20-1073. Eligibility; prohibiting cancellation
because of eligibility for certain benefits
A. Except as specifically provided in sections 20-1379 and 20-1380, with respect to
the determination of whether a person is an eligible individual, a health care services
organization shall not consider the availability of or a person's eligibility for medical
assistance under a program pursuant to title XIX of the social security act (P.L. 89-97;
79 Stat. 344; 42 United States Code section 1396a (1980)) when considering eligibility
for coverage or calculating payments under its plan for eligible enrollees.
B. To the extent that payment for covered expenses has been made under the state
program pursuant to title XIX of the social security act for health care items or
services furnished to an individual, the state is considered to have acquired the rights
of the individual to payment by any other party for those health care items or
services. On presentation of proof that the state program pursuant to title XIX of the
social security act has paid for covered items or services, the health care services
organization shall make payments to the state program pursuant to title XIX of the social
security act according to the coverage provided in the evidence of coverage.
C. A health care services organization may not impose on a state agency that has
been assigned the rights of an individual who is eligible for medical assistance and who
is covered for health benefits from the insurer any requirements that are different from
the requirements applicable to an agent or assignee of any other covered individual.
D. A health care services organization shall not cancel or fail to renew the
contract of any person based on that person's eligibility for or enrollment in a program
funded under title XIX of the social security act or title 36, chapter 29 or 34. Nothing
in this section prohibits cancellation or failure to renew for nonpayment of monies due
under the contract.
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