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Today I will discuss Medicaid and what it means for your personal injury claim

A lot of people have at least part of their healthcare paid for by Medicaid. In New York, that can include straight Medicaid or Fidelis Healthcare. In Vermont, that could be Medicaid for adults, or Dr. Dynasaur for kids. 

In many ways Medicaid and Medicare are both very similar, in that both will pay for your healthcare, even if you’ve been involved in a car crash. 

And both have a right to be paid back, at least in part, if you get a settlement or verdict from a car accident case

But there are some important differences between the two. 

Differences between Medicare and Medicaid

Medicare is the same in every state because it’s run by the federal government. Medicaid on the other hand, is a state by state program and the rules are a little bit different in every state. 

Whether you have Medicaid, Medicare, or any other kind of healthcare, the most important thing you can do for yourself and your injury claim is to get the healthcare you need, follow your provider’s recommendations and take care of yourself. 

Supplementing Medicaid with New York No-Fault Insurance

If you live in New York State, or you were injured in a car crash in New York State, you’ll have access to no-fault benefits. And that means no-fault will pay the first $50,000 of what’s called basic economic loss which is some combination of medical care and lost wages. 

One thing you can do to protect yourself is to make sure that your medical providers bill your no-fault insurance and not Medicaid for any accident related healthcare. 

That’s because you don’t have to pay back your no-fault benefits most of the time, and you do have to pay back Medicaid, and that can make a real difference to your bottom line when you settle your injury claim. 

Using Medicaid After An Accident In Vermont

If you live in Vermont or were injured in Vermont, like many other states, you’re going to have to figure out how to pay for your accident related healthcare on your own. And if you have Medicaid, it’s going to be Medicaid that pays those bills. 

So if you do use Medicaid to pay for accident related healthcare, make sure that you or your lawyer tells the Medicaid office right away about any injury claim that you might have. 

Notifying Medicaid Of Your Accident

There are systems set up in New York and Vermont that allow you to notify the Medicaid office easily. And they’ll keep a running record of how much you owe them at the end of your case. 

In Vermont, that’s done through the Vermont Office of Health Access. 

In New York, there’s the Medicaid Division of Lien Recovery Services, which handles these claims. 

When the case is over, you or your lawyer will let Medicaid know that you’ve settled the case, and you’ll give them some information about the amount of your settlement, the kind of injuries you had, and how much insurance money was available. 

How Medicaid Calculates Repayment After An Accident

Under the rules that are currently in place, Medicaid has to take into account your legal fees and costs when figuring out how much of your settlement can be used to pay back Medicaid. They must also take into account how much of your settlement was for medical expenses, versus how much was for pain and suffering. 

Medicaid can only recover from that part of your settlement that’s for medical expenses and not pain and suffering. There’s some talk of that rule changing, but for now, that’s the law. 

Summary: Medicaid’s Impact On Your Accident Claim

Your takeaways from today’s article are these: 

  1. If you have Medicaid you can still bring a personal injury claim, but you have to follow the rules. 
  2. If you do use Medicaid for accident related healthcare, make sure the office of Medicaid knows about it, but if you have no-fault, make sure you use that instead. 
  3. Remember that Medicaid has to take into account your legal fees and costs, and they can only recover from that part of your settlement that’s for medical expenses and not pain and suffering. 

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