Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney to discuss your specific situation.
Detailed Answer
When you receive medical benefits through Medicaid or Medicare and later file a Missouri personal injury claim, federal and state laws require repayment of those benefits from any settlement or judgment. Failing to address these liens can result in penalties, delays, or lost benefits.
1. Medicaid Liens in Missouri
Under Missouri law, the Department of Social Services may recover Medicaid payments made on your behalf if a third party is responsible for your injuries. Missouri Revised Statutes §208.435 authorizes recovery against settlements or judgments. You must:
- Notify the Department of any claim or lawsuit.
RSMo §208.435 - Request a payoff demand to identify the total amount owed.
- Set aside funds at closing to satisfy the lien before disbursing any net recovery.
2. Medicare Secondary Payer Rules
The federal Medicare Secondary Payer (MSP) Act requires Medicare to be the secondary payer when another party (like an insurer or the at-fault individual) is responsible. Key steps include:
- Obtain a Medicare Conditional Payment Letter from the Centers for Medicare & Medicaid Services (CMS).
- Review and dispute any incorrect charges.
- Ensure CMS receives full reimbursement from your settlement.
Medicare Secondary Payer Overview
3. Impact on Your Settlement Offer
Reimbursement obligations reduce your net recovery. For example, if your gross settlement is $100,000, Medicaid and Medicare may claim $20,000 combined. Your attorney must negotiate with lienholders to secure any available reductions and allocate funds accurately at closing.
4. Best Practices
- Identify all payers early. Include private insurers.
- Obtain payoff statements before mediation or demand letters.
- Negotiate reductions when liens exceed your net recovery.
- Coordinate with your attorney to draft closing statements that allocate each lienholder’s share.
Helpful Hints
- Start lien resolution early to avoid closing delays.
- Keep detailed records of medical bills and payments.
- Work with a lawyer experienced in Medicare and Medicaid subrogation.
- Request conditional payment letters for Medicare as soon as you file a claim.
- Verify lien amounts before accepting any settlement.