Can I challenge or appeal Medicaid's lien? Does Medicaid have to pay any of the attorney fees and costs of my settlement?



Let’s address how to appeal a Medicaid lien first. In individual cases, it may be necessary to involve the court if you and your attorney are unable to agree with Medicaid on its lien amount, at the time of settlement. Recent U.S. Supreme Court decisions make it clear that states do not have a priority right to your entire settlement – states only can be reimbursed from the portion of your settlement for your medical expenses (as opposed to payment for your lost wages, pain and suffering, and your other non-medical losses). Often, it is necessary to involve the court to determine what part of a settlement actually represented payment for your medical losses. Some states will lower their lien amount due to the claimant’s hardship or other reasons, without requiring court involvement.

In terms of paying attorney fees’ and the costs associated with your settlement, in some states, the Medicaid lien amount is reduced by the same percentage that your settlement proceeds were reduced for your attorney fees and case expenses. In other states, no offset is allowed at all, and in certain states the laws governing Medicaid call for the lien amount to be reduced by a pre-set percentage.

If you have a mass tort claim, one benefit of the Garretson Resolution Group's Medicaid process is that most states agree to cap the amount of money you have to reimburse the state Medicaid agency. The Garretson team works with the state Medicaid agencies to reduce lien amounts, and obtain limits on the amount of money the state recovers. Additionally, the Garretson team will review all your medical claims to make sure that your state Medicaid agency only receives payment for treatment specifically related to your injury.

Sometimes state Medicaid agencies include medical costs that are NOT part of the treatment for the injury at issue in a settlement. These are known as “unrelated charges.” The Garretson Resolution Group will review and analyze all claimed medical expenses to ensure that unrelated charges are removed from the state Medicaid agency’s lien. For example, if a lien for $10,000 contains $2,000 in unrelated charges, the auditing process will identify those costs and reduce the lien amount to $8,000. The $8,000 figure is known as the injury-related lien amount. Our staff will make sure that your state Medicaid agency does not claim any more money in a lien than it spent to treat your injury.

The "holdback amount" is a limit on the final lien that your state agreed to. If your final lien obligation is less than the holdback amount, you will ultimately receive that money back, for the difference between your final lien obligation and the holdback amount.