WAG 23-08-00

Sometimes someone else is responsible for paying the medical bills for a client or applicant. This is "Third Party Liability" (TPL). The most common kind of TPL is private health insurance.

HFS is the "payor of last resort" for medical bills. HFS usually pays any bills only after TPL sources pay what they are supposed to pay. Clients have to use all TPL sources before using HFS to pay medical bills. After that HFS pays whatever remains, up to the payment rate for the service.

When HFS is aware of TPL, HFS waits to pay most medical bills until the TPL source either makes payment or shows that they do not have to make payment. If HFS does not find out about TPL until after the bill is paid, then it asks the TPL source for repayment.

Clients must give their rights to TPL payments to HFS when they apply for or get assistance. This includes anyone else they may be applying for, such as a child's right to TPL payments through another parent. An adult who does not help HFS in collecting medical support from an absent parent is not eligible for cash or medical unless there is a good reason not to help.

For TANF and AABD cases, and children receiving SSI, HFS tries to get the absent parent to pay medical bills. Absent parents have to either put the child or dependent on their employer's or union's health plan, if they have one, or get insurance independently. The employer may be ordered to add the child to the employee's health plan.

The TPL program is run by the Third Party Liability Section of the Bureau of Collections. They get information from Family Community Resource Centers, other parts of the Department, insurance companies, medical providers, and others.