Why does Medicaid have a lien on my personal injury case?

 In Law Planet

health puzzleWhen Medicaid recipients are injured in an accident, their medical bills will oftentimes be paid through Medicaid. When that happens, Medicaid has a lien on their personal injury case. Florida statute 409.910 is the process by which Medicaid gets reimbursed.

Florida’s Agency for Healthcare Administration (AHCA) is the entity charged with protecting these liens and arguing on behalf of Medicaid. The specific amount of reimbursement is determined by utilizing a formula. This statutory formula caps recovery at half of the total amount of the settlement after deducting attorneys fees and costs. When the underlying personal injury case is settled and provisions are made in the settlement agreement for a portion of the settlement funds to pay medical expenses, this formula can be modified by the trial judge.

Additionally, the amount of reimbursement can be affected by the amount of available insurance coverage versus the total value of the claim. As an example, if the available insurance coverage only covers 10 percent of the value of a personal injury claim, then it can be said that the Medicaid reimbursement amount must also address this disparity between value and coverage.

In the recent Florida 5th decision of Davis vs. Roberts, MacFarlane, et al., all of these factors were used in reducing the Medicaid lien. The allocation in the settlement agreement addressing the case value versus the available insurance coverage issue was of the utmost importance. The preferred process to be used involved allocating this percentage within the settlement agreement and then also having expert witness testimony from seasoned personal injury trial lawyers as to the value of the case versus available insurance coverage. Without such an allocation in the settlement agreement, the injured party and ACHA still have an opportunity to argue and present testimony through expert witnesses as to the value of the case and how much should be reimbursed. These percentages can be very important as many times the amount of available insurance coverage is nowhere near the total value of the damages.

Having an experienced personal injury lawyer who understands these detailed Florida laws is extremely important in cases involving Medicaid recipients. If you have further questions about why your Medicaid may be affected, don’t hesitate to contact me directly. 

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