Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 354 - MEDICAID HEALTH SERVICES
Subchapter J - MEDICAID THIRD PARTY RECOVERY
Division 4 - DUTIES OF THE COMMISSION
Section 354.2332 - Distribution of Recoveries

Universal Citation: 1 TX Admin Code ยง 354.2332

Current through Reg. 49, No. 38; September 20, 2024

(a) HHSC will distribute third party recoveries, if cost effective, as follows:

(1) HHSC will receive an amount equal to HHSC's total Medicaid expenditures for the recipient, or another individual eligible for Medicaid benefits under the State Plan for whom he or she can legally make an assignment to medical support and payment;

(2) the federal government will receive the federal share of the Medicaid expenditures, minus any incentive payment authorized by federal law; and

(3) the recipient will receive any remaining amount and any amount distributed to the recipient is income or resources for purposes of establishing eligibility for Medicaid benefits.

(b) HHSC may pay reasonable and necessary attorney fees of fifteen percent (15%) of the entire amount recovered on behalf of HHSC, and reasonable expenses, to a person authorized to recover amounts from third party resources, other than a person contracted by HHSC to recover on behalf of HHSC, if the recovery is made in compliance with these rules.

(c) HHSC may pay prorated expenses not to exceed ten percent (10%) of the entire amount recovered on behalf of HHSC if attorney fees are allowed under subsection (b) of this section.

(d) No attorney fees will be paid if the recovery made on behalf of the Medicaid program is waived in whole or in part by the Executive Commissioner under the provisions of §354.2333 of this division (relating to Waiver Authority of the Executive Commissioner).

(e) The amount recovered on behalf of HHSC, for which attorney fees are authorized under this section, must be deducted from the total amount of the recovery before attorney fees and expenses are deducted under the terms of the recipient's contract.

(f) HHSC may pay reasonable and necessary attorney fees and expenses to a person contracted by HHSC to recover amounts from third party resources on behalf of the Medicaid program.

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