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Medicaid Subrogation Process

Auto Accident and Auto Insurance  
Process
Trauma Edit or Third Party Liability Questionnaire  
Frequently Asked Questions

 

What is Subrogation?

 

The Michigan Department of Community Health (MDCH) Court Originated Liability Section pursues subrogation interests for the state. "Subrogation interest" refers to the total amount of related medical claims paid by the Medicaid program.  These subrogation interests are commonly referred to as Medicaid "liens," although, legally, they are not liens.  The Casualty Unit determines the amount of money owed to the Medicaid program through communication with insurance companies and private attorneys. 

 

The state has a subrogation interest in funds paid for Medicaid beneficiaries where another party is responsible to pay.  Below are examples of situations where another party may be responsible for payment:

 

        Cause of Injury:             Possible Third Party:

Ø           Auto accident                 (No-fault Auto Insurance)  
Ø           Job-related injury            (Workers' Compensation Insurance)  
Ø           General accident            (Liability Insurance or Litigation)  
Ø           Intentional harm             (Court Ordered Restitution)  
Ø           Medical Malpractice       (Liability Insurance or Litigation)  
Ø           Product failure               (Product Liability or Litigation)  

The beneficiary, their representative, or their attorney is legally required to let MDCH know when an injury-related lawsuit is filed.  The Casualty Unit then determines if the Medicaid program has paid any related medical claims. 

 

Auto Accident and Auto Insurance

 If a Medicaid beneficiary is injured in an automobile accident, he/she must inform all treating providers of the automobile insurance policy that is responsible for payment. 

 If the automobile insurance policy information is not known until after treatment, please complete the Casualty Information Form  and return it to the address below. 

 More information is available in the Coordination of Benefits chapter of the Medicaid Provider Manual .  

 The State of Michigan started the Assigned Claims Plan (ACP) in 1973. ACP provides financial help to victims of a motor vehicle accident who are not covered under another policy.   

 

Notify MDCH/Request Subrogation Interest Amount (For Attorneys or Insurance Companies)

All Medicaid subrogation interest amount requests must be on business letterhead. 

 

For initial requests, please include:

 

ü       Name of client (injured party)
ü       Date of birth
ü       Social Security number
ü       Medicaid ID number (if known)
ü       Date of Incident
ü       Summary of Incident
ü       Description of Injury
ü       Type of Case
ü       County Filed
ü       Court Case Number

 

For update requests, please include:

 

ü       Name of client
ü       Date of birth
ü       Social Security number
ü       Medicaid ID number
ü       Date of Incident
ü       Scheduled Court Date

 

 

Mail requests to:

 

Michigan Department of Community Health
Third Party Liability Division, Casualty Unit
P.O. Box 30435
Lansing, MI  48909

 

Fax to: 517-346-9876

 

Or email to: MDCH-Casualty@michigan.gov

 

Please allow 10 business days for processing.

 

 

Process

 

The Casualty Unit reviews all Medicaid paid claims for each request.  Only those claims that are related to the injury are selected.  The related claims are totaled, and a response letter is sent stating an initial Medicaid subrogation interest amount. 

 

The Casualty Unit will send a letter that states no subrogation interest will be asserted at that time if:

 

ü       The total amount paid by the Medicaid program is less than a predetermined threshold set by the Department;

ü       The client does not have a Medicaid record; or

ü       The client has only received public assistance through a Medicaid Managed Care  plan.

 

If the client was enrolled in a Medicaid Managed Care plan at any time since the incident date, information regarding that plan will be included in the response.  Medicaid and Medicaid Managed Care Plans are separate entities; therefore, attorneys are required to contact the plans directly to determine their interest. 

 

Detailed information for each selected claim may only be released with a valid Authorization to Disclose Protected Health Information on file.  If you would like detailed claims information, a signed Authorization must be submitted with the request.  If you are using an authorization developed by your office, please ensure that it is HIPAA compliant .  

 

Please note: By default, authorizations expire one year from the signature date.   You may change the date of expiration on the form.

 

Providers have up to twelve months from the date of service to submit a claim to Medicaid.  Casualty employees can only access claims that have been paid.  Casualty staff will not have access to a submitted claim until it has been fully processed.

 

All requests will be reviewed periodically.  If additional related claims are found, an update letter will be sent to the attorney of record.  Please continue to contact our office for updated information at least 10 business days prior to any related proceeding.

Trauma Edit or Third Party Liability Questionnaire

 

The Casualty Information System identifies medical expenses that may be related to an accident or injury.  The system generates a questionnaire which is mailed to the Medicaid beneficiary.  This questionnaire requests additional information about the injury for which treatment was sought.  The Casualty Unit uses this information to determine if there may be a liable Third Party.

 

If you receive one of these forms, please complete and return in the envelope provided within 14  days.  If you would like to inform us of an accident, please click  here  to obtain a copy of the Questionnaire. 

 

Mail completed Questionnaire to:

 

Michigan Department of Community Health
Third Party Liability Division, Casualty Unit
P.O. Box 30435
Lansing, MI  48909

 

Fax to: 517-346-9876

 

Or email to: MDCH-Casualty@michigan.gov

 

Quick Links to Relevant Forms & Information

 

Authorization to Disclose Protected Health Information (TPL)

Casualty Insurance Information Form (DCH-1354(A)

 

Medicaid Managed Care Contact Information

 

 

 

Frequently Asked Questions

 

What gives Medicaid the right of subrogation? 

Section 106 of the Social Welfare Act, MCL 400.106, provides that MDCH is subrogated to any right of recovery that the beneficiary may have for the cost of medical care. The beneficiary executed an assignment of benefits for recoveries related to medical expenditures made by the Medicaid program in their application for assistance. 

 

Can your office give me subrogation information for Medicare?

No.  Medicare is a federal program.  Information about Medicare reimbursement is located at:  http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/recovery-audit-program/index.html

 

Will an attorney be compensated by MDCH for work in recovering medical expenses for the State?  Pursuant to MCLA 14.28-et seq, MSA 3.181, only the Michigan Office of Attorney General can represent the State of Michigan in legal proceedings.  However, not every case can be referred to the Attorney General.  Casualty Unit staff are encouraged to negotiate with private attorneys to obtain Medicaid recoveries in a fair manner.

 

Where do I mail payments? 

 

Mail payments to:

 

Michigan Department of Community Health
P.O. Box 30053
Lansing, MI  48909

 

Please include a copy of the Medicaid subrogation letter to assist with the processing of payments.  Include your client's name and Medicaid ID number on the front of the check .

 

I have a check that is made out to my office and the State of Michigan, what do I do?  Contact the staff person assigned to the case.  Each case is handled specifically.  There is no blanket authorization for depositing or cashing two-party checks. 

 

What criteria determine if Medicaid will be asserting a subrogation interest?  Management determines threshold amounts.  These amounts are based on costs associated with recovery efforts for each case and may change over time.  MDCH will not assert an interest unless related medical expenses exceed this threshold amount.

 

Where do I send a subpoena for Medicaid records?   Please do not send subpoenas directly to Third Party Liability.  All subpoenas are processed by the MDCH Office of Legal Affairs. 

Please send to:

Department of Community Health
Office of Legal Affairs
201 Townsend
Lansing, Michigan 48913

Related Content
 •  Frequently Asked Questions
 •  Process
 •  Trauma Edit or Third Party Liability Questionnaire
 •  Medicaid Subrogation Process
 •  Auto Accident and Auto Insurance
 •  Birth Expense Reporting
 •  Medicare Buy-In
 •  Health Insurance
 •  Third Party Liability (TPL) Coordination of Benefits
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