1. (1) The Utah Third-Party Liability Program establishes:

   1. (a) that private medical resources have been exhausted before a claim is paid by Medicaid; or
   2. (b) the agency shall seek reimbursement when the agency discovers a liable third-party after the payment of a claim.

2. (2) Where appropriate, ORS provides third-party liability fund recovery required by the state plan for Medicaid by:

   1. (a) verifying private health care coverage for Medicaid recipients;
   2. (b) billing private health care coverage to reimburse Medicaid funds;
   3. (c) recovering Medicaid expenditures from tort settlements; and
   4. (d) recovering Medicaid expenditures from the estates of Medicaid beneficiaries.

Medicaid shall be the payor of last resort pursuant to 42 CFR 433.138 and 42 CFR 433.139.

R527-936-4 Utah Third-Party Liability Program.

KEY: Medicaid, debt

Date of Last Change: August 14, 2023

Notice of Continuation: July 28, 2025

Authorizing, and Implemented or Interpreted Law: 26-19-103; 26-18-8; 26B-9-108; 26B-1-202; 42 CFR 433.135 through 433.154