Medicare and MaineCare Liens on a Maine Injury Settlement

By the FigureMyTax Editorial Team · How we calculate

MaineCare has a statutory lien on the proceeds of an award or settlement, to the extent of the recovery for medical expenses. It recovers from what is left after reasonable attorney fees and litigation costs, and its lien may not be reduced to reflect a pro rata share of those fees or costs. Medicare recovers under federal rules.

The right of recovery

22 MRSA 14(1) says that when MaineCare benefits are provided for the medical costs of an injury for which a third party is or may be liable, the commissioner may recover the cost from that party, separately from your own rights, and is subrogated to your claim to the extent of the benefits provided. If necessary, the Attorney General may sue anyone who received a settlement, including your agent or attorney.

The lien

The commissioner's right to recover constitutes a statutory lien on the proceeds of an award or settlement from a third party, if recovery of MaineCare costs was or could have been included in your claim, to the extent of the recovery for medical expenses. MaineCare is the payor of last resort.

After fees and costs

The commissioner recovers the cost of benefits actually paid when collection is cost-effective, to the extent proceeds are available after deduction of reasonable attorney's fees and litigation costs from the gross award or settlement. In deciding whether collection is cost-effective, the commissioner considers liability, comparative negligence, trial risks and low insurance limits. The statute says the lien may not be reduced to reflect a pro rata share of your fees or costs, but the commissioner may compromise or waive the claim.

Federal limit and Medicare

In Arkansas Department of Health and Human Services v. Ahlborn (2006), the U.S. Supreme Court held that Medicaid may reach only the portion of a settlement that represents medical costs. Under the Medicare Secondary Payer statute, 42 U.S.C. 1395y(b)(2), the United States may recover conditional payments and collect double damages from responsible entities; 42 CFR 411.24 governs recovery, and 42 CFR 411.37(c) reduces Medicare's recovery by its procurement-cost share. On a $100,000 settlement with $36,333 of fees and costs, $15,000 of Medicare payments would shrink to about $9,550.

Next steps

See how hospital liens work and how Maine limits health insurer reimbursement, then enter every claim in the Maine medical lien calculator.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Maine's rules apply to your specific case with a licensed Maine attorney.