§ 56-209b — MEDICAL ASSISTANCE — MEDICAL ASSISTANCE ACCOUNT

(1) Medical assistance shall be awarded to persons as mandated by federal law, and medical assistance may be awarded to such other persons not required to be awarded medical assistance as mandated by federal law when such award is to the fiscal advantage of the state of Idaho.
(2) There is hereby created in the dedicated fund the medical assistance account. The medical assistance account shall be an entity primarily designed to receive moneys from the families and relatives of patients receiving medical assistance under the state plan for medicaid and to provide a source of moneys to pay for the state’s share of medical assistance expenses. Moneys in the medical assistance account may not be commingled with moneys in the cooperative welfare fund. Moneys in the medical assistance account must be appropriated in order to be expended to pay for the state’s share of medical assistance expenses.
(3) In all cases where the department of health and welfare through the medical assistance program has or will be required to pay medical expenses for a recipient and that recipient is entitled to recover any or all such medical expenses from any third party or entity, the department of health and welfare will be subrogated to the rights of the recipient to the extent of the amount of medical assistance benefits paid by the department as the result of the occurrence giving rise to the claim against the third party or entity.
(4) If a recipient of medical assistance pursues a claim against a third party or entity through litigation or a settlement, the recipient will so notify the department. If a recipient fails to notify the department of such claim, the department may recover the amount of any public assistance obtained by the recipient while the recipient pursued such claim. In addition, if the recipient recovers funds, either by settlement or judgment, from such a third party or entity, the recipient shall reimburse the department to the extent of the funds received in settlement, minus attorney’s fees and costs, the amount of the medical assistance benefits paid by the department on his behalf as a result of the occurrence giving rise to the need for medical assistance. The department shall be entitled to all the legal rights and powers of a creditor against a debtor in enforcing the recipient’s reimbursement obligation.
(5) The department shall have priority to any amount received from a third party or entity that can reasonably be construed to compensate the recipient for the occurrence giving rise to the need for medical assistance, whether the settlement or judgment is obtained through the subrogation right of the department or through recovery by the recipient, and whether or not the recipient is made whole by the amount recovered. The department will be entitled to reimbursement of medical assistance benefits paid on behalf of the recipient arising from the incident or occurrence prior to any amount being distributed to the recipient. The department may notify such third party or entity of the department’s entitlement to receive the reimbursement prior to any amount being distributed to the recipient. Furthermore, the department may instruct the third party or entity to make such payment directly to the department prior to any amount being distributed to the recipient. Any third party or entity who distributed funds in violation of such a notice shall be liable to the department for the amount of the reimbursement.
(6) In the event a recipient of assistance through the medical assistance program incurs the obligation to pay attorney’s fees and costs for the purpose of enforcing a monetary claim to which the department has a right under this section, the amount that the department is entitled to recover, or any lesser amount that the department may agree to accept in compromise of its claim, shall be reduced by an amount that bears the same relation to the total amount of attorney’s fees and costs actually paid by the recipient as the amount actually recovered for medical expenses paid by the department, exclusive of the reduction for attorney’s fees and costs, bears to the total amount paid by the third party or entity to the recipient. If a settlement or judgment is received by the recipient without delineating what portion of the settlement or judgment is in payment of medical expenses, it will be presumed that the settlement or judgment applies first to the medical expenses incurred by the recipient in an amount equal to the expenditure for medical assistance benefits paid by the department as a result of the occurrence giving rise to the payment or payments to the recipient.
(7) If a responsible third party requires prior authorization for an item or service provided to a recipient of medical assistance, the responsible third party shall accept an authorization provided by the department that such item or service is covered under the state plan or applicable waiver as if such authorization was made by the third party for the item or service.

Legislative History

[56-209b, added 1961, ch. 217, sec. 3, p. 346; am. 1966 (2nd E.S.), ch. 11, sec. 4, p. 28; am. 1973, ch. 161, sec. 2, p. 306; am. 1978, ch. 246, sec. 4, p. 539; am. 1981, ch. 201, sec. 1, p. 354; am. 1982, ch. 180, sec. 1, p. 468; am. 1996, ch. 196, sec. 1, p. 614; am. 2002, ch. 369, sec. 1, p. 1038; am. 2025, ch. 27, sec. 1, p. 85.]