This article is provided by the Michigan Department of Health & Human Services. Visit their website at www.michigan.gov/mdhhs.
Effective immediately, there are some notable changes in the statute that governs Medicaid subrogation. The changes address the shortcomings in the old law and provide clarity to the process where possible. These changes include:
- Defining the process by which “notice to the department” is accomplished. The new statute requires that notice be provided to MDHHS (and any associated Medicaid managed care plan) within 30 days of filing a case and that attorneys certify this notice on the SCAO summons form. A copy of this form, the complaint and all other documents filed with the complaint must be provided to MDHHS and the contracted health plan, if applicable. This change provides a new framework under which attorneys’ offices demonstrate their intent to comply with Medicaid’s right to recover its expenses. (We are working with SCAO on the form change and expect it to be available by February 1.)
- Defining what information must be provided to MDHHS (or managed care plan) at the time of settlement in order for Medicaid to determine its recovery.
- Providing for a specific penalty for each failure to provide notice. An attorney who knowingly fails to notify the department or managed care plan is subject to a $1,000 civil fine.
- Requiring prompt responses from the department and managed care plans or their vendors by specifying that the department and plans must provide detailed responses within 30 days. Failure to provide this information within 30 days releases counsel’s obligation to protect Medicaid’s interest. This new language addresses concerns with poor customer service and unnecessary delays in proceedings due to slow response times.
Lastly, to expedite the process, we are eliminating our internal requirement that attorneys must provide a HIPAA form for casualty subrogation purposes .
We believe these changes add certainty and clarity into the notice process and worked on the language with the Michigan Association for Justice to ensure that your interests were represented. MDHHS values and respects our collaboration in this process and will continue to provide excellent customer service, individualized attention to each case, and reasonable compromises to assist attorneys in your attempts to navigate this process. Medicaid will continue to honor the “50-50” distribution with members and negotiate recoveries with counsel in good faith depending on the terms of the settlement. Please contact us with questions or concerns and we’ll work to address them with you.