Follow
Share

I got hurt at work and workers comp paid for all my bills from injury. then I got cancer and had to go on Medicaid and disability, I'm going to receive PPI money from workers comp. Do I have to pay my PPI money to Medicaid?

This question has been closed for answers. Ask a New Question.
Find Care & Housing
Vicki - I'm not sure if this would apply to you as I don't know how PPI is viewed BUT there is a thing called SECONDARY PAYER ACT that might matter. It is in law for MediCARE but I bet some states may also do this for MedicAID.

The Medicare Secondary Payer Act (MSP), is about Medicare being reimbursed for any payments they made for medical expenses for a Medicare covered individual in which another individual, business or other entity was later found responsible for and made a financial settlement to the Medicare covered individual. The regs on this came out in 2012. It's going to be a nightmare for self-insured's to comply with.

How Secondary works is like this…say there is an accident which pays you later on for damages & expenses. What the medical charges total, what Medicare paid for and what the settlement paid is critical to determine how much everyone gets. If it was a lawsuit, you need to see the attorney who handled the claim or lawsuit. It may be that the attorney will need to set up a trust account (kinda like how earnest $ is held when you buy a house) that the $ in the settlement goes to; and from the account the $ due to Medicare comes from and is not released to you
until Medicare sends her attorney a letter that the reimbursement is settled in full and then the balance released to her. If an attorney wasn’t involved (like if was a product liability claim and you just filled out a form), then you would need to contact MSP compliance dept of the insurance company. This is for Medicare as Medicare is totally federal so the rules are uniform for the US.

But you are on Medicaid and so how the state runs their Medicaid program is going to matter. It may be that the $ you get is going to kick you off Medicaid as your asset limit will be exceeded by the new $ you get in the settlement. But the state may just want part of the funds paid to zero out what Medicaid paid for you.

If you haven't gotten the $$ yet, or deposited the check, i would suggest that you contact an attorney to see if that instead of you getting the $ (which is going to be income and reported to IRS) that you instead use the $ to set up a special needs trust of all the $ for you. Special needs trusts if done right are totally outside of Medicaid assets & income limits as the trust "owns" the $ not you. Then you can draw from the trust for your life time or till the trust de-funds (runs out of $) for those extra things you need that Medicaid does not pay for or pays for minimal equipment. Like instead of the cheap walker you can get a more expensive one or a better much more expensive hearing aid, etc. All this comes from trust $.

Good luck. Let us know what the attorney says too - thanks.
Helpful Answer (0)
Report

I don't think so, but your medicaid qualification may be affected.
Helpful Answer (0)
Report

This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter