56-7-2348 - Eligibility for medicaid. - Tennessee Statutes

56-7-2348. Eligibility for medicaid.

(a)  All entities providing health care benefits, including, but not limited to, insurers, ERISA group health plans, health maintenance organizations and nonprofit hospital and medical service plans, are prohibited from considering the availability or eligibility for medical assistance under 42 U.S.C. § 1396a, which is referred to as “medicaid,” when considering eligibility for coverage or calculating payments under their plans for eligible enrollees, subscribers, policyholders, or certificate holders.

(b)  To the extent that payment for covered expenses has been made under the state medicaid program for health care items or services furnished to an individual, the state is considered to have acquired the rights of the individual to payment by any other party for the health care items or services. Upon presentation of proof that the state medicaid program or any provider who has contracted with the state to provide medicaid services has paid for covered items or services, the insurer, ERISA group health plan, health maintenance organization, or nonprofit hospital and medical service plan shall make payment to the state medicaid program, or contracted provider under the medicaid program according to the coverage provided in the policy or contract on the same basis applicable to an agent or assignee of any other individual so covered.

[Acts 1994, ch. 881, § 2.]