182-503-0535  <<  182-503-0540 >>   182-503-0565

WAC 182-503-0540

Assignment of rights and cooperation.

(1) When you become eligible for any of the agency's health care programs, you assign certain rights to the state of Washington. You assign all rights to any type of coverage or payment for health care that comes from:
(a) A court order;
(b) An administrative agency order; or
(c) Any third-party benefits or payment obligations for medical care which are the result of subrogation or contract (see WAC 182-501-0100).
(2) When you sign the application you assign the rights described in subsection (1) of this section to the state for:
(a) Yourself; and
(b) Any eligible person for whom you can legally make such assignment.
(3) You must cooperate with us in identifying, using or collecting third-party benefits. If you do not cooperate, your health care coverage may end unless you can show good reason not to cooperate with us. Examples of good reason include, but are not limited to:
(a) Your reasonable belief that cooperating with us would result in serious physical or emotional harm to you, a child in your care, or a child related to you; and
(b) Your being incapacitated without the ability to cooperate with us.
(4) Your WAH coverage will not end due solely to the noncooperation of any third party.
(5) You will have to pay for your health care services if you:
(a) Received and kept the third-party payment for those services; or
(b) Refused to give to the provider of care your legal signature on insurance forms.
(6) The state is limited to the recovery of its own costs for health care costs paid on behalf of a recipient of health care coverage. The legal term which describes the method by which the state acquires the rights of a person for whom the state has paid costs is called subrogation.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 19-02-046, § 182-503-0540, filed 12/27/18, effective 1/27/19. Statutory Authority: RCW 41.05.021, 41.05.160, Public Law 111-148, 42 C.F.R. § 431, 435, and 457, and 45 C.F.R. § 155. WSR 14-16-052, § 182-503-0540, filed 7/29/14, effective 8/29/14. WSR 12-13-056, recodified as § 182-503-0540, filed 6/15/12, effective 7/1/12. Statutory Authority: RCW 74.08.090. WSR 01-02-076, § 388-505-0540, filed 12/29/00, effective 1/29/01. Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057 and 74.08.090. WSR 98-16-044, § 388-505-0540, filed 7/31/98, effective 9/1/98. Statutory Authority: RCW 74.08.090 and 74.09.522. WSR 97-04-005, § 388-505-0540, filed 1/24/97, effective 2/24/97. Statutory Authority: RCW 74.08.090. WSR 94-10-065 (Order 3732), § 388-505-0540, filed 5/3/94, effective 6/3/94. Formerly WAC 388-83-012, 388-501-0170 and 388-505-0560.]
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