Personal Injury Medicaid Cases

Brien Roche

You may have the occasion to represent an injured party who is on Medicaid.  Representing such a client presents a host of problems because some providers won’t accept Medicaid.  Those providers who do accept Medicaid know that they are probably going to be low-balled in terms of payment.  In addition it is unfortunate but the simple fact is that the quality of care to some extent bears a direct relationship to the money paid to the provider.  

If you represent a Medicaid client, there is a checklist of things that you should probably be aware of in terms of not only protecting yourself but eventually also discovering what the Medicaid lien is.  It becomes difficult if not impossible sometimes to settle a case without knowing the precise amount of that lien.

There are several stages in terms of dealing with Medicaid and the client:

Pre-planning

• Ask client if they have Medicaid
• Get a copy of the Medicaid card (or number)
• Instruct (in writing) medical providers to bill Medicaid (provide a copy of the Medicaid card or number)
• Get a copy of the medical provider bills and see if Medicaid paid any
• Get a payment breakdown so you can estimate the amount of the lien.

Personal Injury Medicaid Cases-Getting the Lien

• Send a letter of representation, on letterhead, signed by attorney
• HIPAA authorization authorizing both DMAS and the OAG (Office of Attorney General)
• Recipient’s full name, SSN, date of birth
• Recipient’s Medicaid number (12 digit number)
• A copy of the front and back of the Medicaid card
• The date of accident or injury
• A description of the injuries
• An itemized list of all medical expenses for the recipient, including dates of service and medical provider
• The name of the person in our office they should communicate with, including phone, email, and mailing address
• USE TPL Request Form
• Everything must be sent to tplcasualty@dmas.virginia.gov

What to do when the Lien is Wrong

• Provide the right information with your initial request
• If a charge is wrongly included, you must request it be removed
• Send the request to the analyst who processes the lien explaining why the charges should be removed.
• You must provide an explanation and documentation as appropriate.
• If a charge is missing from the line, include the dates of service and provider name.

Is the Client’s Right to Governmental Benefits in Jeopardy?

Before settling a case involving a Medicaid client, you need to ask whether or not the settlement may deprive the client of future benefits.  This may depend on what type of Social Security benefits they are receiving, if any.  Whether they are on SSI or not, they may still have to report these funds to Medicaid.  Furthermore it may be possible to use a special needs trust in order to preserve the client’s Medicaid or other governmental benefits.  Therefore all of these are things that need to be considered before reaching any such settlement.  

Call, or contact us for a free consult. Also for more info on Personal Injury Medicaid Cases see the Wikipedia pages. Also see the post on this site dealing with Medicare issues.