Disclaimer: This article is for informational purposes and does not constitute legal advice.
Detailed Answer
In Utah, when Medicaid covers your medical costs after an injury and you pursue a personal injury settlement, the Utah Department of Health and Human Services (UDHHS) has a right to recover those expenses. The agency’s subrogation and reimbursement authority arises under Utah Code § 26-18-5 and Utah Code § 26-18-6. Understanding these steps will help you protect your recovery.
1. Notice and Subrogation Process
You must notify UDHHS in writing of any third-party claim or lawsuit within 60 days of filing. Provide a copy of the complaint and settlement documents. If you settle or release your claim without timely notice or obtainment of a lien waiver, UDHHS may file a lien for the full amount of benefits paid on your behalf.
2. Calculating the Lien Amount
UDHHS will calculate its lien based on actual Medicaid payments for your injury-related treatment. The agency can also include anticipated future costs if your settlement covers ongoing care.
3. Negotiating or Reducing the Lien
If paying the full lien would undermine your fair compensation, you can negotiate a reduction. UDHHS considers factors such as attorney fees, case strength, and non-medical damages like pain and suffering. A clear settlement agreement should allocate funds: net client recovery, attorney fees, lien payment, and other costs.
4. Paying and Enforcing the Lien
After settlement, UDHHS issues a demand for payment. Your attorney should hold settlement funds in escrow until the lien is resolved. If you disagree with the lien amount, request an administrative hearing under Utah Admin. Code R430-120 to dispute the calculation.
Helpful Hints
- Notify UDHHS of any third-party claim within 60 days to preserve your rights.
- Keep organized records of all Medicaid-covered medical bills.
- Work with a personal injury attorney experienced in Medicaid liens.
- Negotiate lien reductions based on attorney fees and non-medical damages.
- Use an escrow account for settlement funds to ensure lien satisfaction.
- Document all communications with UDHHS in writing.
- Consider an administrative hearing to contest excessive lien amounts.