or cooperate, if that individual is otherwise eligible, despite the failure or refusal of the caretaker relative or any other individual to comply with the requirements of this rule.

 

History: 53-6-113, MCA; IMP, 53-2-612, 53-2-613, 53-6-131, MCA; NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1990 MAR p. 1609, Eff. 8/17/90; AMD, 1998 MAR p. 3281, Eff. 12/18/98; TRANS, from SRS, 2000 MAR p. 476; AMD, 2020 MAR p. 966, Eff. 5/30/20.