2006 Ohio Revised Code - 5101.58. Recovery rights of state and county for cost of medical services and care.

§ 5101.58. Recovery rights of state and county for cost of medical services and care.
 

As used in this section and section 5101.59 of the Revised Code, "public assistance" means aid provided under Chapter 5111. or 5115. of the Revised Code and participation in the Ohio works first program established under Chapter 5107. of the Revised Code. 
 

The acceptance of public assistance gives a right of recovery to the department of job and family services and a county department of job and family services against the liability of a third party for the cost of medical services and care arising out of injury, disease, or disability of the public assistance recipient or participant. When an action or claim is brought against a third party by a public assistance recipient or participant, the entire amount of any settlement or compromise of the action or claim, or any court award or judgment, is subject to the recovery right of the department of job and family services or county department of job and family services. Except in the case of a recipient or participant who receives medical services or care through a managed care organization, the department's or county department's claim shall not exceed the amount of medical expenses paid by the departments on behalf of the recipient or participant. In the case of a recipient or participant who receives medical services or care through a managed care organization, the amount of the department's or county department's claim shall be the amount the managed care organization pays for medical services or care rendered to the recipient or participant, even if that amount is more than the amount the departments pay to the managed care organization for the recipient's or participant's medical services or care. Any settlement, compromise, judgment, or award that excludes the cost of medical services or care shall not preclude the departments from enforcing their rights under this section. 
 

Prior to initiating any recovery action, the recipient or participant, or the recipient's or participant's representative, shall disclose the identity of any third party against whom the recipient or participant has or may have a right of recovery. Disclosure shall be made to the department of job and family services when medical expenses have been paid pursuant to Chapter 5111. or 5115. of the Revised Code. Disclosure shall be made to both the department of job and family services and the appropriate county department of job and family services when medical expenses have been paid pursuant to Chapter 5115. of the Revised Code. No settlement, compromise, judgment, or award or any recovery in any action or claim by a recipient or participant where the departments have a right of recovery shall be made final without first giving the appropriate departments notice and a reasonable opportunity to perfect their rights of recovery. If the departments are not given appropriate notice, the recipient or participant is liable to reimburse the departments for the recovery received to the extent of medical payments made by the departments. The departments shall be permitted to enforce their recovery rights against the third party even though they accepted prior payments in discharge of their rights under this section if, at the time the departments received such payments, they were not aware that additional medical expenses had been incurred but had not yet been paid by the departments. The third party becomes liable to the department of job and family services or county department of job and family services as soon as the third party is notified in writing of the valid claims for recovery under this section. 
 

The right of recovery does not apply to that portion of any judgment, award, settlement, or compromise of a claim, to the extent of attorneys' fees, costs, or other expenses incurred by a recipient or participant in securing the judgment, award, settlement, or compromise, or to the extent of medical, surgical, and hospital expenses paid by such recipient or participant from the recipient's or participant's own resources. Attorney fees and costs or other expenses in securing any recovery shall not be assessed against any claims of the departments. 
 

To enforce their recovery rights, the departments may do any of the following: 

(A) Intervene or join in any action or proceeding brought by the recipient or participant or on the recipient's or participant's behalf against any third party who may be liable for the cost of medical services and care arising out of the recipient's or participant's injury, disease, or disability; 

(B) Institute and pursue legal proceedings against any third party who may be liable for the cost of medical services and care arising out of the recipient's or participant's injury, disease, or disability; 

(C) Initiate legal proceedings in conjunction with the injured, diseased, or disabled recipient or participant or the recipient's or participant's legal representative. 

Recovery rights created by this section may be enforced separately or jointly by the department of job and family services and the county department of job and family services. 

The right of recovery given to the department under this section does not include rights to support from any other person assigned to the state under sections 5107.20 and 5115.07 of the Revised Code, but includes payments made by a third party under contract with a person having a duty to support. 

The director of job and family services may adopt rules in accordance with Chapter 119. of the Revised Code the department considers necessary to implement this section. 
 

HISTORY: 136 v H 707 (Eff 9-30-76); 138 v H 176 (Eff 7-1-80); 139 v H 694 (Eff 11-15-81); 141 v H 428 (Eff 12-23-86); 142 v H 231 (Eff 10-5-87); 144 v H 298 (Eff 7-26-91); 146 v H 249 (Eff 7-17-95); 147 v H 215 (Eff 9-29-97); 147 v H 408 (Eff 10-1-97); 148 v H 471. Eff 7-1-2000; 150 v H 95, § 1, eff. 6-26-03.
 

The effective date is set by section 182 of H.B. 95 (150 v  - ). 

 

Effect of Amendments

H.B. 95, Acts 2003, effective June 26, 2003, substituted "5115.07" for "5115.13" in the third paragraph of (C).