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Mississippi Medicaid Recovery

a service of HMS

Overview

Welcome to the Subrogation website for the Mississippi Division of Medicaid (DOM) operated by Health Management Systems, Inc. (HMS). HMS has contracted with DOM to operate the Subrogation Unit.

Subrogation Unit

The Subrogation Unit is responsible for enforcing DOM’s statutory right to recovery in subrogation claims, and for ensuring the State receives its reimbursement. The Subrogation Unit’s purpose is to recover the cost of medical expenditures from liable third parties when beneficiaries are involved in a personal injury action. These suits may be related to an auto accident, medical malpractice claim, general liability, workers’ compensation, mass torts, or any other tort claim where a settlement has been reached or a judgment has been awarded.

To notify DOM of an action, please fax your standard letter of representation to our office at 1-844-388-0653. The Subrogation Unit will contact you with the subrogation amount to help you settle your claim. If you require a breakdown of the bills paid by DOM, please include a signed medical authorization.

DOM has a statutory right to recovery. As a condition of eligibility, beneficiaries assign their rights to DOM for any third party payments.

Official Mississippi Code Annotated and Code of Federal Regulations

The authority and subrogation recovery rights can be referenced in the following state and federal cites:

Forms

The Transmittal Form can be used to notify DOM that your office represents a Medicaid beneficiary who has an injury claim. It will begin the process of verifying whether Medicaid has a claim, the amount of the Medicaid claim, and the resolution of the claim. Simply complete the form and fax it to the Subrogation Unit at the number below. If you would prefer, you can fax a letter of representation on your firm’s letterhead.

Attn: Subrogation Unit
Fax: 844-388-0653

Transmittal Form (PDF)

Medical Authorization Form

If you would like the DOM Subrogation Unit to provide your attorney, legal representative, or claim adjuster with a list of the providers paid for services related to your accident or injury, please print the following form and sign, date, and fax it to: 844-388-0653.

Subrogation FAQ

  1. What do you do if your client is involved in an accident?

    Ask your client if he or she is covered under Medicaid. You may also contact our office to verify that your client is covered under these programs. You should also check with your client to see if he or she is covered under Mississippi Coordinated Access Network (MississippiCAN), Medicaid’s managed care program. If so, you will also need to contact the appropriate managed care provider for its claim amount.

  2. What are the attorney’s responsibilities?

    Pursuant to Miss. Code Ann. § 43-13-125, attorneys, beneficiaries and insurance companies have a number of responsibilities. For instance, attorneys shall certify to DOM a copy of the pleadings at the time of the institution of suit, and proof of that notice shall be filled in that action. Attorneys should also notify DOM in advance of any potential settlement, which may have been reached prior to or without the necessity of the institution of suit. Beneficiaries and attorneys shall execute and deliver instruments and papers to do whatever is necessary to secure DOM’s rights and shall do nothing after Medicaid is provided to prejudice DOM’s subrogation rights. Any applicable court orders or agreements for reimbursement of DOM’s interest shall direct those payments to DOM.

    Please remember that any Medicaid application is a binding legal document. When a beneficiary signs this application, he or she acknowledges that medical benefits paid on his or her behalf must be reimbursed to DOM if he or she is entitled to benefits from a third party.

  3. What will the Subrogation Unit do for you and your client?

    Upon contact by an attorney’s office, the Subrogation Unit will verify the beneficiary’s eligibility status at the time of the accident or injury, determine whether DOM incurred any medical expenses as a result of the accident or injury, and generate a complete medical history of injury-related claims. This information is available to attorneys who submit a written request along with a signed medical authorization from the client granting the attorney access to the beneficiary’s medical records.

  4. What medical assistance costs are recovered?

    The Subrogation Unit will request reimbursement only for injury-related charges. A reimbursable injury/loss may be related to an auto accident, medical malpractice, general liability, workers’ compensation, or any other tort claim where a settlement has been reached or a judgment has been awarded.

  5. What happens if the beneficiary fails to pay the Division’s claim?

    Failing to reimburse DOM may impact the beneficiary’s present and future Medicaid eligibility. Medicaid is entitled to bring a lawsuit against any person, firm or corporation who fails to protect Medicaid’s claim and recover double the amount of benefits paid to a beneficiary or the amount of the policy limits, whichever is lesser, as well as attorney’s fees and costs of court.

  6. How do you repay the Mississippi Division of Medicaid?

    Make your check payable to the Mississippi Division of Medicaid and mail it to DOM at:

    Mississippi Division of Medicaid
    P.O. Box 1035
    Jackson, MS 39201-9820

– See more at: http://hms.com/ms/subrogation-faq/#sthash.GEcZEXFK.dpuf

Estate Recovery

1. Why does Mississippi have an Estate Recovery program?

The Medicaid program is a joint federal/state program. Federal law requires states to develop and enforce an Estate Recovery Program. DHHS has the responsibility to recover money paid on behalf of the Medicaid beneficiary up to the full amount that Medicaid paid. This requirement is set forth in Title XIX of the Social Security Act.

To comply with this federal requirement Mississippi adopted N.C.G.S. § 108A-70.5. This statue governs the Mississippi Estate Recovery Program.

2. Who is affected by Estate Recovery?

The Estate Recovery Program applies to a person who receives any of the following Medicaid services:

  • A person of any age living in a nursing home, intermediate care facility for the mentally retarded, or other medical institution
  • A person 55 years of age or older who is receiving any of the following:
  • Nursing facility services.
  • Home and community-based services.
  • Hospital care.
  • Prescription drugs.
  • Personal care services.

3. What Medicaid expenses must be reimbursed?

Recoverable Medicaid expenses include any of the Medicaid services listed in question 2, above.

4. What is an undue hardship?

DHHS will waive recovery if enforcement of the claim will cause undue hardship to the surviving heirs of the decedent:

  • Undue hardship is defined as follows:
    1. Real or personal property included in the estate is the sole source of income for a surviving heir and his or her spouse and related family members in his or her household and the gross income available to the surviving heir and his or her spouse and related family members in his or her household is below 200 percent of the federal poverty level.
    2. Recovery would result in forced sale of the residence of a surviving heir who is living in and has continuously lived in the property since the decedent’s death and who lived in the property for at least 12 months immediately prior to and on the date of the decedent’s death and who would be unable to obtain an alternate residence because the gross income available to the surviving heir and his or her spouse and related family members in his or her household is below 200 percent of the federal poverty level and assets of the surviving heir and his or her spouse and related family members of his or her household are valued below twelve thousand dollars ($12,000).
  • A claim of undue hardship to a survivor shall be made in writing to the Division of Medical Assistance estate recovery administrator within 60 days after the surviving heir claiming undue hardship has been notified of the Medicaid claim.

5. What is Medicaid’s claim?

The amount DHHS recovers from the estate of any recipient shall not exceed the amount of medical assistance paid on behalf of the beneficiary. DHHS is a sixth-class creditor for purposes of determining the order of claims against an estate; provided, however, that judgments in favor of other sixth-class creditors docketed and in force before DHHS seeks recovery for medical assistance shall be paid prior to recovery by DHHS.

6. How should notification be given of a Medicaid beneficiary’s death?

Within 30 days of the recipient’s death, the provider, attorney, personal representative, or case manager (if applicable) should contact the Estate Recovery Unit by fax, phone, or mail (see contact information below). The initial notification should include:

  • Full name of the deceased recipient
  • Medicaid ID number and/or Social Security number
  • Date of death and copy of death certificate
  • Name, address, and telephone number of the personal representative and/or attorney handling the estate
  • Information on any estate proceedings that may have been filed with the Clerk of Superior Court

Mississippi Department of Health and Human Services

Mississippi Division of Medicaid
P.O. Box 1035
Jackson, MS 39201-9820

Once the notification of death has been received, the Estate Recovery Unit will advise the personal representative and/or attorney on how to proceed.

Trust Unit

1. What is a trust?

A trust is a legal arrangement where property is held by a trustee (the person who handles the trust) for the benefit of a beneficiary (the person for whom the trust is created). It is usually established either by a written trust agreement or by the terms of a will. The general administration of the trust is governed by the terms of the document that creates it.

2. What should you do if you are a beneficiary of a Trust?

If you are the beneficiary of a trust, then you must contact your county DSS caseworker and inform the county DSS caseworker that you are a beneficiary of a trust.

3. Why does Mississippi review Special Needs Trusts?

If a SNT does not meet certain legal requirements the beneficiary might not be able to become eligible for Medicaid or might lose eligibility for Medicaid. These legal requirements are specified by federal law and policy and Mississippi law and policy.

4. What rules apply to trust expenditures?

In general terms, trustees must always follow the federal and state law applicable to Special Needs Trusts, and also Mississippi Medicaid policy.

5. What happens at the trust beneficiary’s death?

When a trust beneficiary dies, notice of the death must be given to the Trust Review Unit, preferably by fax 844-586-2657. The notification should include:

  • Full name of the deceased beneficiary
  • Medicaid ID number and/or Social Security number of the beneficiary
  • Date of death and copy of the death certificate
  • Contact information for the trustee and the personal representative and/or attorney handling the estate, including name, address, and telephone number

Following notification, the Trust Review Unit will prepare a claim and will send the claim and payment instructions to the appropriate contact person.

Contact Information

Subrogation Unit

Mississippi Division of Medicaid
P.O. Box 1035
Jackson, MS 39201-9820

Phone: 1-855-547-4984

Fax: 1-844-388-0653