What Personal Injury Victims Need to Know About Medicaid Liens

A few weeks ago I posted about Medicare Liens and what people who suffer an injury  as the result of someone else’s negligence need to be on the lookout for if they have Medicare. Similar to Medicare, if a person has Medicaid and suffers an injury, Medicaid may be entitled to a lien on any proceeds received by the person. This lien extends to payments for medical expenses that Medicaid has made on behalf of the person for medical services related to the injury.

Medicaid is a government-run health insurance plan for people and families who have low income or low resources. Medicaid is jointly funded by the states and the federal government, but it is run by the states. Like Medicare, Medicaid must be paid back for any payments made on behalf of the Medicaid recipient. Also like Medicare, the Medicaid program is under-funded and over-worked.

At the earliest sign that Medicaid has made payments on an injured person’s behalf, the attorney needs to immediately begin the process of notifying Medicaid and getting documentation of the benefits Medicaid is claiming have been paid on behalf of the injured person. Once the listing of payments is received from Medicaid, the attorney needs to carefully review all payments to make sure they are related to injuries sustained in the loss that was due to the other person’s negligence. Due to recent rulings by North Carolina’s appellate courts and a position taken by Medicaid, Medicaid believes that it is entitled to payment for all medical bills incurred by the Medicaid recipient between the date of the injury and the settlement. Medicaid’s position on this issue is totally illogical. This is an on-going issue that is being fought by attorneys across the state.

Another issue facing attorneys in North Carolina is how to approach the issue of minor clients who are Medicaid recipients. This is because Medicaid’s lien is based on reimbursement for medical expenses paid. However, a minor’s parents are the persons who have liability and therefore the recovery right for medical expenses. The portion of a minor’s settlement for pain and suffering belongs to the minor. So, the issue is whether a parent can waive the claim for medical expenses and allow the settlement to only be for the minor’s pain and suffering. This would usually apply when there are severe injuries and limited insurance coverage.