Arizona's Medicaid Personal Injury Case Rules

Medicaid is a needs-based health-insurance program jointly funded by federal and state governments. Arizona's Medicaid agency is called the Arizona Health Care Cost Containment System Administration (AHCCCSA). The AHCCCSA oversees program operations in compliance with federal and state laws, as well as eligibility requirements. Dealing with the laws regarding personal-injury cases is as harrowing as navigating a minefield. It is best to seek attorneys who specialize in the specific type of personal injury involved in each case.

Personal Injury Law

Personal injury case rules deal with compensation for physical injuries and emotional sufferings inflicted on a person, together with losses and damages as a consequence of another individual's actions. In a lawsuit, major issues such as the liability, cause of injury and resulting damages must be successfully proven in court. In Arizona, a victim has two years from the date of the accident to file a personal injury claim. Generally, cases are settled out of court before the trial. To ensure that both upfront and hidden costs are accounted for and just compensation is awarded, a claimant should list all injuries, keep track of all medical bills, and compute lost wages arising from the incident.

Section 607.45 of the AHCCCS Eligibility Manual deals with the agency's policies on insurance awards and legal settlements. This section qualifies the AHCCCS customer eligibility treatment type as cash settlement from a personal injury case. Payments may be awarded for financial loss, pain and suffering, loss of ability to earn income, and other legitimate reasons. Financial compensation may be received as a lump-sum payment, in periodic installments or a combination of both.

Certain conditions apply, depending on the payment type. If the payment is to compensate the claimant for loss of property or its value resulting from the damage; to reimburse medical and related expenses that are chargeable to the insurance company; or to pay legal fees, medical and related costs incurred in the settlement, then the treatment is excluded for all AHCCCS programs. If the payment is to compensate the claimant for any other reason, then the treatment is counted for all programs.

Lawyer's fees are deductible. These may have been taken from the award by the insurance company or by the lawyer himself when he received the cash settlement on his client's behalf.

The claimant needs to submit official documents to AHCCCSA in order to process the claim. The types of proofs include a written statement from, and collateral contact with, the insurance company; court documents in connection with the lawsuit; and a copy of the award letter.