MEDICAID 15-5h

Chapter 15: Medicaid

15-5h Major Medical/Accidental Injury Coverage

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  Overview of CoverageMedicaid does not have distinct treatments for major medical or accidental injury claims. Instead, it operates under standard procedures applicable to all claims.

• Subrogation Concept

  • Subrogation occurs when Medicaid takes on the responsibility to cover claims under certain conditions, particularly when there is liability insurance available that can address the injured party's claims.

  • Definition of Subrogation:

    • The process of substituting one party for another in terms of liability. In liability insurance cases, Medicaid may subrogate, assuming financial obligations from another responsible party (e.g., an insurance company).

• Liability Insurance

  • Medicaid may pursue claims against other insurers if those insurers are liable for the medical costs incurred by an individual due to an injury. This ensures that the costs are not solely covered by Medicaid, but rather through appropriate liable insurance policies.