State Medicaid agencies and their recovery contractors, including Optum and Conduent, often rely on a statutory default to set the medical portion of a settlement. The state says one-third. Pay accordingly.
Federal law does not allow it as a fixed rule. In Wos v. E.M.A., the Supreme Court held that a state cannot apply an arbitrary one-size-fits-all presumption to determine how much of a tort recovery is reimbursable. The injury victim has a property right in the rest of the settlement. That property right is protected by the federal anti-lien statute at 42 U.S.C. § 1396p.
Without a procedure to challenge the state’s default, the lien can reach damages it has no right to touch.
Synergy is the industry leader in healthcare lien resolution for personal injury firms. The Synergy team includes attorneys and lien specialists who reduce state Medicaid liens across all fifty states using Ahlborn and Wos principles applied to each state’s third-party liability statute. Synergy resolves Medicaid liens at scale, drawing on hundreds of years of combined subrogation experience to protect injury victims’ net recoveries.
Get the federal framework, the case law, and the procedural posture in one desk reference. Download the State Medicaid Recovery After Wos Guide.
If you have a difficult Medicaid lien where the state default formula does not work, send it over to Synergy.
The Synergy team will work diligently to ensure your case gets the attention it deserves. Contact one of our legal experts and get a professional review of your case today.