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Medicaid, governed by 42 U.S.C. § 1396 and signed into law by President Johnson, provides health insurance plans managed by individual State agencies that are funded jointly by the Federal and State government for low-income adults, their children, pregnant women and people with certain disabilities. Each State Medicaid agency also utilizes Medicaid Managed Care programs where Medicaid recipients enroll in a private health plan, which receives a fixed monthly premium from the State. For more information about Medicaid Managed Care program recovery rights, click here.
When Medicaid has made payments for medical expenses related to an injury, it may assert a lien against the beneficiary’s recovery. Each of the fifty (50) State Medicaid agencies and three (3) United States territories have unique recovery statutes that affect how a State agency can recover medical payments paid from a personal injury, workers compensation or liability settlement.
Medicaid agencies do not require a set-aside, however as the program is an asset and income-based service, receipt of settlement proceeds may disqualify the Medicaid beneficiary from the Medicaid program. For more information about this, click here.
As each State Medicaid agency has a unique recovery statute, each agency has different reduction formulas or guidelines pursuant to their statute. Some Medicaid agencies will only grant a reduction through a compromise process. Cattie & Gonzalez has experience working with these agencies and negotiating reasonable lien reductions based on the current statutory and regulatory environment. If you'd like to put our experience to work for you and your client, please let us know.