Disclaimer: This article is for educational purposes only. It does not constitute legal advice. For advice specific to your situation, consult a qualified attorney.
Detailed Answer
1. Medicare Secondary Payer Requirements
Under the Medicare Secondary Payer Act (42 U.S.C. § 1395y(b)), Medicare pays as a secondary insurer when another party is liable for your injury. Medicare may make conditional payments for medical treatment related to your personal injury. When you reach a settlement, Medicare can demand reimbursement for those conditional payments. Federal regulations at 42 C.F.R. § 411.22 explain how to request a Conditional Payment Letter. You must satisfy Medicare’s lien before distributing settlement funds to avoid interest and penalties under 42 U.S.C. § 1395y(b)(2).
2. Medicaid Reimbursement Claims
Federally funded Medicaid programs, including New Hampshire’s Medicaid, have the right to recover benefits paid on your behalf. Under 42 U.S.C. § 1396k(b)(1), the state must seek reimbursement from any third-party recovery. New Hampshire’s Medicaid agency typically sends a Notice of Claim asserting its interest in the medical portion of your settlement. Although New Hampshire law does not provide a dedicated Medicaid lien statute, the federal recovery right applies and the state can file a claim until it is satisfied.
3. Impact on Your Settlement Funds
Your total settlement often allocates money for medical expenses, pain and suffering, and lost wages. Medicare and Medicaid recoveries generally come out of the portion designated for past and future medical costs. If you disregard these obligations, settling without satisfying liens can delay payments, expose you or your attorney to liability, and trigger collection actions by federal or state agencies.
4. Strategies to Manage Reimbursement Obligations
- Request a Conditional Payment Letter from Medicare’s Recovery Contractor early in your case.
- Obtain a Medicaid Notice of Claim from New Hampshire’s Medicaid agency and negotiate the amount if possible.
- Allocate sufficient settlement funds into escrow to cover anticipated liens.
- Consider a Medicare Set-Aside (MSA) if you have significant future medical needs to ensure compliance with Medicare’s secondary payer rules.
Helpful Hints
- Start lien resolution as soon as you file your claim to prevent last-minute surprises.
- Maintain clear records of all medical bills and insurance payments.
- Work with an attorney experienced in Medicare and Medicaid lien resolution.
- Review federal statutes directly: 42 U.S.C. § 1395y(b) (LII link) and 42 U.S.C. § 1396k (LII link).
- Familiarize yourself with New Hampshire insurer subrogation rules under RSA 415:8 (NH RSA 415:8).