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Reimbursing Medicaid After Receiving an Injury Settlement

Medicaid is a health insurance program that covers lower-income people or those who are under the age of 65 and are considered disabled. Medicaid is a state and federally funded program and does not require participants to pay any premiums for coverage when they're enrolled in the program.

Because Medicaid is financed by tax money and not premiums, every state has laws in place that allow Medicaid to recover monies from a personal injury settlement for any treatment that Medicaid paid for related to the injury. Although the wording of this law may vary from state to state, they all grant this program the ability to recover their expenses in this type of situation. Here's what you should know about reimbursing Medicaid after receiving a personal injury settlement.

1. Reporting The Accident To Medicaid

When you accept the terms and conditions of having Medicaid coverage, some of the fine print includes a requirement to notify the program if you have been injured in an accident and are seeking compensation. If you have legal representation, your attorney is required by law to notify the program. If you are self-representing, you must tell the program yourself before any settlement is reached. Penalties for not reporting the accident to the program vary from state to state. However, these sanctions could include removal from the program, charges for medical care provided, or accusations of fraud for not reporting the event.

"Isn’t The Responsible Party Supposed To Pay For My Medical?"

The negligent party is responsible for your medical care costs. However, if the policy covering the accident has a limit on it as many auto policies do, then the personal insurance of the injury victim usually picks up the costs associated with the damage.

2. Reimbursing Medicaid With The Settlement Funds

When you are ready to settle your case and accept the insurance company’s offer, you will have to notify Medicaid. Medicaid will then seek reimbursement for any expenses they have had related to your accident. Payment to Medicaid will be made by your attorney directly from the settlement before you start receiving any funds. A personal injury case can take an extended period to settle based on the seriousness of the injuries and the time it takes for the injured party to reach maximum medical improvement. For this reason, it is likely that Medicaid will already have a lien filed against your case.

This is standard operating procedures to ensure they receive payment for any care they covered from your injury. Under the rules of the Affordable Care Act, Medicaid liens are non-negotiable and must be repaid in full. Many attorneys refer to these as super liens because there is very little, if any, room to negotiate the amount requested. However, your attorney will make a significant effort to review all the bills that Medicaid is seeking reimbursement for. This review will ensure that they are only associated with your injury and not with any other type of medical care you received during your injury period.

3. Protecting Your Medicaid Eligibility

Infographic Anyone who is on Medicaid and is about to receive a personal injury settlement must speak to their attorney about how this settlement may affect their ability to remain in the Medicaid program. A settlement may place the person above the income and asset guidelines for the program and disqualify them from further medical care through Medicaid. This occurrence can be a significant problem, especially if there is a need for continued medical treatment for the injury or other medical issues outside of the injury. Losing your health coverage can be devastating. In some cases, your attorney may be able to establish a Special Needs Trust on your behalf to protect your Medicaid eligibility.

"What Is A Special Needs Trust?"

A Special Needs Trust (SNT) is a financial tool that allows eligible parties to place their assets into the trust for their care without it impacting their overall finances.

To qualify for this type of trust, you must:

  • Be under the age of 65
  • Be considered disabled
  • Be otherwise qualified to receive Medicaid and other government benefits

An SNT will provide the beneficiary with a way to manage their money for future care without having to count these assets as part of their income. This type of trust requires management by a personal or professional trustee, and funds can only be dispersed for goods and services that benefit the disabled party.

Some of these goods and services include:

  • Medical expenses not covered by Medicaid
  • Home and vehicle costs, including insurance premiums
  • Upgrades to a home or vehicle to accommodate a disability
  • Personal hygiene products
  • Entertainment or positive experiences

Other expenses may be included based on state-specific laws regarding Special Needs Trusts.

4. Working With An Attorney

When you have sustained injuries in an accident, life becomes complicated. Everything quickly begins to revolve around your injury and your recovery. Reduce your stress load and the burdens associated with filing an insurance claim and dealing with Medicaid by working with a qualified Las Vegas attorney. Your attorneys can handle all of the legal paperwork and negations, including dealing with Medicaid and allow you to concentrate on your recovery.

If you are on Medicaid and have sustained injuries in an accident, contact Bernstein & Poisson today. As experienced personal injury lawyers, we can help you correspond with Medicaid to ensure you don't end up paying more than you should. Dealing with Medicaid after an accident injury can be difficult, but with the right legal team on your side, you can protect your rights and secure the compensation you need for your recovery.