An Explanation of Medi-Cal and Medicare Liens and Settlements

It seems as if every case we settle these days gets bogged down to some degree while we attempt to resolve liens with Medi-Cal and/or Medicare. The rules regarding Medicare reimbursement, in particular, have become more stringent in recent years, and no defendant or insurance company is willing to settle a case without written assurance that any potential obligations to Medicare have been satisfied.

We came up with a “cheat sheet” that walks through the steps to follow when resolving a Medi-Cal or Medicare lien. We have found this to be extremely useful in allowing us to resolve liens as quickly, and with as little wasted effort, as possible, and we hope that some of you find it useful as well. You can find that guide on our website via this link: A Cheat Sheet for Medi-Cal Procedures.

There are some important differences to keep in mind between the two systems with regard to liens:

  1. Medi-Cal’s website allows much of the reporting by plaintiff’s lawyers to be done online. Medicare is apparently going to follow suit, but at this point, communications with Medicare still need to take place via telephone, fax and mail.
  2. Under no circumstances will Medi-Cal receive more money in satisfaction of its lien than the plaintiff receives in his pocket. Medicare, on the other hand, has no such limitation and, under some circumstances, is entitled to swallow up the plaintiff’s entire net recovery.

In addition, the Medicare regulations require that Medicare’s interests be protected, not only with regard to payments already made by Medicare, but also with regard to future payments. Medi-Cal has no such requirement.

While it is presently unclear whether a “Medicare Set Aside” is required in personal injury cases, it is certainly something to consider whenever the plaintiff will have substantial medical costs in the future that are related to the subject accident and at least some of those expenses would otherwise by paid by Medicare.

Further reading: Medicare Set Asides – Coming to a Civil Case Near You.