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

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 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.