Important Medicaid Recovery Update

Medicaid can access entire settlement to seek reimbursement for conditional payments.

Medicare and Medicaid are secondary payers.  If Medicaid or Medicare make a payment, but later identify a primary payer (any party legally responsible for payment of a claim, i.e. workers’ compensation insurance, health insurer, self-insured plans, group health plans, etc.), they may recover the amount paid from that party.

Historically, if a personal injury or workers’ compensation case was settled, Medicaid’s recovery for conditional payments was limited to the settlement proceeds allocated to medical expenses.  See Ark. Dep’t of Human Servs. v. Ahlborn, 547 U.S. 268 (2006).  On October 1, 2017, language enacted by Congress in the Bipartisan Budget Act of 2013 became effective and granted Medicaid the right to assert a full recovery against the entire settlement paid to a claimant/plaintiff. 

If you are aware of conditional payments by Medicaid, address the liens prior to settlement.  Settlement language stating that the claimant/plaintiff is not being compensated for past medical expenses will no longer prevent Medicaid from recovering against those payments.  To the extent your state’s Medicaid information is accessible, you may considering implementing and extending the best practices you already have in place for Medicare liens to Medicaid.

We are happy to help you navigate this change.  Please call us if you have any questions.