Medicare and Medicaid Liens on a New Hampshire Injury Settlement

By the FigureMyTax Editorial Team · How we calculate

New Hampshire Medicaid is the payer of last resort. The commissioner may recover the full amount from the portion of a settlement reasonably attributable to medical expenses, may waive or reduce it for good cause on written request, and a court can apportion a disputed amount. Medicare recovers under federal rules.

Assignment and recovery

RSA 167:14-a says a recipient is deemed to have assigned any claim or right of action to the commissioner to the extent of assistance furnished. The program is the payer of last resort, and a recipient who receives a settlement or award must repay the assistance to the extent the recovery makes repayment possible.

The medical portion and reductions

The commissioner may recover the full amount of medical assistance from the portion of any settlement or judgment reasonably attributable to medical expenses, and may waive or reduce the amount due for good cause on written request from the recipient or the recipient's attorney. Accepting a waiver or a reduced payment creates a rebuttable presumption that the apportionment was equitable. The statute gives no attorney-fee formula, so the calculator lets you enter the percentage you expect it to accept.

Notice and disputes

No disbursement of an award or settlement may be made to a recipient without at least 30 days' written notice to the commissioner of any scheduled trial, alternative dispute resolution hearing or settlement, or a written release. The commissioner must state its claim within 21 days. If there is a dispute, the third party or the recipient's attorney must withhold an amount equal to the claim, and either side may ask the superior or district court for an equitable apportionment, with broad discretion.

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 what New Hampshire courts say about health plan reimbursement, then enter every claim in the New Hampshire medical lien calculator.

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