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. § 433.145

Assignment of rights to benefits—State plan requirements

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(a) A State plan must provide that, as a condition of eligibility, each legally able applicant or beneficiary is required to:

(1) Assign to the Medicaid agency his or her rights, or the rights of any other individual eligible under the plan for whom he or she can legally make an assignment, to medical support and to payment for medical care from any third party;

(2) Cooperate with the agency in establishing the identity of a child's parents and in obtaining medical support and payments, unless the individual establishes good cause for not cooperating, and except for individuals described in § 435.116 of this chapter (pregnant women), who are exempt from cooperating in establishing the identity of a child's parents and obtaining medical support and payments from, or derived from, the non-custodial parent of a child; and

(3) Cooperate in identifying and providing information to assist the Medicaid agency in pursuing third parties who may be liable to pay for care and services under the plan, unless the individual establishes good cause for not cooperating.

(b) A State plan must provide that the requirements for assignments, cooperation in establishing paternity and obtaining support, and cooperation in identifying and providing information to assist the State in pursuing any liable third party under §§ 433.146 through 433.148 are met.

(c) A State plan must provide that the assignment of rights to benefits obtained from an applicant or beneficiary is effective only for services that are reimbursed by Medicaid.

[55 FR 48606, Nov. 21, 1990, as amended at 58 FR 4907, Jan. 19, 1993; 81 FR 86450, Nov. 30, 2016]
Notes of Decisions
Cited in 23 cases (2 in the last 5 years), 1987–2025 · leading case: Olszewski v. Scripps Health
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Olszewski v. Scripps Health (2003) cal · cites it 2× “§ 1396a(a)(45); 42 C.F.R. §§ 433.145 , 433.146.) Thus, when a health care provider submits a Medicaid claim, the state Medicaid agency must first ascertain whether a third party may be liable.”
Carl Thulin v. Shopko Stores Operating Co., L (2014) ca7 · cites it 2× “§ 1396k(a)(1)(A) and 42 C.F.R. § 433.145 to assign to the state any rights they have under their private insurance plans.”
Beverly K. Barton v. Paul G. Summers, Harshell C. Downs, Jr. Kathleen D. Downs v. Commonwealth of Kentucky (2002) ca6 “42 C.F.R. § 433.145 (c) (“A State plan must provide that the assignment of rights to benefits obtained from an applicant or recipient is effective only for services that are reimbursed by Medicaid.”
Lopes v. Commonwealth (2004) mass “§ 1396k(a)(l)(A); 42 C.F.R. §§ 433.145 , 433.146 (2003); 130 Code Mass.”
State v. Peters (2008) conn “§ 1396k (b); see also 42 C.F.R. §§ 433.145 and 433.146. The state of Connecticut has elected to participate in the medicaid program, and, therefore, is obligated to comply with federal requirements.”
Calvanese v. Calvanese (1999) ny “Federal law also requires Medicaid recipients to “cooperate with the State in identifying, and providing information to assist the State in pursuing, any third party who may be liable to pay for care and services available under the plan,” unless good cause exists for the…”
State of California v. Superior Court (2000) calctapp “§§ 1396a(a)(25)(B), 1396k(a); 42 C.F.R. § 433.145 (a)(1), (c).) If that had been the scope of the Tobacco Litigation and the MSA, there would be nothing left over for Bolduc.”
Caremark, Inc. v. Goetz (2005) tnmd “§ 1396k(a)(l)(A); 42 CFR 433.145. Federal law also requires group health plans to “provide that payment for benefits with respect to a participant will be made in accordance with any assignment of rights made by or on behalf of such participant or beneficiary of the participant.”
United States Ex Rel. Hixson v. Health Management Systems, Inc. (2009) iasd “No such exception exists in the Iowa statute, and thus even though the State of Iowa’s right of subrogation to damages obtained by plaintiffs who received Medicaid from third-party tortfeasors is arguably based in federal law ( 42 CFR § 433.145 , “Assignment of rights to…”
Caremark, Inc. v. Goetz (2007) ca6 · cites it 2× “§ 1396k(a)(l)(A); 42 C.F.R. § 433.145 (a). Federal law further requires group health plans to “provide that payment for benefits with respect to a participant under the plan will be made in accordance with any assignment of rights made by or on behalf of such participant or…”
New York State Department of Social Services v. Bowen (1987) nysd “§§ 1396a(a)(45) and 1396k(a)(l)(A); 42 C.F.R. §§ 433.145 to 433.149. In order to comply with the Medicaid assignment of rights requirement, a state may enact a law which provides for automatic assignment to the state of all Medicaid recipients’ rights to third party payments for…”
Perry v. Dowling (1996) ca2 “§ 1396k(a)(1)(B); 42 C.F.R. §§ 433.145 (a)(2), 147(a)(1).”
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— 42 C.F.R. § 433.145(c) — 1 case
Robinson v. State (2003) mont
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