Medicaid and Personal Injury Settlements Ohio

Medicaid and Personal Injury Settlements Ohio

Will Ohio Medicaid Coverage Affect My Personal Injury Billing?

Yes, Medicaid has an impact on personal injury management.

No, this should not prevent anyone with Medicaid coverage in Ohio from holding accountable the person or company who caused their injuries through insurance claims or legal action.

Medicaid has coverage now and will seek reimbursement later

First, make sure Ohio Medicaid covers emergency and follow-up care for injuries in a car accident, truck accident, slip and fall, dog attack, or any other accident that would give you grounds for filing a personal injury claim. You don’t have to worry about paying any medical costs imposed on you through someone else’s negligence or reckless behavior.

It is also true that Medicaid requires a refund for any settlement or jury award you receive. However, the program will only draw an amount equal to what it has spent on your care. In most cases, you will keep some or all of the compensation you receive for lost wages, lost income, pain and suffering, and punitive damages, if any.

What the law says

Section 5160.37 (A) of the Revised Ohio Code specifies this

Inclusion of a recipient of medical assistance in a medical assistance program grants the county medical care department and a department of professional and family services an automatic right to reclaim against the liability of a third party for the cost of medical assistance paid on behalf of the recipient. If a lawsuit or lawsuit is brought against a third party by a medical aid recipient, any payment, settlement, or compromise of the lawsuit or lawsuit, or court judgment or judgment is subject to the Medicaid or county division’s right of recovery. Except in the case of a medical aid recipient receiving medical assistance through a medicaid-managed care organization, the department or district department’s entitlement shall not exceed the amount of medical assistance paid by the department or district department on behalf of the recipient. A payment, settlement, compromise, judgment, or arbitration award that precludes medical assistance costs paid by the department or county department does not preclude a department from enforcing its rights under this section.

What the law means

The “third party” referred to in state law is the insurance company for the person or company that caused your personal injury. The amount and percentage of your Comparative or Jury Award that Ohio Medicaid receives will depend on several factors, including

  • How much Medicaid paid for injury-related health services
  • Whether you are on a Medicaid Managed Care plan and
  • Regardless of whether your statement or award includes funds specifically for medical expenses.

While no result can be guaranteed, a personal injury attorney representing a Medicaid insured customer will struggle to have a settlement or jury award reflect all previous and planned Medicaid expenses. In either case, the attorney will work with the insurance company and the Ohio Department of Medicaid to arrange the reimbursement and keep the client from negotiating and doing paperwork.

Corey Heit of Westerville-based Heit Law helps victims of all types of personal injury in and around Columbus, Ohio. He offers free advice to potential customers and can make appointments online or by calling (614) 898-5300.

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