Assignment for Third-party Recoveries

As a condition of eligibility, an applicant or member must inform the MassHealth agency when any such individual is involved in an accident, or suffers from an illness or injury, or other loss that has resulted or may result in a lawsuit or insurance claim. The applicant or member must (A) file an insurance claim for compensation, if available; and (B) agree to comply with all requirements of M.G.L. c. 118E, § 22, including, but not limited to (1) assigning to the MassHealth agency or its agent the right to recover an amount equal to the MassHealth benefits provided from the proceeds of any claim or other proceeding against a third party; (2) providing information about the claim or any other proceeding and cooperating fully with the MassHealth agency or its agent, unless the MassHealth agency determines that cooperation would not be in the best interests of, or would result in serious physical or emotional harm to, the applicant or member, in accordance with 130 CMR 503.005; (3) notifying the MassHealth agency in writing within ten days of filing any claim, civil action, or other proceeding; and (4) repaying and cooperating fully with the MassHealth agency or its agent to ensure the member’s legal representative repays the MassHealth agency from the money received from a third party for all MassHealth benefits provided on or after the date of the accident or other incident, provided that if the member is involved in an accident or other incident after becoming MassHealth eligible, repayment will be limited to MassHealth benefits provided as a result of the accident or incident.