Does a Personal Injury Settlement Affect Medi-Cal?
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Does a Personal Injury Settlement Affect Medi-Cal?

California’s Medi-Cal program offers free or low-cost health care coverage to state residents who meet certain income thresholds. When an accident victim who has Medi-Cal coverage receives medical services for injuries sustained in a car accident or a slip-and-fall mishap, Medi-Cal will typically pay for at least a portion of those services. If the accident victim later receives a personal injury settlement that reimburses the same expenses, the State will look to that settlement to recover the funds that it paid for those services. A personal injury settlement will not cause a cancellation or have any other adverse effects on an injured party’s Medi-Cal coverage. Rather, the program is structured like all other health insurance such that an injured accident victim will not recover double benefits for the same injuries.  

The Los Angeles personal injury lawyers at Ellis Injury Law have regularly represented accident victims that have Medi-Cal health insurance coverage.  We have extensive experience in working with the Medi-Cal program and in recovering other personal injury settlement amounts that Medi-Cal will not claim. 

How does Medi-Cal recover the funds that it has paid? 

Medi-Cal recipients are required by law to report to the State’s Department of Health Care Services any claims and lawsuits they have filed to recover compensation for their damages in a personal injury action. That report must be submitted within thirty days after a lawsuit is filed. The Department will then review the case and notify the injured party of its decision to file a lien. If an injured party does not submit the required notice, the Department can then take legal action to recover any amounts it previously paid on behalf of the Medi-Cal recipient. When the personal injury settlement is resolved and paid, the accident victim’s personal injury lawyer will forward funds to the Department and verify that any liens are extinguished. 

Does Medi-Cal receive the entire personal injury settlement? 

Medi-Cal and the Department of Health Care Services can only claim an amount equal to what they have previously paid for the accident victim’s medical services. A personal injury settlement typically includes reimbursement for several categories of damages, including replacement of lost wages, compensation for occupational and rehabilitation therapy, and payments for pain and suffering. The specific amount of the personal injury settlement that an accident victim will be entitled to recover will always depend on the facts of the case and the skills and abilities of the victim’s personal injury attorneys to demonstrate how those facts caused the total amount of damages. In a majority of cases, the victim will recover and keep a substantial amount even after Medi-Cal’s previous payments are reimbursed. 

How do personal injury lawyers determine the portion of a personal injury settlement that is allocated to medical expenses? 

Personal injury settlements are supported by objective evidence and statements that an accident victim’s lawyer puts together to show the complete extent of losses and injuries, including: 

  • bills and invoices from physicians and hospitals 
  • wage statements, tax returns, and other documents that show salary the injured party received while he or she was still able to work 
  • transportation expenses associated with going to and from appointments 
  • payments to pharmacies for medication 
  • testimony from the victim, his or her family members, and medical caregivers regarding the nature and extent of injuries, the pain that the victim is experiencing, and the adverse effect that the pain is having on the victim’s lifestyle. 

Medi-Cal reimbursements cover only a portion of these losses and injuries. The victim’s attorney will verify that the personal injury settlement agreement clearly demonstrates how the settlement amount was calculated and what portion of that amount might be recoverable by Medi-Cal and the Department of Health Care Services. 

Contact Ellis Injury Law for assistance with coordinating a personal injury settlement and Medi-Cal reimbursements 

Medi-Cal provides healthcare benefits when a covered party suffers injuries as a result of another person’s negligence. Ellis Injury Law helps accident victims to coordinate their personal injury settlements and Medi-Cal benefits to optimize recovery on all fronts. 

Please see our website or call our Los Angeles office directly to consult with one of our accident and injury lawyers about your Medi-Cal benefits and your opportunity to recover a damages award for the total amount of your injuries.  We represent injured accident victims throughout Southern California.  

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