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SCOTUS Limits Medicaid Lien Recoveries

On March 20, 2013 the Supreme Court released its decision in Wos v. EMA, a federal case determining the legality of North Carolina’s Medicaid recovery statute.  The Court held that the anti-lien provision of the federal Medicaid Act prevents a state from taking any portion of a judgment or settlement not designated as medical care.

More simply, Medicaid can only recover for the portion of the settlement that represents medical bills.

North Carolina’s statute stated that it could recover for Medicaid payments up to one-third the total amount of settlement.  The Court ruled that this statute is preempted by the federal anti-lien provision because it permits the state to “take a portion of a Medicaid beneficiary’s tort judgment or settlement not designated for medical care.  The Court continued by noting North Carolina’s statute failed to provide a scheme for determining if the one-third is a reasonable limit.

This decision has both positive and negative effects for Medicaid lien resolution.  The positive is that it provides more mechanisms for reducing Medicaid liens.  Unfortunately, those mechanisms may be more costly than simply applying a formula such as North Carolina’s now illegal one-third maximum.  The negatives continue where, in some cases, it might be possible for Medicaid to now take more than one-third of the settlement.

In order to take full advantage of Wos v. EMA you should consult a Medicaid lien specialist and work with Medicaid representatives throughout the settlement process.  Always be sure to “show your work” in calculating settlements.

The negatives of this decision will only apply where you fail to account for Medicaid’s reimbursement in your settlement preparations.

If you need help with any type of lien resolution we can assist you with Medicare lien resolution, Medicaid lien resolution, ERISA liens, private insurance liens, and more.  We’ll take care of getting you the “lien” and reducing it too.

Ryan J. Weiner
Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

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