THIS ARTICLE IS INTENDED TO SUPPORT THE READER’S AWARENESS AND UNDERSTANDING. IT IS NOT LEGAL ADVICE. IF THE READER SEEKS LEGAL ADVICE CONCERNING HIS OR HER PARTICULAR SITUATION, HE OR SHE SHOULD SEEK OUT AN ATTORNEY IN A LAWYER CLIENT RELATIONSHIP.
The PA Department of Human Services (DHS) is the payer of last resort for Medical Assistance ( i.e. Medicaid) Long Term Care Facility Services . This means that any third party resources that are potentially available to meet the cost of long term intermediate level nursing and related health and medical services in the context of a planned program of health care and management , including third party resources that are available to meet the cost of long term intermittent level nursing and related health and medical services in the context of a planned program of health care and management at a time when the individual is below the need of intermediate level care , such as Medicare’s Home Health Services or the VA’s “Housebound” Veteran’s Improved Pension Benefit , should be used before payment is made by the PA DHS.
The County assistance Office ( CAO) will find any resource that is available to meet the cost of medical services. Third party resources include, but are not limited to, the following: Blue Cross or other hospital insurance; Medicare Part A and Part B ; hospital insurance paid directly to the individual ; Tricare, formerly known as Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); Negligence action or other tort; Institutional contracts, including contracts between an individual and a facility that gives the individual the right to get care at the facility for free or at reduced cost. See 55 Pa. Code §178. 6 ; See also PA Medical Assistance Eligibility Handbook Chapter 340.13
The individual is required to apply for any resources he or she might be able to get. Unless he or she has good cause for not doing so, the individual must take reasonable steps to get and make possible resources available. An individual who, without good cause, fails to cooperate in getting possible resources is ineligible for MA. See 55 Pa. Code §178.1 ( General policy on MA resources common to all categories of MA.) ; See Also Medicaid Assistance Eligibility Handbook Gen Policy 340.1