Understanding Medicaid and Medicare Reimbursements in Utah Personal Injury Settlements

Disclaimer: This article is for informational purposes only and is not legal advice. Consult a qualified attorney to discuss your specific situation.

Detailed Answer

Medicaid Liens in Utah

When Utah Medicaid pays for medical care in a personal injury case, state law gives the Medicaid agency a lien on any settlement or judgment. Under Utah Code § 26-40-102, the Utah Department of Health and Human Services must be reimbursed from proceeds of any third-party recovery. Key points:

• The lien covers actual medical assistance paid by Medicaid.
• You must notify the agency in writing of any pending claim at least 45 days before settlement (§ 26-40-103).
• The state will calculate its lien amount and issue a statement. You may negotiate or request a reduction based on reasonable attorney fees and case risk.
• Failure to satisfy the lien can delay distribution of your net settlement.

Medicare Reimbursement Requirements

Medicare acts as a secondary payer under the federal Medicare Secondary Payer (MSP) Act, 42 U.S.C. § 1395y(b). When Medicare pays for injury-related treatment and another party is responsible, Medicare can seek repayment from your settlement. Steps include:

• Request a conditional payment summary from Medicare well before settlement.
• Set aside sufficient funds in escrow to cover the conditional payments.
• After settlement, provide Medicare with a final release and proof of settlement.
• Medicare issues a demand for reimbursement, typically due within 60 days to avoid interest and penalties.

Impact on Settlement Offers

Insurance adjusters factor in potential Medicaid and Medicare liens when making offers. A higher lien may reduce the net recovery you receive. As a claimant, you should:

• Identify all lien holders early.
• Estimate lien amounts and subtract them from your desired net recovery to guide settlement negotiations.
• Budget for the time and costs of lien resolution when evaluating offers.

Addressing Medicaid and Medicare liens promptly ensures a smoother closing and helps maximize your out-of-pocket recovery.

Helpful Hints

• Start lien resolution as soon as you file your claim.
• Request a Medicare conditional payment report at least 120 days before your planned settlement date.
• Send timely Medicaid notices under Utah Code § 26-40-103.
• Keep detailed records of lien communications and payments.
• Consider negotiating lien reductions based on attorney fees or hardship.
• Set aside escrow funds for Medicare’s final demand.
• Consult an attorney experienced in Medicaid/Medicare subrogation issues.