When calculating the value of a personal injury case, there are several factors to consider: pain and suffering, lost wages, and medical expenses. Medical expenses are reimbursable if paid out of pocket, or if the collateral source/insurance company is seeking reimbursement for the benefits it has paid. In New York, in personal injury lawsuits, certain types of health insurers are entitled to subrogation or repayment of the benefits paid out of any personal injury award. One such insurer is Medicaid.
If Medicaid pays for any care related to a claim, the State may seek reimbursement.
The Medicaid program is a need-based program, jointly administered by the Federal and State governments. If Medicaid pays for any medical care related to a personal injury claim or lawsuit, the State may seek reimbursement at the time of settlement. This is also known as a lien. Generally, Medicaid may also be entitled to seek reimbursement for benefits paid that are unrelated to the injuries sustained in the accident.
Recently, the United States Supreme Court addressed the question of whether a State Medicaid plan can seek reimbursement for future medical expenses – i.e. medical expenses that they may potentially pay on the recipient’s behalf in the future. The decision came down in the case of Gallardo v. Marstiller, a case out of Florida. In Gallardo, the U.S. Supreme Court held that a State Medicaid plan can seek reimbursement from a Medicaid recipient’s personal injury settlement for ALL medical expenses regardless of whether these medical expenses were already paid by Medicaid in the past or are potential expenses for medical care that Medicaid may pay at some point in the future.
Gallardo involved a 13-year-old girl who was hit by a truck in 2008 and sustained catastrophic injuries that left her in a persistent vegetative state. Her parents sued on her behalf and the case was eventually settled for $800,000, with a little over $35,000 specifically designated as compensation for past medical expenses. However, no portion of the settlement was specifically allocated to her future medical care.
Florida’s Medicaid agency paid over $860,000 to cover the initial medical expenses and continued to pay her medical expenses to date since she is permanently disabled. Under federal law, the states may seek reimbursement for Medicaid payments from that portion of a settlement that is designated for medical care and based upon the formula set up by Florida’s Medicaid statute,
What Happens If I Have Medicaid Liens on Personal Injury Settlement
Under the law, the decision on what is reimbursable out of a personal injury award for Medicaid is up to each individual state. In New York, as it currently stands, Medicaid has a right to seek reimbursement from a beneficiary’s settlement only for medical care expenses it has already paid. However, it is important to timely and properly address a possible Medicaid lien in the process of settling a case to ensure that your rights are fully protected. Grandelli & Eskenasi has represented countless Medicaid recipients in personal injury action and can help you navigate the entire process. If you or someone you know has been seriously injured in an accident due to someone else’s negligence, contact the Grandelli Firm for a free consultation.
