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Medicaid and Personal Injury Settlements Ohio

Post By Corey Heit

Does Having Ohio Medicaid Coverage Affect My Personal Injury Settlement?

Yes, Medicaid does affect personal injury settlements.

No, this should not discourage anyone who has Medicaid coverage in Ohio from attempting to hold the person or company that caused their injuries accountable through insurance claims or a lawsuit.

Medicaid Covers Now and Seeks Reimbursement Later

First, know that Ohio Medicaid will cover emergency and follow-up care for injuries suffered in a car crash, truck accident, slip and fall, dog attack, or other accident that would give you grounds for filing a personal injury claim. You do not need to worry about paying all the medical expenses forced upon you by someone else’s negligence or reckless behavior.

It is also true that Medicaid will demand reimbursement from any settlement or jury award you receive. The program will only take an amount equal to what it spent in covering your care, though. In most cases, you will hold onto some or all of the compensation you received for lost wages, loss of future earnings, pain and suffering, and, when they exist, punitive damages.

What the Law Says

Section 5160.37(A) of the Ohio Revised Code stipulates that

A medical assistance recipient’s enrollment in a medical assistance program gives an automatic right of recovery to the department of medicaid and a county department of job and family services against the liability of a third party for the cost of medical assistance paid on behalf of the recipient. When an action or claim is brought against a third party by a medical assistance recipient, any payment, settlement or compromise of the action or claim, or any court award or judgment, is subject to the recovery right of the department of medicaid or county department. Except in the case of a medical assistance recipient who receives medical assistance through a medicaid managed care organization, the department’s or county department’s claim shall not exceed the amount of medical assistance paid by the department or county department on behalf of the recipient. A payment, settlement, compromise, judgment, or award that excludes the cost of medical assistance paid for by the department or county department shall not preclude a department from enforcing its rights under this section.

What the Law Means

The ”third party” referenced in the state statute is the insurance company for the person or company that caused your personal injury. The amount and percentage of your settlement or jury award that Ohio Medicaid will take depends on several factors, including

  • How much Medicaid paid for injury-related health care services,
  • Whether you are enrolled in a Medicaid managed care plan, and
  • Whether your settlement or award includes monies specifically for medical expenses.

While no outcome can be guaranteed, a personal injury attorney who represents a client who is covered by Medicaid will fight to ensure that a settlement or jury award accounts for all of Medicaid’s previous and projected spending. In every event, the attorney will work with the insurance company and the Ohio Department of Medicaid to arrange the reimbursement and spare their client from having to engage in negotiations and complete paperwork.

Corey Heit of Westerville-based Heit Law helps victims in all types of personal injury cases in and around Columbus, Ohio. He offers free consultations to prospective clients, and he can take appointments online or over the phone at (614) 898-5300.

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