States must seek reimbursement from liable third parties for Medicaid benefits paid. Recovery is limited to the portion of a settlement attributable to medical expenses under Ahlborn and Wos.
Allocation determines the recoverable amount.
Alternative Names:
Medicaid Recovery, State Medicaid Lien
Why it Matters?
The medical expense limitation is the substantive protection, since a state cannot reach the portion of a recovery allocated to pain and suffering or lost wages. Where a settlement is undifferentiated the allocation becomes the dispute, and obtaining a court-approved allocation or a stipulation reflecting the actual claim composition is what limits the recovery. Failing to address allocation invites the agency to assert a claim against the entire proceeds.
Frequently Confused with
Related terms
Frequently asked questions
Can Medicaid reach the entire settlement?
How is allocation established?
