C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 433—STATE FISCAL ADMINISTRATION › Subpart D—Third Party Liability

42 C.F.R. § 433.140

FFP and repayment of Federal share

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(a) FFP is not available in Medicaid payments if—

(1) The agency failed to fulfill the requirements of §§ 433.138 and 433.139 with regard to establishing liability and seeking reimbursement from a third party;

(2) The agency received reimbursement from a liable third party; or

(3) A private insurer would have been obligated to pay for the service except that its insurance contract limits or excludes payments if the individual is eligible for Medicaid.

(b) FFP is available at the 50 percent rate for the agency's expenditures in carrying out the requirements of this subpart.

(c) If the State receives FFP in Medicaid payments for which it receives third party reimbursement, the State must pay the Federal government a portion of the reimbursement determined in accordance with the FMAP for the State. This payment may be reduced by the total amount needed to meet the incentive payment in § 433.153.

Notes of Decisions
Cited in 15 cases (4 in the last 5 years), 1982–2024 · leading case: United States v. Caremark, Inc., 634 F.3d 808 (5th Cir. 2011).
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United States v. Caremark, Inc., 634 F.3d 808 (5th Cir. 2011). · cites it 4× “In addition to requiring state Medicaid agencies to seek reimbursement from third parties, federal law directs the States to enact laws *812 that require Medicaid recipients to assign their rights to receive payments from any third party to the state Medicaid agency.”
In Re Zyprexa Prods. Liab. Litig., 451 F. Supp. 2d 458 (E.D.N.Y 2006). · cites it 3× “42 C.F.R. § 433.140 (a)(2). Likewise, if the state could have received reimbursement from a third party but failed to comply with federal regulations requiring it to attempt to establish liability and pursue reimbursement from that third party, see 42 C.”
Arkansas Dep't of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (2006). “See 42 CFR § 433.140 (a)(2) (2005) (federal financial participation “is not available in Medicaid payments if .”
Harlow v. Chin, 545 N.E.2d 602 (Mass. 1989). · cites it 2× “" [16] The Federal regulation, 42 C.F.R. § 433.140 (c) (1989), provides that, if the State receives the third-party reimbursement, "the State must pay the Federal Government a portion of the reimbursement determined in accordance with the [Federal medical assistance percentage]…”
Palumbo v. Myers, 149 Cal. App. 3d 1020 (Cal. Ct. App. 1983). · cites it 2× “) Federal financial participation is not available in Medicaid payments if the state agency "received reimbursement from a liable third party" (42 C.F.R. 433.140(a)(2) (1982)). "Third party" is there defined as "any individual, entity or program that is or may be liable to pay…”
United States ex rel. Spay v. CVS Caremark Corp., 913 F. Supp. 2d 125 (E.D. Pa. 2012). “These requirements impose an obligation on the States to the Government.”
Dist. of Columbia v. Jackson, 451 A.2d 867 (D.C. 1982). · cites it 2× “42 C.F.R. § 433.140 FFP [Federal Financial Participation] and repayment of Federal share, provides: (a) FFP is not available in Medicaid payments if — (1) The agency failed to fulfill the requirements of §§ 433.”
Wallace v. Est. of Jackson, 972 P.2d 446 (Utah 1998). · cites it 2× “" 42 C.F.R § 433.140(f)(1). The State has failed to do so in this case.”
United States Ex Rel. Ramadoss v. Caremark Inc., 586 F. Supp. 2d 668 (W.D. Tex. 2008). · cites it 2× “42 C.F.R. § 433.140 (a)(2). The federal government will not provide FFP to a state Medicaid agency if the Medicaid agency receives reimbursement for care and services from a liable third party, such as a third party coverage provider.”
Francis RUDNICKI & Pamela Rudnicki, as parents, guardians & next friends of Alexander Rudnicki, a minor child v. Peter BIANCO, D.O., 501 P.3d 776 (Colo. 2021). “§ 1396a (a) (25) (A) - (B) ; 42 C.F.R. § 433.140 (a) (1) . This requirement "protects the public fisc while preventing Medicaid beneficiaries from receiving a windfall.”
United States Ex Rel. Hixson v. Health Mgmt. Sys., Inc., 657 F. Supp. 2d 1039 (S.D. Iowa 2009). “42 CFR § 433.140 . 7 Relators claim that Defendants failed to comply with this regulation, 8 and thus are not entitled to a certain amount of FFP dollars.”
Frey v. Health Mgmt. Sys. Inc (N.D. Tex. 2021). · cites it 3× “” 42 C.F.R. § 433.140 . Defendant argues that Relator fails to allege any “obligation” owed to the Government by Defendant.”
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— 42 C.F.R. § 433.140(a)(2) — 1 case
Palumbo v. Myers, 149 Cal. App. 3d 1020 (Cal. Ct. App. 1983). “) Federal financial participation is not available in Medicaid payments if the state agency "received reimbursement from a liable third party" (42 C.F.R. 433.140(a)(2) (1982)). "Third party" is there defined as "any individual, entity or program that is or may be liable to pay…”
— 42 C.F.R. § 433.140(f)(1) — 1 case
Wallace v. Est. of Jackson, 972 P.2d 446 (Utah 1998). “" 42 C.F.R § 433.140(f)(1). The State has failed to do so in this case.”
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