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Detailed Answer

Disclaimer: This information is for educational purposes only and does not constitute legal advice. Consult a qualified attorney for guidance tailored to your situation.

1. Understanding Washington’s Medicaid (Apple Health) Lien Rights

Under Washington law, the Department of Social and Health Services (DSHS) may assert a lien against personal injury settlements when it has paid medical bills on behalf of a Medicaid (Apple Health) recipient. These rights derive from:

• RCW 74.09.620 (Liens—Rules): https://apps.leg.wa.gov/rcw/default.aspx?cite=74.09.620
• RCW 74.09.640 (Third Party Liability—Recovery—Payment of Medical Assistance): https://apps.leg.wa.gov/rcw/default.aspx?cite=74.09.640
• RCW 74.09.680 (Liens—Priority—Distributions): https://apps.leg.wa.gov/rcw/default.aspx?cite=74.09.680

2. How the Lien Attaches

When DSHS pays for medical care under Apple Health, it gains a subrogation right. This right becomes a lien on any settlement or judgment you receive from a third party. The lien covers all medical expenses that DSHS paid related to your injury.

3. Notice Requirements and Timeline

After you believe you have a valid claim, you must:

1. Notify DSHS in writing before finalizing any settlement, judgment, or award. RCW 74.09.640(4) requires prompt notice.
2. Provide documentation of the case and total settlement amount.
3. Allow DSHS 30 days to respond with its lien amount.

4. Calculating and Negotiating the Lien

DSHS will calculate its lien based on the actual medical payments made. You can:

• Request an itemized statement of benefits paid.
• Ask DSHS for a reduction if the full lien would cause undue hardship. RCW 74.09.620(2) allows administrative review.
• Negotiate a global settlement that allocates funds between past medicals, future care, pain and suffering, and attorneys’ fees. Proper allocation can reduce the lien proportionally.

5. Court Approval and Dispute Resolution

If you and DSHS cannot agree, you can petition the court to determine the reasonable amount of the lien. The court may adjust the lien under RCW 74.09.680(2) to prevent inequitable results.

Helpful Hints

• Identify any Medicaid coverage early in your case.
• Include DSHS in all settlement negotiations from the start.
• Work with your attorney to allocate damages strategically.
• Document all communications with DSHS in writing and save receipts.
• Consider filing a hardship waiver if repayment would leave you destitute.
• Obtain court approval for any settlement involving a Medicaid lien.