Question

being a payer of last resort means:

• the program will pay if there is money available
• the program will pay when a person does not have health insurance
• all other insurance must be billed first
• the provider must demonstrate need

Explanation:

Define payer of last resort

By law, Medicaid is generally the payer of last resort. This means that all other legally liable third parties (such as private health insurance, Medicare, or employer-sponsored plans) must meet their legal obligation to pay claims before Medicaid pays.

Evaluate the options

• "The program will pay if there is money available": Incorrect. Funding availability is not the definition of this rule.
• "The program will pay when a person does not have health insurance": Incorrect. It also pays for insured individuals after their primary insurance has paid its share.
• "All other insurance must be billed first": Correct. This directly matches the definition of paying only after other resources are exhausted.
• "The provider must demonstrate need": Incorrect. This does not define the coordination of benefits rule.

Answer:

• The program will pay if there is money available
• The program will pay when a person does not have health insurance
• All other insurance must be billed first (Correct answer)
• The provider must demonstrate need