Third Party Liability Insurance
Medicaid is required by Federal law to bill any primary insurance (TPL) before paying claims. School districts may access primary insurance (TPL) through Medicaid with the parents consent if it does not affect any of the situations listed below. If the parent refuses consent, or one of the situations below apply, the district may send a letter to insurance asking for a denial not to pay IEP Services. It is very important that the district's legal council review letter before sending. See Sample Letter below.
-Decrease available lifetime coverage or any other insured benefit.
-Result in the family paying for services that would otherwise be covered.
-Increase premiums or lead to discontinuation of benefits.
-Risk loss of eligibility for home and community-based waivers
- TPL Sample Letter (doc)