SHARS Third Party Liability

  • SHARS Third Party Liability (as of 10/01/2017)

    Texas Medicaid is a "payer of last resort".  That means that everyone who is legally responsible for paying for your health-care services must pay what they owe before your heath-care services must pay what they owe before Texas Medicaid will pay.  For example, if you have other health insurance, that insurance company must pay its share before Texas Medicaid will pay.  Anyone who is legally responsible for paying is called a "third party" and the responsibility to pay is called "third party liability".  

    It can be hard for you to work with all of the third parties who are resopnsible for paying for your health-care services.  To make it easier for you, Texas Medicaid pays your claims and then goes to the third parties for their share of the costs.  This way of handling payment is called "pay and recover".  

    On Octover 1, 2017, Texas Medicaid began using the pay-and-recover method for the School Health and Related Services (SHARS) program.  This new way of getting payments will have very little impact on you.  You will not have to pay anything, because Texas Medicaid pays your insurance co-payments and deductibles.  However, your lifetime benefits for your private insurance might be affected.  It will depend on your insurance company and policy.  You should read your policy and call your insurance company if you have any questions.  The Individuals with Disabilities Education Act (IDEA) entitles children to a free and appropriate public education.  If you think this change might cost you money, you should talk with your school district.