If you have a personal injury case and some of your medical bills have been paid by Missouri Medicaid, do not settle your case without reading this article.
While your case is pending, Medicaid may pay some of your medical bills. Like Medicare, Medicaid is a payer of last resort and will only make payments when a case is pending on the condition that Medicaid be repaid when the case is resolved. In Medicaid’s case, any amounts they pay are considered a debt due to the state. This debt may be recoverable from the liable third party or from you, the injured participant, for all payments made on behalf of the participant as a result of the accident. §208.215.1 RSMo. The Department of Social Services, MO HealthNet Division, or its contractor (this includes Healthcare USA) may maintain an appropriate civil action to recover funds paid by the Missouri Department of Social Services or MO HealthNet or its contractor in the name of the State of Missouri against the person liable to the injured party. §208.215.2 RSMo. The statute requires that a participant or his representative, upon actual knowledge that the Department of Social Services has paid Medicaid benefits, shall promptly notify MO HealthNet Division as to the pursuit of such legal rights. §208.215.3 RSMo. In other words, as soon as you find out that any of your bills were paid by Medicaid, you need to notify the Department of Social Services/MO HealthNet Division. The current address to send your initial notice of claim is as follows:
MO HealthNet Division
615 Howerton Court
PO Box 6500
Jefferson City, MO 65102-6500
Typically, after notifying MO HealthNet, they will send a lien to you or your attorney, advising as to the amounts they have paid to date. This lien has the legal affect of any other hospital lien, but takes priority over all liens other than the attorney’s lien. §208.215.12 RSMo.
The good news about Medicaid is that the statute does give the Department of Social Services the right to negotiate liens. There is also a procedure contained in the statute that will allow you to bring a court action asking a judge to reduce the lien. This procedure is set forth in §208.215.9 RSMo. In essence, a petition should be filed in Circuit Court, and notice should be given to all interested parties. If you need to seek a significant reduction of your Medicaid lien, you are best to hire an attorney who knows how to handle these court reduction hearings.