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Michael Greene
Michael Greene
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New Limits on Medicaid(2)

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A recent article in the November issue of "The Suffolk Lawyer", discusses the important issue of Medicaid liens. In it, it states that "the Second Department has limited the right of a Social Services Department to recover from a personal injury settlement the monies expended by Medicaid in the care and treatment of a person with Down’s Syndrome to the period after the creation of a supplemental needs trust (SNT) and not from the date Medicaid first established the recipient’s eligibility for benefits. In doing so the court harmonized several provisions of state and federal law respecting the creation of SNTs in light of the requirements that an SNT contain repayment language and in consideration of the recent United States Supreme Court decision in Arkansas Department of Health and Human Services v. Ahlborn (547 US 268). "

The article further discusses the case, Matter of Ruben N. v. Elizabeth T., 2008 Slip Op 06997, decided September 16, 2008, which involved a person with Down’s Syndrome, wherein Medicaid paid his medical bills. Ultimately, the malpractice action settled on August 23, 2002 for $1,600,000.00, with DSS agreeing to accept $102,423.56, in compromise of the 104-b Medicaid lien, attaching against the proceeds of the personal injury action.

By effecting this resolution with DSS, the balance of the settlement proceeds were placed in a supplemental needs trust, which permitted those funds to be disregarded in any calculation of eligibility for Medicaid benefits. The supplemental needs trust in compliance with both federal, state and Social Services law normally contains language, that upon the death of the beneficiary, "the state would receive the remaining trust corpus to the total value of ‘all medical assistance’ provided by Medicaid to the beneficiary."

The party to the case died in 2003. At that time DSS demanded payment, "for all Medicaid disbursements for Ruben’s medical care during his entire lifetime, both before and after the spinal surgery resulting in the paralysis, in the amount of $632,714.22".

It was ultimately decided by the Appellate Division Second Department, to limit the monies received by DSS to the period of time after the creation of a supplemental needs trust, and not the date that Medicaid first established the recipient’s eligibility for benefits.