Higgins Lien Resolution assists plaintiffs by notifying state Medicaid agencies of settlement and undertaking to satisfy any Medicaid liens as favorably as possible for plaintiffs. Medicaid (Medi-Cal in California) is a partially federally-funded, state program that is administered by the state but subject to federal regulation. Rules relating to resolving Medicaid liens vary by state. Let Higgins Lien Resolution navigate those complex regulations on behalf of your plaintiff.

How does Medi-Cal develop a lien against my settlement?

Under federal law, Medi-Cal is required to determine the legal liability of third parties, such as defendants and insurers, to pay for health care and services already paid by Medi-Cal. Medi-Cal then has the right to recover the Medi-Cal rate of payment of those health care and services, including by direct action in a lawsuit against the defendant or insurer. Medi-Cal imposes a lien on a settlement in order to secure that right to recovery. In fact, no settlement is final or deemed satisfied without first notifying Medi-Cal of the settlement and giving Medi-Cal a reasonable opportunity to perfect and satisfy its lien.

What rights does Medi-Cal have against defendants or their insurers to collect its lien?

Medi-Cal has the same rights against the defendant and its insurer to collect its lien as the plaintiff has to collect those healthcare fees and costs from the defendant or its insurer. To assist in Medi-Cal’s ability to collect, the eligibility rules for Medi-Cal require that beneficiaries execute an assignment of the right to payment for medical care from third parties as well as agree to cooperate with the State in identifying and providing information to assist in pursuing any third party that may be liable for health care.

Does Medi-Cal have to share in the plaintiff’s attorney fees and costs?

Medi-Cal will share in attorney’s fees paid by a Medi-Cal recipient who brings a tort action. Medi-Cal’s share, however, is limited to 25% of the lien amount sought to be recovered. Thus, even if the plaintiff is paying fees of 40%, Medi-Cal will pay only 25% of its lien amount in fees. Medi-Cal will pay costs in the same ratio that the lien bears to the total recovery as shown in the example below:

Example. If the settlement is $100,000, fees are $40,000, costs are $5,000 and the lien is $20,000, then Medi-Cal will receive $14,000, computed as follows:

Gross Lien Amount $20,000

Medi-Cal share of fees (25% of gross lien amount) ($5,000)
Medi-Cal share of costs (20,000/100,000 x $5,000) ($1,000)
Net Medi-Cal Lien $14,000If Medi-Cal wishes to do so, it may join as a plaintiff in the tort action at any time before trial. However, in no event can Medi-Cal recover more than the net amount recovered by the plaintiff.

How much of my settlement can Medi-Cal recover?

Recovery of the lien is limited to that portion of a settlement, judgment or award that represents payment for medical expenses or medical care provided on behalf of the plaintiff. That rule is reinforced by the Ahlborn decision (Arkansas Dept. of Health and Human Services, et al. v. Ahlborn, 547 U.S. 268, 126 S.Ct. 1752, 164 L.Ed.2d 459 (2006)) which limits Medicaid recoveries to amounts paid for medical care. That is, the state cannot enforce a lien against amounts recovered for emotional distress, lost income or other elements of damage. To enforce the lien against those other elements of damage would violate federal law.

Are there any circumstances under which Medi-Cal will not pursue its lien?

Medi-Cal may waive, settle or release its reimbursement claims if enforcement would result in an “undue hardship” on the injured party or on the heirs in a wrongful death action. Waiver of the claim means no liability whatsoever to Medi-Cal, rather than simply a reduction based on hardship. The right of Medi-Cal to pursue its right to recovery is not extinguished by the death of the plaintiff.

How can Higgins Lien Resolution assist with my lien?

Higgins Lien Resolution assists with California Medi-Cal and other state Medicaid lien resolution in four critical areas. Using California’s Medi-Cal liens as an example:
  1. First, since Medi-Cal’s recovery right is limited to the portion of a settlement, agreement or judgment allocable to medical expenses, we can provide language and justification for such allocations.
  2. Second, since the allocations to medical expenses, if not agreed to by Medi-Cal in advance, are subject to Court determination, we can assist in those proceedings.
  3. Third, we can audit the character and amount of each claimed lien expense to be sure the claimed expense relates to the injury and is correct in amount.
  4. Fourth, where the lien amount is large in relation to the recovery, we can assist to limit Medi-Cal’s lien rights described above.