Future Medical Treatment and Liens for Personal Injuries Under Medicare v. Medicaid

In personal injury claims, medical liens are almost always an issue. Often times, Medicare and Medicaid liens are involved.

Medical liens must always be addressed properly. In the case of Medicare and Medicaid liens, there can be significant penalties for failure to address them.

If you have suffered personal injuries through the negligence of another in New Mexico, the Albuquerque Attorneys at Collins & Collins, P.C., can help you with your claims while also addressing the many medical lien issues that arise in these cases.

In the meantime, you should understand the difference between the set-aside requirements for Medicare and Medicaid. The set-asides are somewhat different between the two because one is income related while the other is age related.

Medicare is Age Related

The set-asides for Medicare relate only to injuries that arose from personal injury claims treated through Medicare. This is frequently an issue with Medicare claiming an overstated lien which includes treatment, including future treatment, for injuries or illnesses unrelated to the personal injury claims.

Medicare can and does claim a lien for Medicare paid medical bills that are related to the personal injury claims. This again includes future medical treatment for those injuries. Medicare‘s payment of future bills related to the personal injury serves as the basis for the Medicare set-aside. The set-aside may be a portion or even all of the personal injury proceeds to cover future Medicare payments for medical treatment for the subject injuries.

Medicaid is Income Related

Medicaid on the other hand is income-related. Medicaid is means-tested. This means that you may qualify for Medicaid only if your income falls below a certain level. A personal injury settlement or verdict will likely put you above those income levels.

Like Medicare, Medicaid will claim a lien against the proceeds of a personal injury claim to cover Medicaid provided medical treatment. Medicaid will also take a stake in the future medical care along with the settlement proceeds. However, the Medicaid issues are significantly different than Medicare as is approach for addressing them.

In addition, the personal injury claim proceeds may make you ineligible for future Medicaid benefits. In cases involving very serious and permanent injuries, treatment may be required for an indefinite period of time sometimes for the remainder of the injured person‘s life. In these cases, it is important to make sure that the personal injury proceeds do not make the person ineligible for necessary medical treatment.

A special needs trust is often created in these cases to avoid disqualification for Medicaid benefits. Technically, this is not a set-aside as with Medicare. Instead, it is a trust that pays for expenses that the injured person incurs that are NOT subject to public assistance.

An example would be expenses to make a home handicapped accessible or to purchase a vehicle that is equipped to transport the injured person. Very small amounts of money may be received as long as the total received is below the monthly Medicaid income guidelines to avoid ineligibility for benefits.

Medicare and Medicaid Liens are Complex – You Need an Attorney!

Medicare and Medicaid liens are very serious with significant consequences for failure to properly address them. It is extremely important to seek the guidance of a personal injury attorney experienced in addressing medical liens, including Medicare and Medicaid, from day one of your injuries.

There are many steps that must be taken prior to settlement of your claims. Failure to address these in a timely manner can be financially disastrous. Addressing them early and properly can lead to many opportunities to minimize these liens as well as any future obligations or financial consequences from them.


Related Reading:
Medical Liens Can be Half the Battle in a New Mexico Personal Injury Case
Eleventh Circuit Addresses Medicare‘s Responsbilities in Lien Negotiation
Calculating the Medicare Set-Aside: Start Early!

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