LD 1319
pg. 311
Page 310 of 460 PUBLIC Law Chapter 20 Page 312 of 460
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LR 2000
Item 1

 
1. Recovery procedures. When benefits are provided or will
be provided to a beneficiary member under the Medicaid MaineCare
program administered by the department pursuant to the United
States Social Security Act, Title XIX or under the elderly low-
cost drug program under section 254, including any prescription
drug programs administered under the auspices of MaineCare,
referred to collectively in this section as MaineCare, for the
medical costs of injury, disease, disability or similar
occurrence for which a 3rd party is, or may be, liable, the
commissioner may recover from that party the reasonable value
cost of the benefits provided. This right of recovery is
separate and independent from any rights or causes of action
belonging to a beneficiary member under the Medicaid MaineCare
program or under the elderly low-cost drug program under section
254. For Medicaid MaineCare recipients who participated in the
Medicaid MaineCare managed care program, "reasonable value cost"
means the total value of coverable medical services provided
measured by the amount that Medicaid MaineCare would have paid to
providers directly for such services, were it not for the managed
care system. The Medicaid MaineCare program and the elderly low-
cost drug program under section 254 are is the payors payor of
last resort and shall provide medical coverage only when there
are no other available resources. The Attorney General, or
counsel appointed by the Attorney General, may, to enforce this
right, institute and prosecute legal proceedings directly against
the 3rd party in the appropriate court in the name of the
commissioner.

 
In addition to the right of recovery set forth in this
subsection, the commissioner must also be subrogated, to the
extent of any benefits provided under the Medicaid MaineCare
program or under the elderly low-cost drug program under section
254, to any cause of action or claim that a beneficiary member
has against a 3rd party who is or may be liable for medical costs
incurred by or on behalf of the beneficiary member. The Attorney
General, or counsel appointed by the Attorney General, to enforce
this right may institute and prosecute legal proceedings in the
name of the injured person, beneficiary member, guardian,
personal representative, estate or survivor. If necessary to
enforce the commissioner's right of recovery, the Attorney
General, or counsel appointed by the Attorney General, may
institute legal proceedings against any beneficiary member,
including the agent, representative or attorney of that member,
who has received a settlement or award from a 3rd party.

 
The commissioner's right to recover the reasonable value cost of
benefits provided constitutes a statutory lien on the proceeds of
an award or settlement from a 3rd party if recovery for Medicaid
MaineCare costs was or could have been included in the
recipient's claim for damages from the 3rd party. The


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