Navigating Medicaid Liens in West Virginia Personal Injury Settlements
Disclaimer: This article is for educational purposes only and does not constitute legal advice.
Detailed Answer
When Medicaid pays for medical treatment after an injury, the West Virginia Department of Health and Human Resources (DHHR) can assert a lien—or subrogation—against any recovery in a personal injury case. Under West Virginia Code §9-4-10 (Subrogation by DHHR), the state recoups the amount it paid for covered services from your settlement or judgment. Here’s how to navigate the process:
1. Identify Medicaid Payments
Collect all Medicaid Explanation of Benefits (EOBs) and payment records. Confirm the total amount DHHR paid for medical care related to your injury.
2. Provide Timely Notice
Within 120 days of receiving your settlement or court award, you must notify DHHR of your intent to settle. Send a certified letter to:
West Virginia Department of Health
Office of Inspector General – Subrogation Unit
350 Capitol Street, Room 251
Charleston, WV 25301
3. Request a Demand Statement
Ask DHHR to issue a formal demand letter stating the exact lien amount. This document lists the services paid, dates of service, and total reimbursement due under W. Va. Code §9-4-10.
4. Allocate Your Settlement
Work with your attorney to allocate settlement funds among medical expenses, pain and suffering, lost wages, and attorney fees. Only the medical portion is subject to the Medicaid lien. Courts often allow you to deduct attorney fees and litigation costs proportionally before DHHR enforces its lien.
5. Negotiate or Challenge the Lien
If you believe DHHR’s demand overstates the lien, you can:
- Provide evidence of billing errors or unrelated services.
- Ask for a reduction based on equitable allocation principles.
- File a motion in circuit court for a ruling on an appropriate lien amount.
6. Close the Claim
Once you and DHHR agree on the figure, arrange payment directly to DHHR before distributing net proceeds. If you miss the deadline, DHHR can file a separate action to enforce its lien.
Helpful Hints
- Keep meticulous records of all medical bills and Medicaid payments.
- Begin lien discussions early to avoid settlement delays.
- Use a written allocation agreement approved by the court.
- Speak with an attorney experienced in West Virginia Medicaid subrogation rules.
- Confirm that payments to DHHR occur before releasing remaining funds.