Disclaimer: This article is for educational purposes only and does not constitute legal advice.

Detailed Answer

Overview of Medicaid and Medicare Subrogation Rights

When you receive medical coverage through Medicaid or Medicare and later recover money in a personal injury claim, those programs may seek repayment of benefits they paid on your behalf. This process is called subrogation or a lien. It ensures that public funds are reimbursed when a third party is responsible for your injuries.

North Dakota Medicaid Lien Law

Under North Dakota law, the state’s Medicaid agency has a right to recover benefits from any settlement, judgment, or award you receive for a personal injury. Specifically, NDCC § 50-24.1-26.1 allows Medicaid to place a lien on your recovery up to the amount it paid for your medical care.

Federal Medicare Secondary Payer Rules

Medicare is a federal program. Under the Medicare Secondary Payer Act (42 U.S.C. § 1395y), Medicare can seek reimbursement when another party pays for the same services. Unlike Medicaid, Medicare does not file a state-level lien, but it issues a conditional payment letter that lists all services it covered. You must satisfy those amounts from your settlement.

Impact on Your Settlement Offer

1. Reduces Net Recovery: Any liens for past medical expenses paid by Medicaid or Medicare must be paid out of your gross settlement. This reduces the net amount you keep.

2. Allocation Matters: Settlements typically allocate funds among categories such as past medical expenses, future medical care, lost wages, and pain and suffering. Liens attach only to the medical portion, so careful drafting can protect non-medical damages.

3. Timing and Negotiation: Medicaid and Medicare both allow you to request a repayment demand or conditional payment letter. You can challenge incorrect amounts and negotiate reductions before paying their claim.

Steps to Handle Medicaid and Medicare Liens

1. Identify all programs that paid your medical bills.
2. Request a Medicaid repayment statement from the North Dakota Medicaid office.
3. Obtain a Medicare conditional payment letter via the Medicare Secondary Payer Recovery Portal.
4. Review and dispute any inaccurate charges.
5. Set aside funds in escrow to protect against unexpected lien amounts.
6. Secure a lien release or closure letter after repayment.

Key Statutes and Regulations

• NDCC § 50-24.1-26.1 (Medicaid lien and subrogation): legis.nd.gov
• 42 U.S.C. § 1395y (Medicare Secondary Payer Act): govinfo.gov

Helpful Hints

• Work with counsel experienced in Medicaid/Medicare lien resolution.
• Keep detailed records of all medical bills and payments.
• Request lien statements early to avoid settlement delays.
• Consider using escrow to protect your recovery from unexpected liens.
• Negotiate with Medicaid or Medicare before finalizing your settlement.