503 Assignment of Rights to Medical Benefits and Cooperation

 

 

 

Revised 04/26/2018

 

Policy

A person’s rights to medical support and to payment for medical care from any third party are assigned to AHCCCS when the person is approved for AHCCCS Medical Assistance (MA) or KidsCare. 

To qualify for or to keep getting AHCCCS, a person must:

·         Turn in any payments for medical support or medical services to AHCCCS;

·         Provide information about any sources of medical coverage or third-party liability (TPL);

·         Take any actions needed to get payment for medical services from a source of TPL; and

·         Cooperate with the Division of Child Support Services (DCSS) to determine the paternity of a child in the home who is receiving MA, and take any actions needed to get medical support from an absent parent, unless the person has good cause not to cooperate. 

NOTE      While she is pregnant, a woman does not have to cooperate with DCSS for any children she had when she was not married.  Cooperation with DCSS is also not required for people on KidsCare.

 

 

Definitions

Term

Definition

Assignment of rights

Transfers rights to medical benefits and payment for medical services from the member to the AHCCCS Administration. 

Division of Child Support Services (DCSS)

Division of the Department of Economic Security responsible for getting medical support orders in place and enforcing those orders.

Good cause not to cooperate with DCSS

Good cause includes:

·         Cooperation in determining paternity or getting a support order is reasonably expected to result in physical or emotional harm to the child or the person with whom the child is living;

·         Legal proceedings for the child’s adoption are pending before a court;

·         The parent is working with a public or licensed private agency to give the child up for adoption, and discussions have not gone on for more than three months; or

·         The child was conceived as a result of incest or rape.

Third-party liability (TPL)

Responsibility of a person, entity or program to pay for any of a person’s medical costs.

Third-party liability includes:

·         Health and dental insurance;

·         Payments from insurance;

·         Payments from lawsuits;

·         Other medical settlements, claims, or benefits; and

·         Medical support for a child from an absent parent.

 

Proof

Proof of good cause for not cooperating with DCSS, includes:

·         Birth certificate that shows the child was conceived through incest;

·         Medical or law enforcement records that show the mother was raped;

·         Court or other legal documents showing that adoption proceedings are pending before a court;

·         Written statement from the adoption agency that they have been working with the customer on giving up the child for adoption and for how long;

·         Court, medical, criminal, child protective services, psychological, social services or law enforcement records showing that the absent parent might physically or emotionally harm the child or caretaker relative; or

·         Sworn statements from friends, neighbors, clergy or other people who know the about the situation and can support the good cause claim.

When none of the above is available, ask the person to provide any information that would support further investigation.

Good cause must be reviewed at renewal and any time there is a change that shows good cause no longer exists.

 

 

Legal Authority

This requirement applies to the following programs:

Program

Legal Authorities

All programs

42 CFR 435.610

ARS 36-2903(F)

AAC R9-22-306(B)

AAC R9-28-401.01

AAC R9-29-208

AAC R9-31-303