Medicaid is generally the payer of last resort: by law, most other sources of coverage must pay claims under their policies before Medicaid will pay for the care of an eligible individual. This requirement is referred to as third-party liability (TPL) because payment is the responsibility of a third party other than the individual or Medicaid. TPL recoveries are important for two reasons; first, ensuring that the appropriate party pays for care helps preserve Medicaid funds to cover services for beneficiaries, and second, they limit cost-shifting from private insurers and other federal programs to Medicaid, which is 38 percent funded by states.
This presentation focuses on Medicaid TPL policy and interactions between Medicaid and TRICARE program, the Department of Defense health benefits program for U.S. Armed Forces military personnel, military retirees, and their dependents. MACPAC estimates that almost 1 million Medicaid enrollees have primary coverage through TRICARE. The presentation also summarizes Medicaid TPL policies and some of the current operational and policy gaps that limit effective coordination between Medicaid and TRICARE.
