Feds to Expand Second Payer Liability

A section contained in the U.S. budget agreement could allow states to recover costs from the full amount of a beneficiary’s liability settlement, not just medical expenses, in Medicare and potentially, Medicaid and workers’ compensation cases.

Currently, states have the ability to recover costs from Medicaid beneficiaries for portions of settlements designated for medical expense.

However, according to the Centers for Medicare and Medicaid Services (CMS), the budget bill’s language includes an option for states to place liens against “any payment from a third party that has a legal liability to pay for care and services available under the plan.”

That change, which becomes effective Oct. 1, 2014, could be interpreted to apply to workers’ compensation cases, according to UWC, which represents the business community on national unemployment insurance and workers' compensation issues.  

For more information, contact CBIA’s Eric Gjede (860.244.1931; eric.gjede@cbia.com; @egjede).