Third Party Health Insurance - Staff working in this unit investigate and verify health insurance programs that are available to clients. Relevant information is entered into the state computer system. Workers also review and authorize the payments for eligible client's private health insurance. Benefits are monitored and private insurance companies are contacted for refunds where Medicaid has been inappropriately billed (Retrospective Subrogation). The unit oversees the payment of Medicare by the State and restricts certain Medicaid clients as determined by the Department of Health.
This unit also administers the Medicaid Managed Care program by enrolling and disenrolling participants in Health Maintenance Organizations (HMO). These programs offer a wider variety of physicians and services to Medicaid eligible individuals.