Medicaid is a joint federal-state program that provides health care coverage to certain categories of individuals, including children, pregnant women, people with disabilities and elderly adults, based on their financial need.  Each category of applicants has different criteria for eligibility.  To qualify for MA on the basis of disability, there is a cap on both the individual’s income and assets but certain types of resources may be exempt from consideration. (See Special Needs Trusts)

Medicaid Lien
Personal Injury and Medical Malpractice attorneys and injured parties encounter problems when Medicaid has made conditional payments for medical services related to an injury and then assert a lien for recovery from the beneficiary’s judgment or settlement award. The Lien Resolution Group can act on the claimant’s behalf to determine if there are any claims on the proceeds from Medicaid and if so, compromise, settle or execute a release of the Medicaid claim. (see Lien Resolution)

Ahlborn

In Arkansas Department of Health and Human Services v Ahlborn, 126 S.Ct. 1752 (2006), the United States Supreme Court unanimously ruled that

  • A state’s Medicaid Program may recover against proceeds of a personal injury case only as to the part of the proceeds that compensates for the cost of medical care; and
  • When it is established that a settlement represents a particular percentage of the total value of the case, the State may recover only that percentage of the total amount it has paid. (See Arkansas Department of Health and Human Services v Ahlborn)