50 State Primer on Medicaid Recovery Laws

50 State Primer on Medicaid Recovery Laws

HINSHAW & CULBERTSON LLP ON THE LAW SERIES Volume II

Third Edition September 2022

50 State Primer on Medicaid Recovery Laws

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50 State Primer on Medicaid Recovery Laws

Table of Contents

INTRODUCTION .......................................................................................................................... 1 ALABAMA .................................................................................................................................... 6 ALASKA ........................................................................................................................................ 8 ARIZONA..................................................................................................................................... 10 ARKANSAS ................................................................................................................................. 11 CALIFORNIA .............................................................................................................................. 13 COLORADO ................................................................................................................................ 15 CONNECTICUT .......................................................................................................................... 17 DELAWARE ................................................................................................................................ 18 FLORIDA ..................................................................................................................................... 19 GEORGIA..................................................................................................................................... 21 HAWAII ....................................................................................................................................... 22 IDAHO.......................................................................................................................................... 24 ILLINOIS...................................................................................................................................... 25 INDIANA ..................................................................................................................................... 27 IOWA............................................................................................................................................ 29 KANSAS....................................................................................................................................... 31 KENTUCKY................................................................................................................................. 32 LOUISIANA................................................................................................................................. 34 MAINE ......................................................................................................................................... 37 MARYLAND ............................................................................................................................... 41 MASSACHUSETTS..................................................................................................................... 43 MICHIGAN .................................................................................................................................. 45 MINNESOTA ............................................................................................................................... 49 MISSISSIPPI ................................................................................................................................ 50 MISSOURI ................................................................................................................................... 52

?2022 Hinshaw & Culbertson LLP

50 State Primer on Medicaid Recovery Laws

MONTANA .................................................................................................................................. 54 NEBRASKA ................................................................................................................................. 57 NEVADA...................................................................................................................................... 59 NEW HAMPSHIRE ..................................................................................................................... 62 NEW JERSEY .............................................................................................................................. 65 NEW MEXICO............................................................................................................................. 67 NEW YORK ................................................................................................................................. 70 NORTH CAROLINA ................................................................................................................... 71 NORTH DAKOTA ....................................................................................................................... 75 OHIO............................................................................................................................................. 78 OKLAHOMA ............................................................................................................................... 80 OREGON ...................................................................................................................................... 83 PENNSYLVANIA........................................................................................................................ 87 RHODE ISLAND ......................................................................................................................... 93 SOUTH CAROLINA.................................................................................................................... 94 SOUTH DAKOTA ....................................................................................................................... 97 TENNESSEE ................................................................................................................................ 98 TEXAS........................................................................................................................................ 102 UTAH ......................................................................................................................................... 104 VERMONT................................................................................................................................. 111 VIRGINIA .................................................................................................................................. 114 WASHINGTON ......................................................................................................................... 117 WEST VIRGINIA ...................................................................................................................... 120 WISCONSIN .............................................................................................................................. 124 WYOMING ................................................................................................................................ 125

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50 State Primer on Medicaid Recovery Laws

Introduction

50 State Primer On Medicaid Recovery Laws

This primer is intended to provide a brief introduction to Medicaid Recovery laws and act as a practical reference guide for insurance, legal, or medical service providers on Medicaid reimbursement or subrogation claims, or Medicaid compliance issues. In this highly regulated industry, it is essential to understand the individual State laws that affect reimbursement and subrogation claims.

This 3rd Edition includes both procedural and substantive changes to individual State laws since 2019, including Connecticut, Florida, Georgia, Louisiana, Maine, Michigan, Montana, New Jersey, North Dakota, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Utah, Virginia, and West Virginia As well, you will find a Comment on the recent United States Supreme Court decision in Gallardo v. Marstiller which decided whether the Medicaid Act permits states to seek reimbursement from settlement payments allocated for future medical care.

INTRODUCTION TO MEDICAID AND STATE AGENCY RECOVERY RIGHTS

Medicaid is the single largest health plan in the United States with reported enrollment totaling nearly 89 million individuals. An analysis of recent enrollment trends, published by Kaiser Family Foundation in September 2022 (), showed a 25% growth during the COVID Pandemic period from February 2020 to May 2022. In fact, every state across the country realized an increase in Medicaid enrollment during the COVID period: from 15% in Connecticut to 68% in Oklahoma. KFF's analysis also found that, while enrollment numbers continue to increase, the rate recently flattened; and pre-pandemic numbers were at a downward trend from 2017 to 2019. According to KFF, COVID's effect on Medicaid enrollment may be explained by economic factors, legacy legislation like Affordable Care Act (ACA) expanding Medicaidqualified individuals, and emergency legislation like Families First Coronavirus Response Act's (FFCRA) quid pro quo where states that continuously enroll Medicaid-qualified individuals receive increases in matching federal funds.

Medicaid is separate and distinct from Medicare, which is a federal health plan based on age and certain disabilities. Medicaid is a joint federal and State program that funds medical care. Low income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory Medicaid eligible groups, whereas other groups are provided optional coverage at the State's discretion such as individuals receiving home and community based services and children in foster care who are not otherwise eligible. States are not required to participate in Medicaid; however, all States have opted to do so. The federal government covers a percentage of the medical costs that are paid by the States. In return, States must pay their portion of medical costs as well as follow the requirements the federal government has set in place for Medicaid.

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