The law requires Medicare recipients to write a form permitting them to handle personal medical information. If they can’t give consent, the personal representative can fill out the Authorization to Disclose Personal Health Information.
If you want to be the representative payee for someone on Social Security, go to the local office. At the Social Security office, submit a letter from the recipient’s doctor that states the need for a representative payee. Also, you’ll need to have proof of identity.
Is Having a Standard Power of Attorney Enough for Medicare? Having a standard power of attorney isn’t enough when it comes to Medicare or Social Security. Standard power of attorney allows you to handle most of the finances; but, it doesn’t allow you to make health care choices.
An attorney can notarize any documents in your state. Each state has different rules.
A person with power of attorney has the authority to manage limited benefits. A power of attorney can’t negotiate federal payments such as Social Security checks. So, if you need to handle affairs for someone unable to manage their benefits, you’ll need to apply for Representative Payee.
Yes, Medicare recognizes power of attorney as legal authorization when someone else is acting on behalf of the beneficiary. Does a representative payee have limits? Unless you’re the guardian, you can’t sign a legal document for the beneficiary.
Davis v. Roberts , 130 So. 3d 264 (Fla. 5th DCA 2013), 16 became the final key to confirming that Medicaid lien limitations (reductions) were possible. Finally, the attorneys got it right. Here, as a crucial part of the mediation settlement, all parties agreed in writing to a reasonable allocation of the plaintiff’s past medical expenses, as well as the projected actual total value of all the damages, and finally, the actual amount of money paid to plaintiff due to mitigating conditions. Once a settlement was reached, the plaintiff’s attorneys filed two motions with the court — one to approve the settlement of the minor plaintiff and one to determine the reasonableness of the allocations set forth above. The Fifth District held that a plaintiff has the right to petition the court to demonstrate that the lien amount exceeds the amount recovered for past medical expenses. 17 The Fifth District noted that their instant decision was consistent with their decision in Smith, but that the facts differed. In Smith, the plaintiff lacked an allocation of the settlement and proffered no evidence at trial as to what amount of the settlement represented past medical expenses. In Davis, the plaintiffs not only had an allocation, but also presented ample proof as to the reasonableness of the allocation. 18 As a result, the Fifth District held that when there is an allocation and when the allocation is supported by evidence, a court may determine whether the allocation was reasonable, thereby limiting the lien amount to the amount allocated to past medical expenses. 19
Subrogation liens acquired by clients who receive benefits from Medicaid and Medicare , however, are not considered “collateral sources” under the statute, and, therefore, are not subject to the same reduction arguments of equity and the other factors mentioned above. As a result, these types of liens are more resistant to reduction than others (ERISA 2 and Medicaid being the primary examples). For the past several years, plaintiffs were rarely, if ever, able to reduce Medicaid liens on their clients’ settlement funds when the total settlement funds exceeded the Medicaid lien. 3 When settlement funds are less than the Medicaid lien, then and only then, a formula to reduce the Medicaid lien found in §409.910 (11) (f) permits the plaintiff the right to split the settlement proceeds with Medicaid 50/50, with each side taking a one-half interest in the settlement funds. 4
If the lien represents a significant amount of money and the settlement amount recovered is more money than the lien, but less than full value of the case (this determination varies on a case-by-case basis), then the attorney will need to take the following steps to attempt to limit the Medicaid lien:
The party only received 10 percent of all damages, including the Medicaid lien, thus, Medicaid’s lien is limited to only the 10 percent that has been recovered for the client’s medical bills in the settlement — a 90 percent reduction.
Technically, a Medicaid lien still cannot be reduced, but the Medicaid lien can be limited so as to apply only to the amount of your settlement allocated for the past medicals. A brief history of the law follows.
The Florida statute implementing the state’s requirement to seek reimburs ement from Medicaid recipients when there is a third-party tortfeasor recovery, entitles AHCA to impose a lien on a Medicaid recipient’s claim against the tortfeasor, and, therefore, on any monetary amount recovered by the recipient as a result of a judgment, award, or settlement of the claim. Basically, Medicaid is always paid back in full with only one exception, that being §409.910 (11) (f). As previously mentioned, this section provides a formula to determine what amount the state may recover from a settlement, which caps recovery at half of the total amount of the settlement after deducting attorneys’ fees and costs. Example: a policy limits settlement of $50,000, when the claimant has $75,000 in medical expenses that were paid by Medicaid. After all the fees and costs are deducted, the net to client is $30,000, based on §409.910 (11) (f), the client and Medicaid split 50/50, with each taking $15,000.
The U.S. Supreme Court unanimously held that the federal requirement of state Medicaid programs to seek reimbursement “does not sanction an assignment of rights to payment for anything other than medical expenses — not lost wages, not pain and suffering, not an inheritance.” 8 Therefore, under Ahlborn, states may not “force an assignment of, or place a lien on, any other portion” of a settlement other than that which represents payment for medical care. 9
If a loved one becomes incapacitated and unable to make decisions for themselves, a durable power of attorney can authorize someone else to immediately take over financial decisions and retain control for the remainder of their life. You can decide on the parameters of the power of attorney and pre-determine the scope of its authority.
A living will is a written, legal document that outlines what medical treatments you want or do not want in terms of procedures, pain management, organ donation, and more. Discuss your concerns, questions, and wishes with your physician, family members, and trusted advisers. You will address end-of-life care, including:
If you would like someone to represent you in any dealings with the Social Security Administration, you may appoint someone by filling out the Appointment of Representative Form (SSA-1696). This representative does not need to be an attorney, but they will need to adhere to standards of conduct.
The United States Veterans Affairs Fiduciary Program was designed to help protect veterans who are unable to manage their own financial affairs. A fiduciary, chosen by the beneficiary, is appointed to oversee the financial management of VA benefit payments.
Once payment of the lien is made to CMS, a closure letter will be issued advising the parties that the lien issue has been resolved.
This can usually be determined by evaluating a claimant’s age. Most individuals are entitled to Medicare coverage when they reach sixty-five (65) years of age. However, a claimant can become a Medicare beneficiary prior to reaching sixty-five (65) years of age in certain circumstances. Usually, this will occur when a claimant has applied for, and is awarded, Social Security Disability benefits. A claimant can also be entitled to Medicare coverage if he/she had End Stage Renal Disease (ESRD). As such, prior to settling a claim, you always want to determine if the claimant is a Medicare beneficiary, and in fact, federal law requires you to make that determination.
Most individuals are entitled to Medicare coverage when they reach sixty-five (65) years of age. However, a claimant can become a Medicare beneficiary prior to reaching sixty-five (65) years of age in certain circumstances.
In our last post, we discussed the issues posed by ERISA liens and how the presence of an ERISA lien can complicate a potential settlement. Another similar issue that complicates settlements is the potential presence of a Medicare lien. This applies to workers’ compensation and liability cases.
Usually, if a workers’ compensation claim has been accepted as compensable and all medical payments have been made through workers’ compensation, there should be no lien. However, you will still need to confirm this with Medicare prior to any settlement through a request for lien information to the Centers for Medicare and Medicaid Services’ (CMS) relevant contractor. The CMS contractor that handles lien recovery in accepted workers’ compensation claims is the Commercial Repayment Center (CRC).