Attorney at Law

If you are a Medicaid beneficiary and make a personal injury claim that leads to you receiving a settlement, these two things will affect each other. In this article, we’ll define Medicaid and explain how it affects personal injury cases.

Key Takeaways

  • Medicaid is a public health insurance program in the United States made to help low-income families and individuals whose income is insufficient to cover healthcare
  • Medicaid is jointly funded by states and the federal government but is managed and administered on the state level
  • If a Medicaid beneficiary receives a personal injury settlement, they will be required to reimburse Medicaid for damages paid by the negligent third party
  • This is due to the Medicaid lien statute
  • Medicaid covers a broad range of services including inpatient and outpatient hospital services, laboratory services, home health services, and more
  • Unlike Medicare, Medicaid covers long-term stays in a nursing home
  • All nursing home residents should be aware of the risk of nursing home abuse

What Is Medicaid?

Medicaid is the name of a public health insurance program in the United States. It provides health care coverage to over 70 million low-income individuals and families that are U.S. citizens, permanent residents, or legal immigrants. It is funded by both the federal government and individual states, although it is operated at the state level, with variation in coverage and administration from state to state. Individuals and families must meet income-based criteria in order to qualify. 

Medicaid is designed for people of any age whose resources and income are insufficient to cover healthcare. Instead of providing health care directly, it covers health-related costs such as doctor visits and hospital stays.

It is up to individual states to manage and administer their own Medicaid program, including determining who qualifies for coverage, types of coverage, and the process for how health care workers and hospitals are paid. The federal government’s role is to match state spending at a rate of between 50% to 83%. While states are not required to participate in Medicaid, all of them do. 

Medicaid Coverage of Nursing Homes

Unlike Medicare and commercial health insurance, Medicaid does cover long-term stays in nursing homes and other home- and community-based long-term services and supports. If the insured individual meets eligibility requirements, Medicaid will pay 100% of nursing home costs. The monthly income limit in most states is $2,382 for individuals or $4,764 for spouses. 

The patient’s countable resources must total less than $2,500. Resources that count toward the limit include:

  • Veteran benefits
  • Property‌
  • Stocks and bonds
  • Wages
  • Life insurance
  • Bank accounts
  • Pensions
  • Social security benefits
  • Trusts and annuities

Medicaid coverage of nursing homes is available only for nursing homes licenses and certified by the state survey agency as a Medicaid Nursing Facility. 

Medicaid and Nursing Home Abuse

All residents of nursing homes and their loved ones should be aware of the risk of nursing home abuse, which is defined as any intentional or unintentional harm to a nursing home patient by a staff member. This is unfortunately all too common, making it crucial to be on the lookout for the warning signs of nursing home abuse.

Medicaid and Personal Injury Law

If you receive Medicaid coverage and also plan to make a personal injury insurance claim, the two might affect one another. For example, let’s say you are injured and get the cost of your medical care paid for by Medicaid. Additionally, you also make a successful personal injury claim and receive a settlement for damages. In this situation, you will be required to repay Medicaid for any payments that they made for your injury.

This is all related to Medicaid lien, which is a right that requires anybody involved in the settlement of a personal injury claim to reimburse the Medicaid program for benefits it has paid to a Medicaid beneficiary. It does not matter what the settlement money was paid out for, whether it be medical bills or pain and suffering. Either way, you must reimburse Medicaid for any payout you received from a negligent third party. 

Your personal injury attorney will be able to help you make sure that you only reimburse Medicaid for payouts relevant to your personal injury case. To do this, they will obtain documentation of your Medicaid benefits and review your payments. This is why, if you are a Medicaid beneficiary, it is important to choose a personal injury attorney experienced working with individuals with Medicaid coverage.

Medicaid and Social Security Disability

Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families. It is a means-tested program, which means that eligibility is based on income and assets. Medicaid is administered by the states, but the federal government sets standards for the program and provides financial assistance to states to help them cover the costs of providing Medicaid benefits to eligible individuals.

Social Security is a federal program that provides financial assistance to eligible individuals who are retired, disabled, or the surviving family members of a deceased worker. Social Security is funded through payroll taxes and is not means-tested, which means that eligibility is not based on income or assets.

There is a relationship between Medicaid and Social Security benefits in that some individuals who receive Social Security benefits may also be eligible for Medicaid. For example, individuals who receive Social Security Disability Insurance (SSDI) may also be eligible for Medicaid, as may individuals who are aged 65 or older and receiving Social Security retirement benefits. However, not all individuals who receive Social Security benefits are automatically eligible for Medicaid, and vice versa. Eligibility for Medicaid is based on financial need, while eligibility for Social Security is based on an individual's work history and contributions to the Social Security system.



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