Several years ago, GRG noted the settlement community's need for dedicated specialists to address the reimbursement interest of state health care plans in settlements.
A U.S. Supreme Court ruling (Arkansas Department of Health & Human Services v. Ahlborn) drastically changed the rules and regulations with respect to resolving Medicaid liens. With this holding, a state’s Medicaid department is limited to reimbursement from only that portion of a judgment or settlement that represents payment for medical expenses. States are prohibited from seeking reimbursement for Medicaid costs from settlement proceeds that were intended to cover items other than medical expenses, such as pain and suffering and wage loss.
While straightforward at first blush, this rule means that the settling parties must analyze the nature of the settlement payments to determine what portions are for medical losses and what portions are for non-medical losses. Such allocation has rarely, if ever, been done in settlements, as settlements are generally offered sum for release of all damages/claims by an injured person.
Medicaid lien resolution involves many challenges, including the determination of the settling parties' obligation to notify the agency and the evaluation of the agency's right of recovery. The exposure for the settling parties varies by state.
How does GRG help?
Full Resolution Process: Medicaid Reimbursement Claims
- Evaluate case and establish dialogue with the respective tort recovery department and submit formal lien inquiry
- Audit and analyze all reimbursement claims to determine accuracy and “carve out” items unrelated to injury/settlement
- Review and settle all relevant claims to minimize the lien obligation (date of injury - date of settlement)
- Secure final payment demand from Medicaid agency and provide reimbursement instructions to your firm
- Provide regular status updates on your case
- Includes all waivers and compromises (if applicable) to ensure appropriate recovery for the claimant
How is GRG uniquely qualified to handle Medicaid lien resolution?
As the first firm to specialize in this area, we've set the standard. GRG has settled thousands of liens in every state and U.S. territory. By working with numerous mass tort and personal injury firms that in aggregate provide a consistent pipeline of cases, GRG is able to navigate the challenges associated with Medicaid lien resolution by leveraging significant efficiencies.
Firms that engage GRG’s vast resources:
- Expedite the process
- Achieve more favorable results
- Significantly lower internal costs, lost opportunities, and financial risks associated with complex obligations
- Eliminate post-settlement liability related to Medicaid
- Protect claimants’ Medicaid eligibility
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