About Medicaid Liens
Medicaid provides need-based health insurance plans administered by the State and funded federally. Eligibility and income requirements vary by state, and sometimes by county. Generally, Medicaid recipients are all ages, with some programs developed specifically for children of low income families. Medicaid programs cover both hospital and outpatient care, and may offer prescription drug discounts or benefits. The Medicaid Institutional Care Program (“ICP”) provides benefits for those in nursing homes.
Where Medicaid has made payments for medical services related to an injury it may assert a lien against the beneficiary’s recovery under state Medicaid third party recovery laws. Synergy offers complete resolution assistance including the request for compromises, statutory reductions, or Ahlborn reductions, as applicable under State provisions.
Medicaid Lien Glossary
When a lien has been asserted by Medicaid, a compromise may be proposed in an attempt to reduce the lien beyond the standard reduction under state statutes.
The process of notifying, verifying, and negotiating a lien until final resolution is reached. This may include the pursuit of compromises, appeals or waivers until the lien holder produces their final offer for recovery.
The process of determining if an insurer has a lien (an affirmative obligation to the lien holder). If there is a lien, the case is negotiated to resolution.
Medicaid Lien FAQ
Why is Medicaid different in every state?
Medicaid is a joint federal-state program. The federal government contributes approximately 50% to fund the program. As a result, states pay the remaining costs and are given wide discretion about whom to cover and what benefits to provide. Each state has an agency in place that manages the individual state’s program. Some states allow county and city governments to administer the program. Alternatively, other states, such as Florida, hire recovery contractors.
Can I release funds to my client before the lien has been resolved?
It is not suggested that funds be released before the liens are resolved and confirmed in writing. In cases where there may be need-based benefits such as Medicaid/SSI, the distribution of funds may affect the claimant’s eligibility. Distributing funds before a valid lien is resolved can have consequences for both attorney and client. However in some cases, if there is a guarantee that a lien holder will not increase their lien amount, a holdback may be recommended.
Can our client lose their benefits after receiving a settlement?
If your client is receiving a need-based (low income) benefit like Medicaid or SSI, a settlement or award may impact their eligibility for benefits.