Disclaimer: This article is for educational purposes only and does not constitute legal advice. Always consult a qualified attorney to discuss your specific circumstances.
Detailed Answer
When you receive Medicaid benefits in New York and later recover a personal injury settlement, the State Medicaid program has the right to seek reimbursement for the medical expenses it paid on your behalf. Understanding how to navigate these liens can help you maximize your recovery and comply with your legal obligations.
1. Medicaid’s Third-Party Liability and Subrogation Rights
Under New York Social Services Law § 366, New York State is subrogated to your rights against any third party whose actions caused your injury. This means Medicaid can step into your shoes to recoup the cost of your medical care. You implicitly assign these rights when you apply for or receive Medicaid benefits. Learn more: SSL § 366.
2. Identifying Benefits Paid
Before settlement, request a detailed statement of benefits paid from your local Medicaid district or the New York State Department of Health. This statement will list the dates of service, providers, and amounts reimbursed by Medicaid. It serves as the basis for any lien.
3. Settlement Allocation Strategy
Not all funds you recover are subject to Medicaid’s claim. You can allocate portions of your settlement to non-medical damages—such as pain and suffering or lost wages—that Medicaid cannot recover. Work with your attorney to structure the release and allocation clauses to separate medical expenses from other categories.
4. Negotiating and Satisfying the Lien
Once you know the lien amount, communicate with the local Medicaid district to confirm the exact figure and request a payment demand. Medicaid sometimes allows negotiation, particularly if you demonstrate hardship or if the lien exceeds the portion of your settlement attributable to medical bills. After reaching an agreement, Medicaid will issue a satisfaction of lien upon payment.
5. Filing Required Notices
New York regulations at 18 NYCRR Part 519 require you to notify Medicaid before settling any claim that may involve its subrogation rights. Failure to do so can lead to delays or reductions in your net recovery. Provide notice of the pending settlement, a copy of all key documents (complaint, settlement draft, lien statement), and request a formal lien waiver or release.
6. Final Disbursement
After satisfying the Medicaid lien, the remaining settlement funds are available for distribution to you for non-medical damages and to pay your attorney’s contingency fee and any other liens (such as medical provider or Medicare secondary payer claims). Ensure all payments are documented and you receive written confirmation that the Medicaid lien is fully resolved.
Helpful Hints
- Request a written benefits-paid statement early in the case.
- Structure your release to allocate non-medical damages first.
- Provide prompt notice to Medicaid as required by 18 NYCRR § 519.
- Negotiate the lien if it exceeds your medical portion or creates hardship.
- Obtain a lien satisfaction or waiver in writing before final disbursement.
- Keep detailed records of all communications and payments.
- Consult a personal injury attorney experienced in Medicaid subrogation.