Category: Medicaid

Medicaid Reimbursement Claims for Minors

As personal injury lawyers, our main duty to our clients is to maximize each clients’ net recovery. So, while it’s great to get a big settlement, such a settlement is much smaller when a large portion must be repaid to a health insurance company or to Medicaid. At our firm, we work hard dealing with and extinguishing any reimbursement claims not allowed under Georgia law.

An example is when a minor is injured. In these situations, often PeachCare pays the medical bills and claims a lien against future settlements. Our interpretation of Georgia and federal law is PeachCare is not entitled to be reimbursed out of any settlement with a minor. We therefore fight these reimbursement claims tooth and nail.

In Georgia, an injured child has a claim for pain and suffering only. This was discussed in Southern Guaranty Ins. Co. v. Sinclair, 228 Ga. App. 386 (1997). In that case, the Court held that minor child has no claim for medical expenses because that obligation rests with the parents. This makes sense because until a minor child reaches the age of 18, he or she cannot be bound under contract. A minor child is therefore neither incapable of being held liable for medical expenses, nor able to make a claim for reimbursement of medical expenses.

PeachCare/Medicaid can only claim a lien against that part of an injured person’s recovery that was money received for medical expenses. Arkansas Dept. of Health and Human Services v. Ahlborn, 547 U.S. 268; 126 S. Ct. 1752 (2006). Ahlborn establishes that Medicaid/PeachCare can only reach settlement monies paid as reimbursement of medical bills.

When Sinclair and Ahlborn are read together, the result is that Medicaid/PeachCare cannot claim a lien against a minor child’s settlement proceeds. To ensure any settlement is shielded from Medicaid/Peachcare, it is important to structure the settlement so it is between the wrongdoing party and the minor child, and that the settlement clarifies it only covers pain and suffering.

If you have a question about these issues, please call Gomez & Golomb LLC at 404-382-9994.