Chicago Medicare and Medicaid Set Aside Attorneys
Skilled Guidance on CMS Medicare and Medicaid Set Aside Arrangements (MSAs) in Illinois and Nationwide
Medicare and Medicaid Set Asides (MSAs) are financial arrangements that allocate a portion of a workers' compensation settlement to pay for future medical expenses that would otherwise be covered by Medicaid or Medicare if the injury or illness was not work-related. These arrangements are administered by the Centers for Medicare and Medicaid Services (CMS) and call for the creation of a special account in which to set aside monies for future medical payments. MSAs are quite complex and if done incorrectly, can expose employers and insurers to numerous pitfalls. For this reason, it is important to work with a skilled workers' compensation defense attorney with specific experience in this area of the law.
At Brady, Connolly and Masuda, P.C., we have nearly two decades of experience defending employers and insurers in Illinois, Missouri, and throughout the country for workers' compensation claims and all related legal matters. Our award-winning lawyers have a strong track record of success providing a thorough and swift defense of workers' compensation claims at a lower cost to clients. When a Medicare or Medicaid Set Aside is called for, we work hand in hand with our clients to ensure their interests are fully protected throughout each step of the process.
When is an MSA Required for a Workers' Compensation Claim?
Not all workers' compensation claims call for the creation of a Medicare or Medicaid Set Aside. MSAs are required on claims that meet the following criteria:
- The claimant is already a Medicare beneficiary and the total amount of the settlement exceeds $25,000.
- The claimant has a "reasonable expectation" of becoming eligible for Medicare within 30 months of the date of the workers' compensation settlement, and the total settlement amount is expected to exceed $250,000.
The MSA is set up as a trust, and can be administered by the claimant, a family member or anyone that has been approved by both the claimant and the CMS. The claimant is not allowed to spend any of the monies set aside in the trust until he/she becomes eligible for government benefits, and a full accounting of monies spent must be provided to the CMS. Failure to comply with these requirements can result in the claimant being audited and sued by the CMS. In many cases, this can expose the account administrator and/or the workers' compensation insurance carrier to litigation as well.