{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-325.2.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-325.2.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-325.2.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-325.2.html"}],"law_id":56047,"edition_id":1,"section_id":56047,"structure_id":13276,"section_number":"32.1-325.2","catch_line":"Department is payor of last resort","history":"1986, c. 550; 1994, c. 213; 1996, c. 851; 2007, c. 535.","full_text":"A\n\nInsurers, including group health plans as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, self-insured plans, health services plans, service benefit plans, health maintenance organizations, managed care organizations, pharmacy benefits managers, or other parties that are, by statute, contract, or agreement legally responsible for payment of a claim for a health care item or service, are prohibited from including any clause in health care contracts which would exclude enrolling an individual or in making any payment for benefits to the individual or on the individual’s behalf for health care when the individual is eligible for medical assistance.B\n\nThe Department of Medical Assistance Services shall be the payor of last resort to any insurer, including a group health plan as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, a self-insured plan, a health services plan, a service benefit plan, a health maintenance organization, a managed care organization, a pharmacy benefits manager, or other party that is, by statute, contract, or agreement legally responsible for payment of a claim for a health care item or service for persons eligible for medical assistance in the Commonwealth. The above entities, as a condition of doing business in the Commonwealth, shall comply with the requirements set forth in 42 U.S.C. 1396a (a) (25) (I) (i)-(iv).C\n\nTo the extent the Department of Medical Assistance Services has made payment for medical services where a third party has a legal obligation to make payment for such services, the Commonwealth shall automatically acquire all rights to such payment from the third party.D\n\nTo the extent the Department of Medical Assistance Services is permitted by law to obtain recoveries from third parties, actions at law for such recoveries shall be decided under the same laws, rules and standards including applicable bases of liability and defenses as would apply if the individual receiving the services had brought the action directly; provided that nothing herein shall affect the sovereign immunity of the Commonwealth.E\n\nThe term “insurer” as used herein shall be deemed to include without limitation “insurance carriers.”","order_by":null,"text":{"0":{"id":205448,"text":"Insurers, including group health plans as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, self-insured plans, health services plans, service benefit plans, health maintenance organizations, managed care organizations, pharmacy benefits managers, or other parties that are, by statute, contract, or agreement legally responsible for payment of a claim for a health care item or service, are prohibited from including any clause in health care contracts which would exclude enrolling an individual or in making any payment for benefits to the individual or on the individual’s behalf for health care when the individual is eligible for medical assistance.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":205449,"text":"The Department of Medical Assistance Services shall be the payor of last resort to any insurer, including a group health plan as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, a self-insured plan, a health services plan, a service benefit plan, a health maintenance organization, a managed care organization, a pharmacy benefits manager, or other party that is, by statute, contract, or agreement legally responsible for payment of a claim for a health care item or service for persons eligible for medical assistance in the Commonwealth. The above entities, as a condition of doing business in the Commonwealth, shall comply with the requirements set forth in 42 U.S.C. 1396a (a) (25) (I) (i)-(iv).","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":205450,"text":"To the extent the Department of Medical Assistance Services has made payment for medical services where a third party has a legal obligation to make payment for such services, the Commonwealth shall automatically acquire all rights to such payment from the third party.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":205451,"text":"To the extent the Department of Medical Assistance Services is permitted by law to obtain recoveries from third parties, actions at law for such recoveries shall be decided under the same laws, rules and standards including applicable bases of liability and defenses as would apply if the individual receiving the services had brought the action directly; provided that nothing herein shall affect the sovereign immunity of the Commonwealth.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":205452,"text":"The term “insurer” as used herein shall be deemed to include without limitation “insurance carriers.”","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":13276,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":13275,"metadata":{},"date_created":"2026-06-26 03:44:33","date_modified":"2026-06-26 03:44:33","permalink":{"id":201355,"object_type":"structure","relational_id":13276,"identifier":"1","token":"32.1\/10\/1","url":"\/32.1\/10\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13275,"edition_id":1,"name":"Department of Medical Assistance Services","identifier":"10","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:44:33","date_modified":"2026-06-26 03:44:33","permalink":{"id":201353,"object_type":"structure","relational_id":13275,"identifier":"10","token":"32.1\/10","url":"\/32.1\/10\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":75748,"structure_id":13276,"section_number":"32.1-323","catch_line":"Department of Medical Assistance Services","url":"\/32.1-323\/","token":"32.1\/10\/1\/32.1-323","metadata":false},{"id":73079,"structure_id":13276,"section_number":"32.1-323.1","catch_line":"Department to submit forecast of expenditures","url":"\/32.1-323.1\/","token":"32.1\/10\/1\/32.1-323.1","metadata":false},{"id":78209,"structure_id":13276,"section_number":"32.1-323.2","catch_line":"Elimination of waiting lists for certain waivers","url":"\/32.1-323.2\/","token":"32.1\/10\/1\/32.1-323.2","metadata":false},{"id":65434,"structure_id":13276,"section_number":"32.1-323.3","catch_line":"Dependents of foreign service members; waiting lists for certain waivers","url":"\/32.1-323.3\/","token":"32.1\/10\/1\/32.1-323.3","metadata":false},{"id":74370,"structure_id":13276,"section_number":"32.1-323.4","catch_line":"Department to facilitate transition of persons between certain waiver programs","url":"\/32.1-323.4\/","token":"32.1\/10\/1\/32.1-323.4","metadata":false},{"id":56444,"structure_id":13276,"section_number":"32.1-324","catch_line":"Board of Medical Assistance Services","url":"\/32.1-324\/","token":"32.1\/10\/1\/32.1-324","metadata":false},{"id":82951,"structure_id":13276,"section_number":"32.1-324.1","catch_line":"Authority to administer oaths, conduct hearings; obtaining relevant documents and other information","url":"\/32.1-324.1\/","token":"32.1\/10\/1\/32.1-324.1","metadata":false},{"id":68172,"structure_id":13276,"section_number":"32.1-324.2","catch_line":"Director to facilitate communication","url":"\/32.1-324.2\/","token":"32.1\/10\/1\/32.1-324.2","metadata":false},{"id":75151,"structure_id":13276,"section_number":"32.1-324.3","catch_line":"Uninsured Medical Catastrophe Fund established","url":"\/32.1-324.3\/","token":"32.1\/10\/1\/32.1-324.3","metadata":false},{"id":77747,"structure_id":13276,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; 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individuals confined in state correctional facilities","url":"\/32.1-325.04\/","token":"32.1\/10\/1\/32.1-325.04","metadata":false},{"id":75066,"structure_id":13276,"section_number":"32.1-325.1","catch_line":"Appeals of agency determinations","url":"\/32.1-325.1\/","token":"32.1\/10\/1\/32.1-325.1","metadata":false},{"id":87103,"structure_id":13276,"section_number":"32.1-325.1:1","catch_line":"Definitions; recovery of overpayment for medical assistance services","url":"\/32.1-325.1_1\/","token":"32.1\/10\/1\/32.1-325.1_1","metadata":false},{"id":56047,"structure_id":13276,"section_number":"32.1-325.2","catch_line":"Department is payor of last resort","url":"\/32.1-325.2\/","token":"32.1\/10\/1\/32.1-325.2","metadata":false},{"id":60758,"structure_id":13276,"section_number":"32.1-325.3","catch_line":"Disclosure or use of information for purpose not connected with medical assistance program; Department not subject to certain disclosure","url":"\/32.1-325.3\/","token":"32.1\/10\/1\/32.1-325.3","metadata":false},{"id":55595,"structure_id":13276,"section_number":"32.1-325.4","catch_line":"Penalty for violation","url":"\/32.1-325.4\/","token":"32.1\/10\/1\/32.1-325.4","metadata":false},{"id":60835,"structure_id":13276,"section_number":"32.1-325.5","catch_line":"State pharmacy benefits manager","url":"\/32.1-325.5\/","token":"32.1\/10\/1\/32.1-325.5","metadata":false},{"id":62094,"structure_id":13276,"section_number":"32.1-326","catch_line":"Director may make payments to or for eligible persons in state-owned medical facilities","url":"\/32.1-326\/","token":"32.1\/10\/1\/32.1-326","metadata":false},{"id":75399,"structure_id":13276,"section_number":"32.1-326.1","catch_line":"Department to operate program of estate recovery","url":"\/32.1-326.1\/","token":"32.1\/10\/1\/32.1-326.1","metadata":false},{"id":86309,"structure_id":13276,"section_number":"32.1-326.2","catch_line":"Pilot school\/community health centers","url":"\/32.1-326.2\/","token":"32.1\/10\/1\/32.1-326.2","metadata":false},{"id":69227,"structure_id":13276,"section_number":"32.1-326.3","catch_line":"Special education health services; memorandum of agreement between the Department of Education and the Department of Medical Assistance Services","url":"\/32.1-326.3\/","token":"32.1\/10\/1\/32.1-326.3","metadata":false},{"id":81598,"structure_id":13276,"section_number":"32.1-327","catch_line":"Claim against indigent's estate for payments made","url":"\/32.1-327\/","token":"32.1\/10\/1\/32.1-327","metadata":false},{"id":59946,"structure_id":13276,"section_number":"32.1-328","catch_line":"Repealed","url":"\/32.1-328\/","token":"32.1\/10\/1\/32.1-328","metadata":false},{"id":74371,"structure_id":13276,"section_number":"32.1-329","catch_line":"Repealed","url":"\/32.1-329\/","token":"32.1\/10\/1\/32.1-329","metadata":false},{"id":85726,"structure_id":13276,"section_number":"32.1-330","catch_line":"Long-term services and supports screening required","url":"\/32.1-330\/","token":"32.1\/10\/1\/32.1-330","metadata":false},{"id":80319,"structure_id":13276,"section_number":"32.1-330.01","catch_line":"Reports related to long-term services and supports","url":"\/32.1-330.01\/","token":"32.1\/10\/1\/32.1-330.01","metadata":false},{"id":56351,"structure_id":13276,"section_number":"32.1-330.02","catch_line":"Average hourly payment rates; publication","url":"\/32.1-330.02\/","token":"32.1\/10\/1\/32.1-330.02","metadata":false},{"id":75895,"structure_id":13276,"section_number":"32.1-330.1","catch_line":"Department to implement premium assistance program for HIV-positive individuals","url":"\/32.1-330.1\/","token":"32.1\/10\/1\/32.1-330.1","metadata":false},{"id":67982,"structure_id":13276,"section_number":"32.1-330.2","catch_line":"Medicaid managed care programs; program information documents; plain language required","url":"\/32.1-330.2\/","token":"32.1\/10\/1\/32.1-330.2","metadata":false},{"id":67859,"structure_id":13276,"section_number":"32.1-330.3","catch_line":"Operation of a PACE plan; oversight by Department of Medical Assistance Services","url":"\/32.1-330.3\/","token":"32.1\/10\/1\/32.1-330.3","metadata":false},{"id":85218,"structure_id":13276,"section_number":"32.1-330.4","catch_line":"Uniform assessment instrument for PACE plans","url":"\/32.1-330.4\/","token":"32.1\/10\/1\/32.1-330.4","metadata":false},{"id":56407,"structure_id":13276,"section_number":"32.1-330.5","catch_line":"Reports related to eligibility renewal","url":"\/32.1-330.5\/","token":"32.1\/10\/1\/32.1-330.5","metadata":false},{"id":59199,"structure_id":13276,"section_number":"32.1-331","catch_line":"Repealed","url":"\/32.1-331\/","token":"32.1\/10\/1\/32.1-331","metadata":false},{"id":60720,"structure_id":13276,"section_number":"32.1-331.01","catch_line":"Health Care Coverage Assessment Fund","url":"\/32.1-331.01\/","token":"32.1\/10\/1\/32.1-331.01","metadata":false},{"id":76953,"structure_id":13276,"section_number":"32.1-331.02","catch_line":"Health Care Provider Payment Rate Assessment Fund","url":"\/32.1-331.02\/","token":"32.1\/10\/1\/32.1-331.02","metadata":false},{"id":79240,"structure_id":13276,"section_number":"32.1-331.03","catch_line":"Process for payment directly to nursing facility or ICF\/MR","url":"\/32.1-331.03\/","token":"32.1\/10\/1\/32.1-331.03","metadata":false},{"id":80605,"structure_id":13276,"section_number":"32.1-331.04","catch_line":"Personal care aides; orientation program","url":"\/32.1-331.04\/","token":"32.1\/10\/1\/32.1-331.04","metadata":false},{"id":84036,"structure_id":13276,"section_number":"32.1-331.05","catch_line":"Coordinated specialty care; work group","url":"\/32.1-331.05\/","token":"32.1\/10\/1\/32.1-331.05","metadata":false},{"id":77511,"structure_id":13276,"section_number":"32.1-331.06","catch_line":"Annual review of medications and treatment for sickle cell disease; report","url":"\/32.1-331.06\/","token":"32.1\/10\/1\/32.1-331.06","metadata":false}],"previous_section":{"id":87103,"structure_id":13276,"section_number":"32.1-325.1:1","catch_line":"Definitions; recovery of overpayment for medical assistance services","url":"\/32.1-325.1_1\/","token":"32.1\/10\/1\/32.1-325.1_1","metadata":false},"next_section":{"id":60758,"structure_id":13276,"section_number":"32.1-325.3","catch_line":"Disclosure or use of information for purpose not connected with medical assistance program; Department not subject to certain disclosure","url":"\/32.1-325.3\/","token":"32.1\/10\/1\/32.1-325.3","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-325.2\/","history_text":"

This law was first created in 1986. The record of its establishment is cataloged in chapter 550 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1986 \u201cActs\u201d aren\u2019t available online. It has been modified 3 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1994, chapter 213<\/a>; in 1996, chapter 851<\/a>; in 2007, chapter 535<\/a>.<\/p>","references":[{"id":81706,"section_number":"38.2-3500","catch_line":"Form of policy","order_by":null,"url":"\/38.2-3500\/"},{"id":84457,"section_number":"8.01-66.9:2","catch_line":"Lien in favor of the Department of Medical Assistance Services on claim for personal injuries","order_by":null,"url":"\/8.01-66.9_2\/"}],"refers_to":false,"permalink":{"id":201425,"object_type":"law","relational_id":56047,"identifier":"32.1-325.2","token":"32.1\/10\/1\/32.1-325.2","url":"\/32.1-325.2\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-325.2\/","token":"32.1\/10\/1\/32.1-325.2","dublin_core":{"Title":"Department is payor of last resort","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-325.2","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Insurers, including group health plans as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, self-insured plans, health services plans, service benefit plans, health maintenance organizations, managed care organizations, pharmacy benefits managers, or other parties that are, by statute<\/span>, contract<\/span>, or agreement legally responsible for payment of a claim for a health care item or service, are prohibited from including any clause in health care contracts<\/span> which would exclude enrolling an individual or in making any payment for benefits to the individual or on the individual’s behalf for health care when the individual is eligible for medical assistance. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> The Department<\/span> of Medical Assistance Services shall be the payor of last resort to any insurer, including a group health plan as defined in § 607(1) of the Employee Retirement Income Security Act of 1974, a self-insured plan, a health services plan, a service benefit plan, a health maintenance organization, a managed care organization, a pharmacy benefits manager, or other party<\/span> that is, by statute<\/span>, contract<\/span>, or agreement legally responsible for payment of a claim for a health care item or service for persons<\/span> eligible for medical assistance in the Commonwealth. The above entities, as a condition of doing business in the Commonwealth, shall comply with the requirements set forth in 42 U.S.C. 1396a (a) (25) (I) (i)-(iv). <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> To the extent the Department<\/span> of Medical Assistance Services has made payment for medical services where a third party<\/span> has a legal obligation to make payment for such services, the Commonwealth shall automatically acquire all rights to such payment from the third party<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> To the extent the Department<\/span> of Medical Assistance Services is permitted by law<\/span> to obtain recoveries from third parties, actions at law<\/span> for such recoveries shall be decided under the same laws<\/span>, rules and standards including applicable bases of liability and defenses as would apply if the individual receiving the services had brought the action directly; provided that nothing herein shall affect the sovereign immunity of the Commonwealth. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The term “insurer” as used herein shall be deemed to include without limitation “insurance carriers.” <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDEPARTMENT IS PAYOR OF LAST RESORT (\u00a7 32.1-325.2)\n\nA. Insurers, including group health plans as defined in § 607(1) of the\nEmployee Retirement Income Security Act of 1974, self-insured plans, health\nservices plans, service benefit plans, health maintenance organizations, managed\ncare organizations, pharmacy benefits managers, or other parties that are, by\nstatute, contract, or agreement legally responsible for payment of a claim for a\nhealth care item or service, are prohibited from including any clause in health\ncare contracts which would exclude enrolling an individual or in making any\npayment for benefits to the individual or on the individual’s behalf for\nhealth care when the individual is eligible for medical assistance.\n\nB. The Department of Medical Assistance Services shall be the payor of last\nresort to any insurer, including a group health plan as defined in § 607(1)\nof the Employee Retirement Income Security Act of 1974, a self-insured plan, a\nhealth services plan, a service benefit plan, a health maintenance organization,\na managed care organization, a pharmacy benefits manager, or other party that\nis, by statute, contract, or agreement legally responsible for payment of a\nclaim for a health care item or service for persons eligible for medical\nassistance in the Commonwealth. The above entities, as a condition of doing\nbusiness in the Commonwealth, shall comply with the requirements set forth in 42\nU.S.C. 1396a (a) (25) (I) (i)-(iv).\n\nC. To the extent the Department of Medical Assistance Services has made payment\nfor medical services where a third party has a legal obligation to make payment\nfor such services, the Commonwealth shall automatically acquire all rights to\nsuch payment from the third party.\n\nD. To the extent the Department of Medical Assistance Services is permitted by\nlaw to obtain recoveries from third parties, actions at law for such recoveries\nshall be decided under the same laws, rules and standards including applicable\nbases of liability and defenses as would apply if the individual receiving the\nservices had brought the action directly; provided that nothing herein shall\naffect the sovereign immunity of the Commonwealth.\n\nE. The term “insurer” as used herein shall be deemed to include\nwithout limitation “insurance carriers.”\n\nHISTORY: 1986, c. 550; 1994, c. 213; 1996, c. 851; 2007, c. 535.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}