How Much Money Will Medicaid Take from My Personal Injury Settlement?

Posted in: Uncategorized by Graham Scofield Injury Lawyers

It may take you several months or even years to receive a personal injury settlement from the at-fault party that injured you. Unfortunately, while your case is pending, you will likely incur thousands of dollars in medical treatment bills.

If you’re a Medicaid beneficiary, Medicaid may cover some of your medical expenses while your personal injury case is pending. However, Medicaid requires injured victims to reimburse them once their personal injury cases are settled.

Medicaid’s reimbursement amount depends on several factors, including the specifics of your case, Georgia’s state laws, and the type of settlement. Despite those complexities, there are ways to determine Medicaid’s applicable reimbursement amount. Once that amount is determined, an experienced Atlanta personal injury attorney can help you negotiate Medicaid’s reimbursement claim so that you can maximize your settlement.

What Is Medicaid and Who Does It Serve?

Medicaid is a joint federal and state program that provides health coverage to millions of low-income Americans, including children, pregnant women, elderly adults, and individuals with disabilities.

Each state manages its Medicaid program within federal guidelines, with the federal government covering at least half of the funding. Because of this joint funding, rules and services can vary slightly between states.

In Georgia, you must meet certain income and residency requirements to qualify for Medicaid.

Georgia Medicaid Eligibility Criteria

1. Residency: Must be a Georgia resident.
2. Citizenship: Must be a U.S. national, citizen, permanent resident, or legal alien.
3. Income Level: Must have low or very low income, typically below specified federal poverty level.
4. Age and Condition Requirements: Must be pregnant, responsible for a child aged 18 or younger, blind, possess a disability or have a family member in the household with a disability, or be 65 years of age or older.

Georgia Medicaid’s Annual Income Thresholds by Household Size

Household Size	Total Annual Income (Before Taxes)
1	$30,768
2	$41,616
3	$52,464
4	$63,300
5	$74,148
6	$84,996
7	$95,844
8	$106,692
9	$117,528
10	$128,376
11	$139,212
12	$150,071

How Do I Apply For Medicaid?

You can apply for Medicaid through Georgia’s Medicaid agency, the Health Insurance Marketplace, or local health departments and community organizations. Required documentation typically includes proof of income, residency, citizenship, and any relevant medical conditions. Once approved, you will receive a Medicaid card and can begin accessing covered health services.

An Atlanta personal injury lawyer can help you apply for Medicaid coverage. That way, you can reduce the likelihood that your application is delayed or denied.

How Is Medicaid Different From Medicare?

Medicaid is need-based and serves low-income individuals of all ages, while Medicare is an age-based program primarily for individuals aged 65 and older, regardless of income, and for some younger people with disabilities.

Why Can Medicaid Take Money from My Injury Settlement?

When you receive medical treatment for injuries caused by an accident and Medicaid covers those medical expenses, Medicaid has the legal right to be reimbursed from any settlement you receive related to those injuries. This process is known as a Medicaid lien.

Key Reasons Medicaid Can Claim Money from Your Settlement:

1. Federal Law Requirement: Federal law mandates that Medicaid must be the payer of last resort. This means that if there is another source of payment available for medical expenses, such as a personal injury settlement, Medicaid must be reimbursed for the expenses it covered. This is established under the Medicaid Third Party Liability (TPL) rules, which require Medicaid to seek reimbursement from liable third parties, including insurance settlements.
2. Preventing Double Recovery: Allowing Medicaid to claim a portion of your settlement prevents you from receiving a double recovery for medical expenses. Without this reimbursement, you would effectively be paid twice for the same medical costs—once by Medicaid and once by the settlement.
3. Ensuring Program Integrity: Reimbursement to Medicaid helps ensure the sustainability of the Medicaid program by recouping funds that can then be used to help other beneficiaries in need of medical assistance.
4. Legal and Contractual Basis: When you apply for and receive Medicaid benefits, you typically agree to Medicaid’s right to recover costs from any future settlements related to injuries they covered. This agreement forms a legal basis for Medicaid to place a lien on your settlement.

How Does Medicaid Recovery Work?

1. Notification: Once you receive a personal injury settlement, you are required to notify Medicaid or your state’s Medicaid agency. This allows Medicaid to assert its lien rights.
2. Lien Amount Determination: Medicaid will determine the amount it spent on your medical care related to the injury and claim that amount from your settlement. The lien is limited to the actual costs incurred for your treatment.
3. Negotiation and Reduction: It is possible to negotiate the lien amount with Medicaid. A personal injury attorney can assist in negotiating a reduction of the lien, ensuring that the charges are reasonable and accurately reflect the care received.
4. Payment: The agreed-upon lien amount is paid to Medicaid out of the settlement proceeds before you receive your portion of the settlement.

Example Scenario:

Medical Expenses Covered by Medicaid: $20,000
Total Personal Injury Settlement: $80,000
Medicaid Lien: $20,000 (the amount Medicaid paid for your medical treatment)

In that scenario, Medicaid would be reimbursed $20,000 from your settlement, and you would receive the remaining $60,000.

Get in Touch With an Experienced Atlanta Personal Injury Attorney

Your recovery depends on the value of your settlement. Healthcare providers have a right to payment from your settlement, but it should not come at your expense. The experienced Atlanta personal injury lawyers at Graham Scofield Injury Lawyers have decades of experience representing injured victims. Contact us for a free case review to protect your interests during settlement negotiations.