Medicaid Secondary Payer

Issue:

The Federal Medicaid statute requires each state participating in the Medicaid program to have a Medicaid Secondary Payer program, and each statutorily-required “State Plan” to include a CMS-approved secondary payer plan.

Many states, however, have found it cost effective to enforce their secondary payer programs, and have not aggressively sought recoveries from settlements or judgments.  The states, however, are beginning to shift their focus, and state Medicaid Directors, or contractors selling services to the states, are increasing secondary payer recovery activities.  Most recently, Rhode Island, Vermont, and West Virginia, as well as other states have been exploring settlement reporting.

Importantly, each state currently operates a different and unique Medicaid program, with individual secondary payer requirements.  MARC will engage with the Congress, states and other stakeholders to discuss ways in which the state systems can be uniform and streamlined.

Issue Brief:

Medicaid Secondary Payer Issue Brief

Reference Documents:

Rhode Island Interceptor Program
Federal Medicaid Statutes