Disclaimer: This article does not provide legal advice but offers general information to help you understand your options under Oklahoma law.
Detailed Answer
1. Federal and State Reimbursement Rights
When Medicaid or Medicare covers your medical bills after an injury, each program has a right to recover those payments from any third-party settlement. Under federal law, Medicare exercises that right through the Medicare Secondary Payer statute (42 U.S.C. § 1395y(b)), and Medicaid relies on a combination of federal mandates (42 U.S.C. § 1396k) and Oklahoma state law (56 O.S. § 240.7).
2. Medicaid Liens in Oklahoma
Oklahoma’s Medicaid agency—the Oklahoma Health Care Authority—must seek reimbursement from any third party who is legally liable for your injuries. Title 56 O.S. § 240.7 authorizes the Authority to file a lien or claim against your personal injury settlement. You or your attorney must formally notify the Authority of your claim before or at the time you file suit. The Authority then provides a statement of its lien amount, and you must reserve those funds in your settlement or face potential enforcement action.
Learn more about Title 56 restrictions: 56 O.S. § 240.7
3. Medicare’s Recovery Process
Medicare pays as a secondary payer when another party is responsible for medical expenses. Under 42 U.S.C. § 1395y(b), you must notify the Centers for Medicare & Medicaid Services (CMS) when you expect to receive a settlement. CMS issues a demand letter specifying how much it will recover from your gross settlement. You must set aside enough funds to satisfy that demand before you finalize your agreement.
See federal statute: 42 U.S.C. § 1395y(b)
4. Impact on Your Settlement Offer
Because both programs assert liens, your negotiated settlement figure must account for the amount you owe to Medicaid and Medicare. Settlement offers typically include line items for:
- Past and future medical expenses (gross amount).
- Attorney’s fees and litigation costs.
- Liens and reimbursements to Medicaid/Medicare.
- Net compensation for pain and suffering.
If you accept an offer without reserving funds for reimbursement, you risk personal liability for the unpaid balance plus interest or penalties. Your attorney can negotiate with each agency for a reduction or payment plan, but final approval rests with the program.
Helpful Hints
- Notify CMS and the Oklahoma Health Care Authority early—missing deadlines can trigger fines.
- Obtain lien statements in writing before signing any release.
- Work with your attorney to reserve the correct reimbursement amounts in escrow.
- Consider negotiating Medicare’s conditional payment amount if the initial demand seems high.
- Keep detailed records of all medical bills paid by Medicare or Medicaid.
- Consult a qualified attorney to help you address complex lien issues.