Blog Post

Settlement With Client Dual Eligible for Medicaid and Medicare

John Darer • Jan 06, 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.


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