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Texas' Health and Human Services (HHS) Taps MAIS Program

Texas' Health and Human Services (HHS) Taps MAIS Program

Texas' Health and Human Services (HHS) recently signed an agreement with the Medical Assistance Intercept System (MAIS) program for retention of its services, which are currently being rendered.

MAIS is a fully integrated, online solution that is customizable for all state and insurance users. States can submit Medicaid recipient records into the MAIS database, which is matched daily with personal injury and workers' compensation claims indexed by the insurance industry. MAIS identifies and provides participating member states with quality matches and comprehensive outreach services. Once matches have been disclosed, States can then issue a lien to the insurer using that information. To expedite the process, states are also given the option to have MAIS file the appropriate notices on their behalf. Medical claim costs are then collected by the state from the insurer at the time of settlement.

As of December 2018, the Texas Medicaid program had a total of 4,282,676 enrollees, an overall increase of 1.88% from the first Market Open Enrollment Period and related Medicaid program changes back in October 2013 1. Under this specific agreement, HHS will look to MAIS as an integral tool to offset the rise in medical assistance costs, statewide.

For Texas, this program will act as a cost control initiative which will intercept insurance payments [and other lump sum payments] to claimants who receive medical assistance through Medicaid. Retaining MAIS will allow the State to receive relevant, quality assured data matches thereby increasing medical assistance subrogation through the interception of insurance claim settlements, before proceeds are allocated to an insurance claimant. As a result, HHS expects to receive a higher reimbursement rate for applicable casualty claims.

Texas is the second state to implement and leverage the MAIS program, following the launch of MAIS with the State of Rhode Island.

1 "Medicaid & CHIP in Texas." State Index | Medicaid.gov, United States Government, 2019,www.medicaid.gov/state-overviews/stateprofile.html?state=Texas.

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