The Times West Virginian

Breaking News

West Virginia

February 20, 2013

Proposal: Help Medicaid recover costs

When recipients or survivors receive damage awards or court settlements

CHARLESTON — A state Supreme Court justice has warned that a recent ruling will cost West Virginia taxpayers millions of dollars, prompting Gov. Earl Ray Tomblin to ask the Legislature to revamp the way Medicaid recovers some of its spending.

Legislation introduced on the governor’s behalf this session would apply when Medicaid recipients or their survivors stand to receive damage awards or court settlements. Medicaid provides health coverage mostly to the blind, disabled and low-income children. The program’s rising health care costs place increasing pressure on the state general revenue budget.

The bill would require notice to the Department of Health and Human Resources of a lawsuit, claim or settlement offer. The department, which oversees Medicaid, would then become a party in the case. Any damage award or settlement must specify the amount meant to cover past medical expenses. The department would then receive at least some of that amount. The bill would also require that the department approve a settlement’s terms, or else a judge must hold a hearing to resolve the impasse.

Tomblin’s measure responds both to a June ruling from a divided Supreme Court, and a dissent to that decision from Justice Menis Ketchum. The case involves a child born in 2005 with severe brain damage, and a resulting medical malpractice lawsuit that was settled for $3.6 million.

The child’s mother had promptly enrolled him in West Virginia’s Medicaid program upon moving to Hancock County from Ohio, where he was born, in 2007. The program then sought to recover at least half of the more than $557,100 it had spent on the child’s care by the time the malpractice case settled in late 2009. The mother objected. Her lawyers argued that as the $3.6 million reflected a fraction of the true value of the child’s case, which they estimated at $25.3 million, Medicaid should only receive a similar percentage. A judge agreed in 2010, limiting the program’s recovery to $79,000.

Supreme Court rulings do not identify minors or their families, instead using initials or partial names. The June opinion written by Chief Justice Brent Benjamin largely upheld that judge’s findings, while increasing Medicaid’s recovery amount to $96,000. Justice Margaret Workman partly agreed and partly disagreed in the case. Ketchum, meanwhile, blasted the outcome.

“As a result of the majority holding, West Virginia’s taxpayers will not be reimbursed for the millions of dollars a year it pays on the medical bills of Medicaid recipients,” his dissent said. “Settlements paid by insurance companies to Medicaid recipients will be kept by the recipients and West Virginia will keep paying their medical bills.”

Ketchum’s key concern: Benjamin’s decision wrongly concludes that West Virginia cannot recover money for future medical expenses.

Medicaid continues to pay for 16 hours of nursing care for the Hancock County child. His mother estimates that most of his case’s true value, around $19.1 million, reflects future medical costs. She also expects that Medicaid will provide that future medical care, as the settlement was placed in a trust fund that does not count against his eligibility. But she balked at allowing the program to receive any money for future costs. The circuit judge and the Supreme Court both agreed.

“There is no question that (the department) may only be reimbursed for its past medical expenses,” Benjamin wrote.

Ketchum argues that this finding misreads a U.S. Supreme Court opinion addressing Medicaid recoveries.

“West Virginia’s taxpayers will be paying, through Medicaid, plaintiff’s future medical bills that will total more than $19 million dollars,” Ketchum wrote. “The plaintiff will be able to use the millions put in the special needs trust as a supplement to enhance quality of life.”

Tomblin’s bill reflects Ketchum’s recommendations for responding to the decision. It also adopts the process outlined by Benjamin in the majority ruling for resolving disputes over settlement terms. While focusing on recovering past medical expenses, the governor’s proposal also mandates that any settlement or damage award identify a specific amount for covering future expenses as well.

“”We’re trying to update the statute, to put it in compliance with (the decision),” said Peter Markham, Tomblin’s chief lawyer. “We’re also trying to address some of Justice Ketchum’s concerns, that DHHR is properly compensated for past medical expenses.”

Text Only
West Virginia
  • Energy-state Dems split from Obama

    Scrapping to keep a West Virginia Senate seat Democratic in a state that’s sprinted to the right, Natalie Tennant is counting on her allegiance to the coal industry to separate herself from an unpopular President Barack Obama.
    Her approach reflects common Democratic strategy and tactics this midterm election year in energy-producing states that lean Republican: Sen. Mary Landrieu is vying for a fourth term representing Louisiana; Alaska Sen. Mark Begich is running for re-election for the first time; and Kentucky Democrat Alison Lundergan Grimes wants to replace Senate Minority Leader Mitch McConnell.

    April 17, 2014

  • Official: $2M in chemical spill costs reimbursable

    Public agencies and nonprofits that helped after a Jan. 9 chemical leak into the water supply could receive $2 million in reimbursements for their emergency work, a West Virginia homeland security official said.
    Federal and state emergency officials briefed fire departments, paramedics and other government groups Wednesday on how to recoup costs.

    April 17, 2014

  • Manchin urges mines to speak out for coal

    The Democratic senator leading the battle against the White House’s strategy to fight climate change urged the mining industry on Tuesday to speak out about coal’s role in providing affordable, reliable electricity to the country to help combat strict new emissions rules for coal-fired power plants.

    April 16, 2014

  • Many schools already meet new mandate for breakfast

    Many West Virginia public schools have changed the way they serve breakfast to students ahead of a requirement that goes into effect in September.

    April 14, 2014

  • W.Va. grower promotes unmodified feed corn

    Lyle Tabb is hoping that his non-genetically modified corn will take off with farmers who can charge top dollar for “all natural” eggs.
    Genetically modified or GMO corn has greatly simplified the process of getting rid of weeds, but has also substantially increased the amount of a chemical call glyphosate.

    April 13, 2014

  • Geologists link small quakes to fracking

    Geologists in Ohio have for the first time linked earthquakes in a geologic formation deep under the Appalachians to hydraulic fracturing, leading the state to issue new permit conditions Friday in certain areas that are among the nation’s strictest.
    A state investigation of five small tremors last month in the Youngstown area, in the Appalachian foothills, found the injection of sand and water that accompanies hydraulic fracturing, or fracking, in the Utica shale may have increased pressure on a small, unknown fault, said State Oil & Gas Chief Rick Simmers. He called the link “probable.”

    April 12, 2014

  • Phares looks forward to retirement

    James Phares looked forward to the challenge and opportunity to help make a difference in a state education system under fire when he was hired in late 2012 as West Virginia’s schools superintendent.
    After 18 months, Phares will be stepping down on June 30 — which he said was set long ago as the day at age 61 that he’d walk with his wife into retirement.

    April 11, 2014

  • Teacher planning, abortion ban among W.Va. vetoes

    Gov. Earl Ray Tomblin signed about 200 bills and nixed eight this year, leaving teachers and abortion opponents unsatisfied.

    April 7, 2014

  • Spill company president ‘bears no fault’

    The president of Freedom Industries “bears no fault” for a West Virginia chemical spill that spurred a water-use ban for up to 10 days for 300,000 people, his lawyer says in a court filing.
    On Friday, Freedom President Gary Southern withdrew his application to get paid for work he already did during the company’s bankruptcy proceedings. He also wanted Freedom and its insurance to cover his legal fees related to the Jan. 9 spill.

    April 5, 2014

  • Agencies to ask West Virginia residents about chemical spill

    Health agencies are making thousands of phone calls and going door-to-door to ask West Virginians how a January chemical spill affected them.
    The state Bureau for Public Health announced Thursday that volunteers will survey randomly selected households in nine counties about health concerns from the spill.

    April 5, 2014

House Ads
Featured Ads