42 U.S.C. § 1396k

Assignment, enforcement, and collection of rights of payments for medical care; establishment of procedures pursuant to State plan; amounts retained by State

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(a) For the purpose of assisting in the collection of medical support payments and other payments for medical care owed to recipients of medical assistance under the State plan approved under this subchapter, a State plan for medical assistance shall—(1) provide that, as a condition of eligibility for medical assistance under the State plan to an individual who has the legal capacity to execute an assignment for himself, the individual is required—(A) to assign the State any rights, of the individual or of any other person who is eligible for medical assistance under this subchapter and on whose behalf the individual has the legal authority to execute an assignment of such rights, to support (specified as support for the purpose of medical care by a court or administrative order) and to payment for medical care from any third party;(B) to cooperate with the State (i) in establishing the paternity of such person (referred to in subparagraph (A)) if the person is a child born out of wedlock, and (ii) in obtaining support and payments (described in subparagraph (A)) for himself and for such person, unless (in either case) the individual is described in section 1396a(l)(1)(A) of this title or the individual is found to have good cause for refusing to cooperate as determined by the State agency in accordance with standards prescribed by the Secretary, which standards shall take into consideration the best interests of the individuals involved; and(C) 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 such individual has good cause for refusing to cooperate as determined by the State agency in accordance with standards prescribed by the Secretary, which standards shall take into consideration the best interests of the individuals involved; and(2) provide for entering into cooperative arrangements (including financial arrangements), with any appropriate agency of any State (including, with respect to the enforcement and collection of rights of payment for medical care by or through a parent, with a State’s agency established or designated under section 654(3) of this title) and with appropriate courts and law enforcement officials, to assist the agency or agencies administering the State plan with respect to (A) the enforcement and collection of rights to support or payment assigned under this section and (B) any other matters of common concern.(b) Such part of any amount collected by the State under an assignment made under the provisions of this section shall be retained by the State as is necessary to reimburse it for medical assistance payments made on behalf of an individual with respect to whom such assignment was executed (with appropriate reimbursement of the Federal Government to the extent of its participation in the financing of such medical assistance), and the remainder of such amount collected shall be paid to such individual.(Aug. 14, 1935, ch. 531, title XIX, § 1912, as added Pub. L. 95–142, § 11(b), Oct. 25, 1977, 91 Stat. 1196; amended Pub. L. 98–369, div. B, title III, § 2367(b), July 18, 1984, 98 Stat. 1109; Pub. L. 99–272, title IX, § 9503(e), Apr. 7, 1986, 100 Stat. 207; Pub. L. 101–508, title IV, § 4606(a), Nov. 5, 1990, 104 Stat. 1388–170; Pub. L. 113–67, div. A, title II, § 202(b)(2), Dec. 26, 2013, 127 Stat. 1177; Pub. L. 115–123, div. E, title XII, § 53102(b)(1), Feb. 9, 2018, 132 Stat. 298.)Editorial NotesAmendments

2018—Subsec. (a)(1)(A). Pub. L. 115–123, § 53102(b)(1), repealed Pub. L. 113–67, § 202(b)(2), and provided that the provisions amended by section 202(b) shall be applied and administered as if such amendment had never been enacted. See 2013 Amendment note below.

2013—Subsec. (a)(1)(A). Pub. L. 113–67, § 202(b)(2), which directed substitution of “any payment from a third party that has a legal liability to pay for care and services available under the plan” for “payment for medical care from any third party”, was repealed by Pub. L. 115–123, § 53102(b)(1).

1990—Subsec. (a)(1)(B). Pub. L. 101–508 inserted “the individual is described in section 1396a(l)(1)(A) of this title or” after “unless (in either case)”.

1986—Subsec. (a)(1)(C). Pub. L. 99–272 added subpar. (C).

1984—Subsec. (a). Pub. L. 98–369 substituted “State plan for medical assistance shall” for “State plan for medical assistance may”.

Statutory Notes and Related SubsidiariesEffective Date of 2018 Amendment

Pub. L. 115–123, div. E, title XII, § 53102(b)(1), Feb. 9, 2018, 132 Stat. 298, provided that the repeal of section 202(b) of Pub. L. 113–67 is effective Sept. 30, 2017, and the provisions amended by section 202(b) shall be applied and administered as if such amendments had never been enacted. In addition, such repeal by section 53102(b)(1) of Pub. L. 115–123 applicable with respect to any open claims, including claims pending, generated, or filed, after Sept. 30, 2017, see section 53102(b)(3) of Pub. L. 115–123, set out as a note under section 1396a of this title.

Effective Date of 1990 Amendment

Pub. L. 101–508, title IV, § 4606(b), Nov. 5, 1990, 104 Stat. 1388–170, provided that: “The amendment made by subsection (a) [amending this section] shall take effect on the date of the enactment of this Act [Nov. 5, 1990].”

Effective Date of 1986 Amendment

Amendment by Pub. L. 99–272 applicable to calendar quarters beginning on or after Apr. 7, 1986, except as otherwise provided, see section 9503(g)(1), (2) of Pub. L. 99–272, set out as a note under section 1396a of this title.

Effective Date of 1984 Amendment

Amendment by Pub. L. 98–369 effective Oct. 1, 1984, except as otherwise provided, see section 2367(c) of Pub. L. 98–369, set out as a note under section 1396a of this title.

Notes of Decisions

Cited in 189 cases (10 in the last 5 years), 1980–2025 · leading case: Martin Ex Rel. Hoff v. City of Rochester, 642 N.W.2d 1 (Minn. 2002).

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Martin Ex Rel. Hoff v. City of Rochester, 642 N.W.2d 1 (Minn. 2002). · cites it 13× “Compare 42 U.S.C. § 1396k with Minn.Stat. § 256B.”

McClendon v. Georgia Dep't of Cmty. Health, 261 F.3d 1252 (11th Cir. 2001). · cites it 7× “See 42 U.S.C. § 1396k(a). 5 Georgia has implemented this federal command through Section 49-4-149 of its state code, which provides that: A recipient of medical assistance who receives medical care for which the department may be obligated to pay shall be deemed to have made…”

Tristani Ex Rel. Karnes v. Richman, 609 F. Supp. 2d 423 (W.D. Pa. 2009). · cites it 11× “Other provisions of Title XIX, which are codified at 42 U.S.C. § 1396k, provide: § 1396k. Assignment, enforcement, and collection of rights of payments for medical care; establishment of procedures pursuant to State plan; amounts retained by State (a) For the purpose of…”

Watson v. State of Texas, 261 F.3d 436 (5th Cir. 2001). · cites it 7× “The class argued before the district court that it was entitled to a share of the settlement proceeds pursuant to 42 U.S.C. § 1396k. That statutory provision, entitled “Assignment, enforcement, and collection of rights of payments for medical care; establishment of procedures…”

Carl Thulin v. Shopko Stores Operating Co., L, 771 F.3d 994 (7th Cir. 2014). · cites it 6× “Thulin alleges that when dual-eligibles apply for Medicaid, they are required by 42 U.S.C. § 1396k(a)(1)(A) and 42 C.F.R. § 433.”

Houghton v. Dep't of Health, 2002 UT 101 (Utah 2002). · cites it 10× “" 42 U.S.C. § 1396k(a)(1)(A) (1992). While states are explicitly required to obtain an assignment of rights before an individual becomes eligible for Medicaid, the recipient's rights to payment for medical care are deemed assigned to the state in any event: (a) A state plan for…”

Cricchio v. Pennisi, 683 N.E.2d 301 (NY 1997). · cites it 6× “The recoupment of Medicaid funds from responsible third parties is accomplished by Federal directives that the State plan include assignment, enforcement and collection mechanisms (42 USC § 1396k [a] [1] [A]; § 1396a [a] [25] [I]).”

Beverly K. Barton v. Paul G. Summers, Harshell C. Downs, Jr. Kathleen D. Downs v. Commonwealth of Kentucky, 293 F.3d 944 (6th Cir. 2002). · cites it 4× “If a state pursues an assigned claim, 42 U.S.C. § 1396k(b) provides a framework for distribution.”

Bynum v. Magno, 101 P.3d 1149 (Haw. 2004). · cites it 4× “42 U.S.C. § 1396k(a) (2003); [HRS] § 346-37 (2003).”

Lopes v. Commonwealth, 811 N.E.2d 501 (Mass. 2004). · cites it 5× “Although Medicaid recipients must execute and deliver a written “assignment” of rights in favor of the participating State whenever benefits are received for an injury caused by a third party, see 42 U.S.C. § 1396k(a)(l)(A); 42 C.F.R. §§ 433.”

Grey Bear v. North Dakota Dep't of Human Servs., 2002 ND 139 (N.D. 2002). · cites it 6× “Section 1396k provides: (a) For the purpose of assisting in the collection of medical support payments and other payments for medical care owed to recipients of medical assistance under the State plan approved under this title .”

Arkansas Dep't of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (2006). · cites it 2× “to payment for medical care from any third party,” 42 U. S. C. § 1396k(a)(1)(A) (emphasis added), not rights to payment for, for example, lost wages.”

Show all 189 citing cases →

— 42 U.S.C. § 1396k(1)(a)(A) — 1 case

Newby v. Newby, 734 N.E.2d 663 (Ind. Ct. App. 2000).

— 42 U.S.C. § 1396k(C)(1994) — 1 case

Wilson v. State, 10 P.3d 1061 (Wash. 2000).

— 42 U.S.C. § 1396k(a) — 11 cases

Martin Ex Rel. Hoff v. City of Rochester, 642 N.W.2d 1 (Minn. 2002). “Compare 42 U.S.C. § 1396k with Minn.Stat. § 256B.”

McClendon v. Georgia Dep't of Cmty. Health, 261 F.3d 1252 (11th Cir. 2001). “See 42 U.S.C. § 1396k(a). 5 Georgia has implemented this federal command through Section 49-4-149 of its state code, which provides that: A recipient of medical assistance who receives medical care for which the department may be obligated to pay shall be deemed to have made…”

Grey Bear v. North Dakota Dep't of Human Servs., 2002 ND 139 (N.D. 2002). “Section 1396k provides: (a) For the purpose of assisting in the collection of medical support payments and other payments for medical care owed to recipients of medical assistance under the State plan approved under this title .”

Bynum v. Magno, 101 P.3d 1149 (Haw. 2004). “42 U.S.C. § 1396k(a) (2003); [HRS] § 346-37 (2003).”

Greenless v. Almond, 277 F.3d 601 (1st Cir. 2002).

— 42 U.S.C. § 1396k(a)(1) — 4 cases

Perry v. Dowling, 95 F.3d 231 (2d Cir. 1996).

Hull v. Burwell, 66 F. Supp. 3d 278 (D. Conn. 2014).

Ahlborn v. Arkansas Dep't of Human Servs., 397 F.3d 620 (8th Cir. 2005).

State Ex Rel. Off. of Recovery Servs. v. Streight Ex Rel. Jensen, 2004 UT 88 (Utah 2004).

— 42 U.S.C. § 1396k(a)(1)(A) — 60 cases

Carl Thulin v. Shopko Stores Operating Co., L, 771 F.3d 994 (7th Cir. 2014). “Thulin alleges that when dual-eligibles apply for Medicaid, they are required by 42 U.S.C. § 1396k(a)(1)(A) and 42 C.F.R. § 433.”

Arkansas Dep't of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (2006). “to payment for medical care from any third party,” 42 U. S. C. § 1396k(a)(1)(A) (emphasis added), not rights to payment for, for example, lost wages.”

Gianinna Gallardo v. Mary Mayhew, 963 F.3d 1167 (11th Cir. 2020).

Tristani Ex Rel. Karnes v. Richman, 652 F.3d 360 (3rd Cir. 2011).

Olszewski v. Scripps Health, 69 P.3d 927 (Cal. 2003).

— 42 U.S.C. § 1396k(a)(1)(B) — 2 cases

Perry v. Dowling, 95 F.3d 231 (2d Cir. 1996).

Douglas v. Sullivan, 792 F. Supp. 1030 (E.D. Mich. 1991).

— 42 U.S.C. § 1396k(a)(1)(C) — 6 cases

Houghton v. Dep't of Health, 2002 UT 101 (Utah 2002). “" 42 U.S.C. § 1396k(a)(1)(A) (1992). While states are explicitly required to obtain an assignment of rights before an individual becomes eligible for Medicaid, the recipient's rights to payment for medical care are deemed assigned to the state in any event: (a) A state plan for…”

Wallace v. Est. of Jackson, 972 P.2d 446 (Utah 1998).

Norwest Bank of North Dakota, N.A. ex rel. Sonya Lotzer Trust v. Doth, 159 F.3d 328 (8th Cir. 1998).

Auto Club Prop. Cas. Ins. Co. v. Jessica A. Moser (W. Va. 2022).

— 42 U.S.C. § 1396k(a)(l) — 10 cases

United States Ex Rel. Hixson v. Health Mgmt. Sys., Inc., 613 F.3d 1186 (8th Cir. 2010).

Tristani Ex Rel. Karnes v. Richman, 609 F. Supp. 2d 423 (W.D. Pa. 2009). “Other provisions of Title XIX, which are codified at 42 U.S.C. § 1396k, provide: § 1396k. Assignment, enforcement, and collection of rights of payments for medical care; establishment of procedures pursuant to State plan; amounts retained by State (a) For the purpose of…”

In re E.B., 729 S.E.2d 270 (W. Va. 2012).

MARIA ISABEL GIRALDO & Juan Gonzalo Villa v. Agency For Health Care Admin., 208 So. 3d 244 (Fla. 1st DCA 2016).

Caremark, Inc. v. Goetz, 395 F. Supp. 2d 683 (M.D. Tenn. 2005).

— 42 U.S.C. § 1396k(a)(l)(A) — 49 cases

Sai Kwan Wong Ex Rel. Wong v. Doar, 571 F.3d 247 (2d Cir. 2009).

Tristani Ex Rel. Karnes v. Richman, 652 F.3d 360 (3rd Cir. 2011).

Olszewski v. Scripps Health, 69 P.3d 927 (Cal. 2003).

Wos v. E. M. A. Ex Rel. Johnson, 133 S. Ct. 1391 (2013).

State Dep't of Health & Welfare v. Hudelson, 196 P.3d 905 (Idaho 2008).

— 42 U.S.C. § 1396k(a)(l)(B) — 4 cases

Perry v. Dowling, 888 F. Supp. 485 (W.D.N.Y. 1995).

Douglas v. Babcock, 990 F.2d 875 (6th Cir. 1993).

Douglas v. Sullivan, 792 F. Supp. 1030 (E.D. Mich. 1991).

Perry v. Dowling, 963 F. Supp. 231 (W.D.N.Y. 1997).

— 42 U.S.C. § 1396k(a)(l)(B)(i) — 1 case

Douglas v. Babcock, 990 F.2d 875 (6th Cir. 1993).

— 42 U.S.C. § 1396k(a)(l)(C) — 4 cases

Wilson v. State, 142 Wash. 2d 40 (Wash. 2000).

Douglas v. Babcock, 990 F.2d 875 (6th Cir. 1993).

— 42 U.S.C. § 1396k(b) — 49 cases

Beverly K. Barton v. Paul G. Summers, Harshell C. Downs, Jr. Kathleen D. Downs v. Commonwealth of Kentucky, 293 F.3d 944 (6th Cir. 2002). “If a state pursues an assigned claim, 42 U.S.C. § 1396k(b) provides a framework for distribution.”

Cardenas v. Anzai, 311 F.3d 929 (9th Cir. 2002).

Harris v. Owens, 264 F.3d 1282 (10th Cir. 2001).

— 42 U.S.C. § 1396k(d) — 1 case

United States v. Purdue Frederick Co., 963 F. Supp. 2d 561 (W.D. Va. 2013).

— 42 U.S.C. § 1396k(l)(a)(A) — 1 case

Newby v. Newby, 734 N.E.2d 663 (Ind. Ct. App. 2000).

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