National Conference of Insurance Legislators adopts Model Medicaid Intercept Act

By Lynn Roberts February 4, 2015

The ISO ClaimSearch® team would like to advise you that the National Conference of Insurance Legislators (NCOIL) adopted the Model Act Regarding Medicaid Interception of Insurance Payments on November 20, 2014, at its 2014 annual meeting in San Francisco. Based on the Rhode Island Medicaid Assistance Act passed in 2012, the Model Act establishes a reporting process by which Medicaid departments would discover and recoup payments made by property/casualty insurers and self-insureds to Medicaid beneficiaries. If the Model Act passes through additional state legislatures in 2015, it will affect your company in a number of ways. Below are several key points ISO would like to bring to your attention regarding the Model Act:

  1. In accordance with state law, when applying for Medicaid, an applicant automatically assigns his or her rights to the state to recoup any payments made under applicable insurance coverage.
  2. The goal of the Model Act Regarding Medicaid Interception of Insurance Payments is to help Medicaid state agencies recover money it paid for beneficiaries’ healthcare treatment.
  3. The model applies to no-fault, personal injury protection, medical payments, and third-party bodily injury liability claims of $2,000 or more that are filed against property/casualty insurers and self-insureds.
  4. The model allows the ISO ClaimSearch Medicaid Reporting Service to serve as a compliance tool for ISO ClaimSearch participants. This service is offered at no additional cost to ISO ClaimSearch participants.
    • The service matches ISO ClaimSearch claims against a state’s Medicaid records.
    • When a match occurs, the Medicaid agency could apply a lien against the claim payment.
    • Once the lien has been addressed, the balance of the payment will be disbursed to the claimant.
    • A process for appeals will exist.

Additional information about the ISO ClaimSearch Medicaid Reporting Service is available at Info.claimsearch@iso.com.