Disclaimer: This article is for general informational purposes only and does not constitute legal advice. Consult a qualified attorney for advice about your specific situation.
Detailed Answer
1. Medicaid Subrogation in Nebraska
When Medicaid pays medical bills for a Nebraska resident injured by a third party, it gains a statutory right to recover those costs from any subsequent settlement. Under Neb. Rev. Stat. § 68-911, Medicaid has a lien against any tort recovery to the extent of medical expenses it paid. The lien attaches when a claim for damages is filed or when Medicaid files a notice of lien in the county court where the action arises.
The process generally works like this:
- Medicaid pays for your medical treatment related to the injury.
- Your attorney notifies the Nebraska Department of Health and Human Services (DHHS) of the pending claim.
- DHHS files a lien through the county clerk’s office. See Neb. Rev. Stat. § 68-911.
- At settlement, funds are set aside to satisfy the lien. You must resolve or negotiate this amount before distributing net proceeds.
2. Medicare Secondary Payer Requirements
Under federal law, Medicare may pay for your treatment only if no other source of payment is available. When you recover from a third party, Medicare exercises a right of reimbursement under the Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b). Before settling, you must request a Medicare Conditional Payment Letter that lists medical bills paid.
Key steps include:
- Submit a request to Medicare for a conditional payment statement.
- Review the itemized list of expenses and dispute any unrelated charges.
- Reimburse Medicare from your settlement for all valid conditional payments.
3. Impact on Settlement Offers
Medicaid and Medicare liens directly reduce the amount you receive. Suppose you negotiate a $100,000 personal injury settlement, but Medicaid paid $20,000 and Medicare paid $15,000. Before attorney fees and costs, you must pay those liens from the gross recovery. In this example:
- Gross settlement: $100,000
- Minus Medicaid lien: $20,000
- Minus Medicare conditional payment: $15,000
- Net before fees: $65,000
Your actual proceeds shrink further when you account for attorney fees and litigation costs. To protect your recovery, work with counsel to:
- Identify and verify each government lien.
- Negotiate lien reductions where permitted.
- Allocate settlement amounts between medical and non-medical damages.
- Include specific language in the settlement agreement addressing lien resolution.
Helpful Hints
- Notify DHHS and Medicare early to obtain lien statements before settlement talks.
- Ask whether Nebraska allows a discount or waiver of part of the Medicaid lien under special hardship rules.
- Consider setting aside funds in escrow to cover any future disputes over Medicare payments.
- Keep detailed records of all medical bills and payments to streamline lien negotiations.
- Consult an attorney experienced in Nebraska subrogation law to protect your net recovery.