Settlement With Client Dual Eligible for Medicaid and Medicare

John Darer • January 6, 2020

Understand Countable or You Could be Held Accountable

Dual Eligibility Medicaid Medicare
We are receiving a number of calls from individuals who received workers compensation settlements who were dually eligible, but there was a failure to recognize this in settling the workers compensation claim, possibly putting other public benefits in jeopardy.  Whether you are a plaintiff's personal injury lawyer or workers compensation applicant attorney you obviously don't want to be there. 

What Does It Mean to Be Dually Eligible?
Being eligible for both Medicaid and Medicare under the rules of the respective programs. Medicaid, a state and federally funded program that provides basic health care coverage for those whose income and assets are below certain thresholds, can be used to supplement Medicare coverage if the claimant has both programs.

A Medicare Set-Aside account is considered an available resource for purposes of asset/income sensitive needs-based benefits such as SSI and Medicaid.  

If the Medicare Set-Aside account is not set up inside a special needs trust or Supplemental Needs Trust (New York), the plaintiff/claimant may lose Medicaid/SSI eligibility.  To maintain their Medicaid/SSI benefits,  the MSA must be placed within a special needs trust, using a hybrid trust which addresses both Medicaid and Medicare.  

Be mindful of this issue in the run up to settlement negotiations.


most infomative structured settlement websites
By John Darer August 26, 2025
The 4structures.com website is one of the most comprehensive structured settlement resources, particularly for those who want detailed, expert-level information, according to Google AI
most informative
By John Darer August 22, 2025
Based on Grok's review of prominent sites as of August 2025, 4structures.com (including its associated blog at structuredsettlements.typepad.com) stands out as the most comprehensive. Run by structured settlement expert John Darer, it offers detailed guides, and specialized insights
fountain
By John Darer August 17, 2025
Retained asset accounts for life insurance beneficaries, are temporary accounts that earn interest, give you time to breathe and give you time to figure it out.. Retained asset accounts are pay nterest from the date of death to date of settlement of the claim as a general practice,
knuckles
By John Darer August 16, 2025
How to avoid a "Knuckles Sandwich" when entering into settlement of claims or lawsuits involving taxable damages, or elements of taxable damages. What is the intent of the Payor? What happens if the intent of Payor is not clearly set forth in the settlement agreement?
structured  settlements
By John Darer August 15, 2025
Structured settlement annuity issuers have stood the test of time, which is crucial if you're depending on them to pay you stable income for a long time or the rest of your life or pay your beneficiaries . For Structured settlement annuities . Call John Darer at 888-325-8640
New Y
By John Darer August 14, 2025
While rising yields have narrowed the gap for defendants in New York CPLR 50A and 50B projections, plaintiffs can still " fly inverted" and get plenty of "lift" when negotiating settlements by using savvy settlement experts
baseball caps of many colors
By John Darer July 29, 2025
The cap rate on index linked structured settlement annuities is a limit set by the insurance company on the maximum interest rate that can be credited to the annuity based on the performance of the underlying index that also helps provide the downside prtection..
longevity road
By John Darer July 28, 2025
Do your financial resources give you enough road, or will the road run out before you do? A structured settlement annuity helps mitigate the risk of outliving your savings, no matter how long you live. A structured settlement can inlcude one or more customized payment streams and types.
USAA structured settlements
By John Darer July 16, 2025
USAA Life Insurance Company, an A++ rated insurance company, issues structured settlement annuities with 1%, 2% and 3% COLAs. USAA Life structured settlements are exceptionally compatitive on lifetime benefit payments with long duration certain periods for ages under 35.
MetLife Structured Installment Sales Now Available in New York
By John Darer July 8, 2025
Owners of highly appreciated NY businesses or NY real estate may benefit from a structured installment sale tax deferral program as an alternative to a 1031 exchange. MetLife's structured installment sale program is now available in NY and in all 50 states. Call 888-325-8640 for more info
More Posts