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:
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
- Be sure to include the following information:
- 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.
- 2.3 Million of the 2.5 Million Medicaid eligible members are in enrolled in a Managed Care Plan (MCP).
- Most children, pregnant women, and parents enrolled are required to enroll in a managed care plan.
- There are five Medicaid MCPs contracted with ODM: Buckeye Health Plan, Caresource, Molina, Paramount Advantage, and United Healthcare.
Ohio Tort Recovery Unit
5475 Rings Rd., Suite 200
Dublin, OH 43017