How Much Can Medi-Cal Take from Your Car Accident Settlement?
TMedi-Cal is entitled to be paid back for money they spent on your car accident. This can make sense. If they paid the money should go to them, not you. BUT .... lots of times there is not enough money to go around. So who gets what ????????
The First Steps - After your Car Accident Give Notice to Medi-Cal
You or your lawyer must report your lawsuit or personal injury claim in writing to the Department of Health Care Services (DHCS). This is the law. See: Welfare and Institutions (W&I) Code section 14124.70 et seq.
Here is the Online Link New Case Signup W&I Code section14124.73(c) outlines the information you have to provide.
Notice At Settlement
When the case settles, your lawyer must give notice to DHCS (W&I Code section 14124.785 and 14124.79)
DHCS creates a lien which means you don't get a penny until they get paid first. Here is the online link to give notice of a settlement. Notice of Settlement
They Don't Get Everything
Your lawyer knows that the amount Medi-Cal can recover from a personal settlement for their lien is specifically limited to the portion of the settlement that represents payment for medical expenses or medical care provided on behalf of the beneficiary. See: Espericueta v. Shewry, 164 Cal.App.4th 615 (2008); Aguilera v. Loma Linda University Medical Center, 235 Cal.App.4th 821 (2015)) and Cal.Welf. & Inst.Code § 14124.76)[ This limitation is clearly stated in multiple legal sources.
Medi-Cal & the 50% Rule
In no case is DHCS entitled to receive more of the settlement funds than the beneficiary after reduction for attorneys’ fees and costs. (Welf. & Inst. Code, § 14124.78) So your attorney gets paid. You get at least 1/2 of what is left.
What if Medi-Cal Gets Greedy?
What if Medi-Cal doesn't want to follow the 50% rule?
The legislation mandates that all reasonable efforts should be made to obtain the Department's advance agreement on the determination of the portion of a settlement that represents payment for medical care; in the absence of such agreement, the matter must be submitted to a court for decision. See: Espericueta v. Shewry, 164 Cal.App.4th 615 (2008); Cal.Welf. & Inst.Code § 14124.76)
In Daniel C. v. White Memorial Medical Center, it was noted that the court, not the beneficiary, determines what portion of a settlement is fairly allocated to satisfy the Medi-Cal lien, based on the reasonable value of benefits provided (Daniel C. v. White Memorial Medical Center, 83 Cal.App.5th 789 (2022) Similarly, in McMillian v. Stroud and other cases, courts have emphasized that Medi-Cal's recovery is confined to the portion of the settlement that corresponds to medical payments (Boehm & Associates v. Workers' Compensation Appeals Bd., 108 Cal.App.4th 137 (2003)
Moreover, following the Supreme Court's decision in Arkansas Department of Health and Human Services v. Ahlborn, California amended its statutes to ensure that Medi-Cal's recovery is exclusively tied to the portion of the settlement pertaining to medical expenses, aligning state law with this precedent.
Accident attorney Daniel Horowitz works with chiropractor and law school graduate Michael Yates to provide the best representation for people injured in car accidents. Call us as soon as possible. There is never any charge or fee until you recover money.