Detailed Answer
When you receive Medicaid or Medicare benefits and later sustain injuries due to someone else’s fault, both programs can seek repayment from your personal injury recovery. Understanding how these reimbursements work helps you negotiate a settlement that fairly addresses everyone’s rights.
Connecticut Medicaid Reimbursement (Subrogation)
Under Connecticut law, the Department of Social Services has a right to repayment (subrogation) from any third-party recovery after a personal injury. Conn. Gen. Stat. § 17b-93 requires you to notify the department of any claim and preserve its lien. Per § 17b-93 and § 17b-93a, the state may recover the lesser of the total medical assistance paid or its pro rata share of the settlement.
Medicare Repayment (Federal Secondary Payer Rules)
Medicare’s right to recover comes from the federal Medicare Secondary Payer statute, 42 U.S.C. § 1395y(b). Medicare pays medical bills only after exhausting other sources. When you settle a personal injury claim, Medicare issues a conditional payment notice listing what it paid. You must reimburse Medicare the full amount of conditional payments before using settlement funds for other expenses.
Impact on Your Settlement Offer
- Determining Liens: Your attorney should identify Medicaid and Medicare liens early. Submit demand letters to DSS (for Medicaid) and to CMS (for Medicare) for official lien figures.
- Reducing Exposure: You can negotiate Medicaid’s reimbursement amount under state law if certain expenses (e.g., legal fees, non-reimbursement damages) qualify for reduction. CT statutes and regulations allow deduction of reasonable attorney’s fees from the recovery before calculating Medicaid’s share.
- Escrow or Structural Settlement: You can set aside funds in escrow for future medical expenses. This approach may lower immediate reimbursement demands from Medicaid and Medicare.
- Timing and Net Recovery: Any settlement offer must account for Medicaid and Medicare liens. Your net recovery equals gross settlement minus all valid liens, attorney’s fees, costs, and statutory deductions. Negotiating a higher gross amount may offset these mandatory repayments.
Next Steps
1. Inform your personal injury attorney of all public benefits received.
2. Request detailed lien statements from DSS and CMS.
3. Structure your settlement to address both future medical costs and outstanding liens.
4. Review any reductions allowed under Conn. Gen. Stat. § 17b-93a.
Disclaimer
This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.
Helpful Hints
- Start lien resolution early—link DSS and CMS letters to your timeline.
- Keep thorough records of medical payments and benefits.
- Ask your attorney about off-setting future medical expenses.
- Verify lien calculations—errors can occur.
- Consider a settlement structure that allocates amounts to different categories (medical vs. general damages).