Medical Assistance

2.1.1.2.1.3 Third Party Liability (Archive)

Third parties are people, entities, or programs that are, or may be, liable to pay all or part of the medical costs provided to Medical Assistance (MA) or Children Health Insurance Plan (CHIP) funded MA enrollees.

A third party may be liable to pay all or part of the medical costs provided to MA or CHIP-funded MA enrollees because  these programs are the payer of last resort, with limited exception, such as Indian Health Services. This means enrollees with third party liability (TPL) must have medical costs covered by TPL paid by those sources before MA pays claims.

A third party payer includes, but is not limited to:

• Other health care coverage, such as group health plans, COBRA continuation of group health plans, individual health plans, Medicare, and military insurance

• Medical support from absent parents

• Other sources such as automobile insurance, court judgments or settlements, workers’ compensation, and fundraisers to pay for medical expenses

Other Health Care Coverage

Applicants and enrollees must cooperate with identifying sources of existing health coverage and assign rights to other health care coverage. Those who fail to cooperate with TPL requirements may be denied coverage or have their MA or CHIP-funded MA coverage ended. See the MA Cooperation policy for more information.

People must cooperate with TPL requirements by:

• Providing information to assist the Minnesota Department of Human Services (DHS) or an enrollee’s managed care plan to pursue any third party liable for payment, and applying for other benefits that may help pay for their medical costs. This includes:

  • Cooperation with completing Medical Service Questionnaires (MSQs) when the person has received a service that potentially indicates a third party may be responsible

  • Giving complete information about third party health, dental, vision and long-term care insurance policies that cover MA enrollees

• Enrolling or maintaining enrollment in:

  • A group health plan that is cost effective

  • A group health plan when there is no cost for the policyholder to cover all family members enrolled in MA

  MA eligibility continues for people who do not enroll in, cooperate with or assign rights to a group health plan if they cannot do so on their own behalf. See MA Cost Effective Health Insurance for more information.

• Assigning rights to DHS for medical support and payment for medical care from any third party

Enrollees do not have to cooperate with TPL requirements when they are Safe at Home (SAH) Address Confidentiality program participants and the policyholder is their probable assailant.

Medical Support

Medical support may include cash payments or health insurance coverage that a parent who does not live with their children must provide or are court-ordered to provide to meet the medical needs of their children. Parents and relative caretakers who are referred for medical support must cooperate with the county, tribal or state servicing agency as a condition of their own eligibility, unless they show good cause for non-cooperation. See MA Medical Support for more information.

Other Third Party Liability

In some situations, automobile insurance, homeowner insurance, court judgments or settlements, workers’ compensation and other third parties may pay health care costs. See MA Other Third Party Liability for more information.

Legal Citations

Code of Federal Regulations, title 42, sections 433.135 to 433.154

Code of Federal Regulations, title 42, section 435.610

Federal Register, Vol.60, No.131 (July 10, 1995), page 35498

Minnesota Statues, section 256B.042

Minnesota Statutes, section 256B.056

United States Code, title 42, section 1396a

United States Code, title 42, section 1396e

United States Code, title 42, section 1396g-1

Published: September 1, 2018

Archived: October 1, 2021