Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney about your specific situation.
Detailed Answer
In Tennessee, TennCare (the state Medicaid program) has a right to recover medical expenses from third-party payments, such as a personal injury settlement. Under Tennessee law (Tenn. Code Ann. §71-5-117), the state may file a lien against any judgment or settlement to recoup costs it paid on your behalf. You must address this lien before you receive your settlement funds.
1. Statutory Basis for TennCare Liens
Tenn. Code Ann. §71-5-117 authorizes TennCare to seek reimbursement. You can review TennCare’s recovery policy on the official website: TennCare Laws, Rules & Policies. This statute requires the state to file a notice of claim in the court handling your case.
2. Identifying the Lien Amount
The lien equals the total medical expenses TennCare paid related to your injury. Your attorney should request an itemized breakdown from TennCare. Verify each charge, as some services may not be lienable (for example, costs unrelated to the incident).
3. Negotiating Lien Reductions
Your attorney can negotiate with TennCare to reduce the lien. Courts often allow a percentage reduction to account for attorney’s fees and case risk. While Tennessee law does not guarantee a specific discount, many claimants obtain a reduction of 20–40% of the billed amount.
4. Court Approval and Lien Release
After negotiation, submit a joint stipulation or motion to the court that: (1) lists the settlement total; (2) identifies all payees, including TennCare; and (3) specifies the reduced lien amount. The court must approve the allocation before funds disburse. Once approved, TennCare will issue a lien release.
5. Disbursement of Settlement Funds
Once the court signs off and you obtain the release, the settlement administrator or defendant’s insurer can disburse funds. They must pay TennCare directly before distributing the remainder to you and your attorney. This procedure protects all parties and ensures compliance.
Helpful Hints
- Start lien negotiations early to avoid settlement delays.
- Obtain an itemized billing statement from TennCare for accuracy.
- Keep detailed records of all communications with TennCare.
- Work with an attorney experienced in Tennessee Medicaid recoveries.
- Verify the court’s procedural requirements for lien approval in your county.