Medicare and Medicaid Liens on a Wyoming Injury Settlement

By the FigureMyTax Editorial Team · How we calculate

If you recover from a third party, Wyoming is entitled to be reimbursed for all Medicaid payments made or to be made. The department must be notified of any settlement and signs the release. Its claim is reduced for attorney fees, by up to 33 percent plus its share of costs, only if it states in writing that it will neither sue nor intervene.

Reimbursement

W.S. 42-4-201(a) says that if a Medicaid applicant or recipient recovers from the third party in any manner, including judgment, compromise, settlement or release, the state is entitled to be reimbursed for all payments made or to be made.

Notice and release

The department must be served with the complaint by certified mail within seven days of filing, and notified in writing of any judgment, compromise, settlement or release. The attorney general is made a party to settlement negotiations. The department may accept less than its claim. The person paying the settlement remains liable to the state unless the state signs the release before payment.

Fee share

Under subsection (e), if after notice the department states in writing that it will neither file an independent action nor intervene, its reimbursement is reduced by not more than 33 percent for attorney fees together with its proportionate share of costs. If it does not give that statement, its reimbursement is not reduced by any share of your fees or costs.

Other payors

The department is also subrogated to rights against insurers, group health plans and other payors, up to what it spent (42-4-204).

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. See how provider bills differ from liens and the Wyoming medical lien calculator.

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