Medical Assistance Other Third Party Liability

In some situations, Medical Assistance (MA) enrollees may have access to third party liability other than health care coverage for all or part of their medical expenses related to an illness, accident or injury. The DHS Benefit Recovery Section (BRS) assists in the coordination of Third Party Liability (TPL) benefits and MA.

Examples of TPL that are not health care coverage include, but are not limited to the following:

  • Workers' Compensation may be liable for the cost of medical care and subsistence related to on-the-job injuries

  • Auto insurance policies may cover medical costs related to auto accidents or injuries involving a motor vehicle

  • Homeowners or business liability policies may cover medical costs related to accidents on the home or business owner's property

  • Tort claims and lawsuits may result in court-ordered awards for recovery of medical expenses caused by another party's negligence or malpractice including but not limited to:

    • Product liability

    • Medical malpractice

    • Pedestrian injuries

  • Health Reimbursement Account (HRA) is considered a Group Health Plan (GHP) as provided for Under the Internal Revenue Code.

Actual or potential non-health care coverage TPL payments are not a barrier to MA eligibility; however, the enrollee must cooperate in providing information to determine whether those third parties are liable.

Accidents and Injuries

Enrollees must complete additional documentation when possible TPL coverage is identified.

  • A Medical Service Questionnaire (MSQ) (DHS-2337A) when there is an accident or injury with an identified treatment code.

  • A Work Injury Report (WIR) wehn there is a work-related accident or injury.

  • An Accident Injury Report (AIR) (DHS-7336-ENG) when there is a motor-vehicle related accident or injury.

Adults who fail to cooperate with TPL requirements may have their MA coverage ended. See the MHCP Cooperation policy for more information.

Legal Citations

Minnesota Statutes, section 256B.056