Q: When does a Medicaid lien get triggered and what is the statutory citation for a Medicaid lien in New York?
A: First, it is important to point out that a Medicaid beneficiary automatically assigns their right to receive medical payments from a third-party tortfeasor to the Social Services Agency:
(d) Conditions of eligibility. A person shall not be eligible for medical assistance under this title unless he or she:
(1) is a resident of the state, or, while temporarily in the state, requires immediate medical care which is not otherwise available, provided that such person did not enter the state for the purpose of obtaining such medical care; and
(2) assigns to the appropriate social services official or to the department, in accordance with department regulations:
(i) any benefits which are available to him or her individually from any third party for care or other medical benefits available under this title and which are otherwise assignable pursuant to a contract or any agreement with such third party; or
(ii) any rights, of the individual or of any other person who is eligible for medical assistance under this title and on whose behalf the individual has the legal authority to execute an assignment of such rights, to support specified as support for the purpose of medical care by a court or administrative order;
Next, the Social Services agency enforces that assignment through the NYS CPL SS §104-b: Liens for public assistance and on claims and suits for personal injuries, the statutory citation for a Medicaid lien in New York.
Q: Can you challenge the capitation payments contained within a Medicaid lien?
A: NYS CPL SS §104-b provides for a lien for “all assistance and care” from the date of the accident. Medicaid argues that payment of capitation fees falls squarely within the definition of “assistance and care.” Further, thus far court challenges have been unsuccessful.
For an example, click here to see Matter of the Application of Anthony Mormile