Some employees, especially those with children, are Medicaid eligible. Medicaid is a government health insurance program for families and persons with limited assets, resources, and income.

Medicaid is funded by both state and federal governments, with state governments in charge of administering the program. This leads to varying eligibility requirements between the states.

If you’re injured in a work accident, your employer’s workers compensation insurance company may deny the claim and refuse to offer a panel of physicians from which to treat. If this happens, you should seek treatment using either your private health insurance or Medicaid coverage. You must seek medical treatment to have a chance of winning your Virginia workers compensation claim.

Using private health insurance or Medicaid to get medical treatment, however, adds to the list of things you must consider when pursuing your claim. Medicaid will want you to protect its interests if it pays for medical care related to your work injury.

Does Medicaid Have a Lien against My Virginia Workers Compensation Case?

If Medicaid is paying for medical treatment related to your work accident, then Medicaid may assert a lien against any money you receive from the insurance company in a workers compensation settlement. By asserting a lien, Medicaid is asking you to reimburse it for payments made to your medical providers for treatment related to your work injury.

If the insurance company accepted your workers’ comp claim or the Commission found in your favor after a workers compensation hearing, you should tell your doctor that you have an Award Order. All treatment related to your work injury should be billed to the workers comp insurance company.

If your claim is denied and you are waiting for a hearing, you must decide how to treat Medicaid’s potential lien. Virginia workers compensation lawyers often debate whether Medicaid has a lien against settlements in disputed cases. Disputed cases are those where the Commission has not entered an Award Order. This is a complicated issue and not one that you should try to answer on your own.

I recommend that my clients exercise caution and take Medicaid’s lien into consideration when trying to settle a case. You are better off negotiating with Medicaid before you settle your claim or setting part of your settlement proceeds to the side, than trying to deal with Medicaid after your case settles. You do not want the federal or state government threatening you with legal action related to liens.

An experienced workers comp attorney can also help you draft the settlement documents so that you reduce the risk that Medicaid seeks to assert its lien or recover money from you in a disputed claim. Though there is no guarantee that you can protect your settlement from Medicaid, carefully worded settlement documents will increase the likelihood that you get to keep more of your settlement money.

Other Considerations if You Have Medicaid and Are Injured at Work

Accepting a workers compensation settlement can impact your Medicaid eligibility. All states have eligibility requirements that limit the amount of income and resources you can have while receiving Medicaid. If your settlement is above that amount, you may lose Medicaid coverage until you spend down the money below the eligibility level. An experienced attorney can help you figure this out.

Have a question that you want answered? Then read our article on frequently asked workers compensation questions in Virginia. Still don’t see what you’re looking for? Call or e-mail us for a free consultation.