2-011.04 Third Party Medical Payments Received Directly

469 NAC 2-011.04

If the client receives a third party medical payment directly and the medical expense for which the third party medical payment is intended is payable by NMAP, the worker must take the following actions:

Recoupment of Third Party Medical Payments:

1. Send a demand letter advising the client that s/he must reimburse the Department or the provider. The client is allowed ten days from the date of notification to reimburse the medical payment. For an applicant, the worker shall not delay determination of eligibility for assistance and authorization for payment pending the applicant's reimbursement. At the time the application is approved, the worker shall notify the client of the number of days left in which to reimburse the payment;

2. If the client refunds within the ten days, take no further action; or

3. If the client fails or refuses to refund within the ten days, consider the entire third party payment as unearned income in the first month possible, taking into account adequate and timely notice. Any balance remaining is considered a resource in the following month (see 469 NAC 2-010.01B2d).

If the insurance payment exceeds NMAP rates, the excess is considered unearned income unless paid out on other medical services or supplies.

Regardless of the existence of a good cause claim, any third party medical payment that is received directly by the client must be reimbursed.