When a Worker is eligible for Medicaid benefits, their workers’ compensation case must go through a review by Medicaid to determine whether Medicaid is owed any money for benefits they paid that they believe to be the responsibility of the workers’ compensation carrier.
With more and more workers becoming eligible for Medicaid benefits, Medicaid has been unable to keep up with the demand for requests. This causes delays in the resolution of the workers’ compensation case. Judges are reluctant to approve settlements when there are outstanding Medicaid issues.
The real problem is that there is no mechanism in place to compel Medicaid to act within a certain period, nor is there any recourse when there is a dispute between the Worker and Medicaid. The current situation is ‘do it our way or hit the Highway.’
When Medicaid pays for a condition that it deems related to the workers’ compensation case, it is almost impossible to get that charge removed. Trying to get charges removed can take six months to a year without any guarantee the charges are going to be removed. The situation often requires workers to reimburse Medicaid out of their settlement just to get their compensation case settled.
Medicaid is a State-run Federal program that needs a legislative fix. Until Medicaid is compelled to respond within certain time limits and is required to answer disputes on whether a medical condition is work related, workers’ compensation cases will continue to drag on and on with no end in sight.
At Levinson Axelrod, P.A., we have New Jersey Supreme Court Workers’ Compensation Specialists with extensive experience dealing with the intricacies of Medicaid in workers’ compensation cases. If you have questions about a claim, we can help. Call (732) 440-3089 or contact us online for a FREE consultation.