Medicaid Casualty Recovery Overview

Section 1902(a)(25) of the Social Security Act, 42 CFR 433.135, requires that States take all reasonable measures to ascertain the legal liability of third parties to pay for medical services furnished to a Medicaid recipient. Pursuant to 1902(a)(25) the State of Ohio enacted Ohio Revised Code Section 5160.37, which gives the Department of Medicaid (ODM) a statutory right of recovery against the liability of any third party for the cost of medical services and care arising out of the injury, disease, or disability of a Medicaid recipient.

ODM contracted with Health Management Systems Inc., (HMS) to identify, manage, and recover all Medicaid paid funds when a Medicaid recipient was involved in a tort or casualty accident/incident. If you are an attorney with a Medicaid recipient client involved in a tort accident /incident and you want to obtain a listing of all of the bills that Medicaid paid please do the following:

  1. Complete a Referral Form and return it to the ODM Tort Recovery Unit with a HIPAA compliant Medical Release Authorization signed by the Medicaid recipient.
    • Be sure to include the following information:
      • Recipient First and Last Name
      • Social Security Number
      • Date of Birth
      • Date of Accident/Incident
      • Last date of treatment
      • Liable Third Party's Name, Address, Phone Number and Claim Number
    • It is helpful for us to know:
      • Pre-existing conditions
      • Last date of treatment according to the recipient.
      • If you have any of the bills, and if you have or will be paying those charges we will need proof of payment
  2. When we receive this form and release, we will enter the data into our Case Management System. This System will generate a letter that we will send to you citing ODM' right to recovery of Medicaid paid funds

Approximately two (2) - three (3) weeks after we send the letter, we will send you a claims printout of claims that ODM paid that we believe are related to the accident/incident. This printout will represent either an Interim or a Final statement of the aid paid by ODM. This printout will be the official recovery interest of the State of Ohio.

If you have any questions, please feel free to contact us.

Did you know ... ?
  • 2.6 Million of the 2.9 Million Medicaid eligible members are in enrolled in Managed Care Entities (MCE).
  • Most children, pregnant women, and parents enrolled are required to enroll in a managed care plan.
  • There are 8 Medicaid MCEs contracted with ODM: Aetna Better Health (Ohio Rise), AmeriHealth Caritas, Anthem Blue Cross and Blue Shield, Buckeye Health Plan, Caresource, Humana, Molina, and United Healthcare.

Contact Information

Phone

Ohio Tort Recovery Unit
PO Box 166529
Irving, TX 75016

Local:  614-242-1045
Toll Free:  888-245-9019
Fax:  614-242-1051
Email:  ohiotort@gainwelltechnologies.com