Disclaimer: This article is for informational purposes only and does not constitute legal advice. Always consult a qualified attorney to discuss your specific situation.
Detailed Answer
When you settle a personal injury claim in Mississippi and Medicaid or Medicare paid for your medical care, these programs have a legal right to recover those payments from your settlement. In Mississippi, the Medicaid agency enforces its recovery right through a statutory lien under Miss. Code Ann. § 43-13-115 (link). Federally, Medicare enforces repayment under the Medicare Secondary Payer statute, 42 U.S.C. § 1395y(b) (link).
Medicaid Liens in Mississippi
Mississippi Medicaid automatically acquires a lien against any recovery you obtain for injuries it has paid. The agency must file notice of its lien within six months after it pays medical expenses. Once filed, the lien attaches to your settlement, judgment or award. You must satisfy that lien before you disburse net proceeds to yourself or your attorney.
Medicare’s Conditional Payments
Under federal law, Medicare pays first for covered treatment in a personal injury case only if no other payor exists. If Medicare pays initially, it issues a “conditional payment” letter identifying what it paid. After you resolve your claim, Medicare demands repayment of those conditional payments. You must request a final demand letter and satisfy the amount within the timeframe specified.
How Reimbursements Affect Your Offer
- Reduced Net Proceeds: Your gross settlement amount shrinks by the total lien and conditional payment balance.
- Negotiation Impact: Defendants often optimize their offer after factoring in expected reimbursements. Higher liens can depress your net recovery.
- Escrow and Holdbacks: Lawyers often withhold funds in escrow until agencies issue final payoff statements.
Practical Steps
- Identify All Lien Holders: Request Medicaid and Medicare payoff statements early.
- Negotiate Your Settlement: Factor in lien amounts so you negotiate a higher gross settlement.
- Set Up Escrow: Hold sufficient funds to pay liens promptly once you receive final demands.
- Obtain Lien Releases: After payment, secure written releases from Medicaid and Medicare before dispersing any settlement money.
Helpful Hints
- Contact Medicaid promptly to request a statement of lien balance and procedural requirements.
- Use the Medicare Coordination of Benefits Contractor (COBC) portal to obtain your conditional payment letter quickly.
- Keep detailed records of all medical bills, payments, and correspondence with agencies.
- Consider a structured settlement to manage ongoing medical needs and reduce immediate lien pressure.
- Talk to an attorney experienced in Medicaid and Medicare recovery to protect your rights and maximize your net recovery.