Frequently Asked Questions  

 

 

What is the difference between Medicaid and Medicare?

 

In broad, general terms, Medicaid is health insurance for the indigent; Medicare is health insurance for the elderly and disabled.  Medicaid is a State administered health insurance program overseen by the federal Centers for Medicaid and Medicare Services (CMS).  Medicare is a federally administered program.  A person may have both Medicaid and Medicare.  The Ohio Tort Recovery Unit is only responsible for the identification and recovery of Medicaid paid funds.  The Medicare Secondary Payor (MSP) Unit is responsible for the identification and recovery of Medicare funds.  You can contact the MSP unit at (513) 852-4353.

 

Does the State of Ohio contribute to attorney's fees and costs for recovery in a settlement or lawsuit that involves a Medicaid recipient?

 

Pursuant to Ohio Revised Code Section 5160.37, the State of Ohio does not contribute to attorney’s fees or costs for recovery of Medicaid funds in a settlement or lawsuit that involves a Medicaid recipient.  Attorney’s fees and costs are subtracted from any settlement or judgement before ODM recovers its lien amount, but ODM lien is not pro rated for any fees or costs.

 

How long does it take to get Medicaid paid claims information from the Tort Recovery Unit?

 

Typically it takes two to three weeks to get paid claims information from the Tort Recovery Unit.  However, each case is different.  For example, if the date of the accident or incident is greater than one year, it may take longer to get claims information than if the accident or incident was six months ago.  Also, Medical providers have up to one year from the date of service to bill Medicaid.  If a Medicaid Manage Care Plan (MCP) provided services to the Medicaid recipient, the Tort Recovery Unit must request claim information from the MCP and the MCP has 30 days to reply.

 

What is a Medicaid recipient's liability to the Medical provider?

 

Please see Ohio Administrative Code 5101:3-1-13.1 Medicaid consumer liability [except for consumers enrolled in medicaid managed care]

 

If the tort or casualty incident involves a Municipality, is the municipality immune from subrogation or recovery under Ohio Revised Code 2744.05, especially in light of the Ohio Supreme Court's decision in State ex rel. Ohio Academy of Trial Lawyers v. Sheward?

 

History of ORC section 2744.05

 

ORC section 2744.05 was first enacted under HB 176 and became effective November 20, 1985.  In essence ORC 2744.05 places limitations on damages awarded a person in actions against a political subdivision where the damages were the result of an act or omission of the subdivision in connection with a governmental or proprietary function.  HB 350 amended ORC 2744.05 effective January 27, 1997.  The HB 350 amendment predominately added language to subsection (C)(2) to clarify the meaning of the phrase "the actual loss of the person who is awarded the damages".  HB 350 did not address the subrogation rights of ODM.  The subrogation rights of ODM were addressed in HB 215, effective September 29, 1997.  HB 215 added subsection (B)(2)(b) that specifically stated that the limitation to damages in an action against a political subdivision does not "prohibit the Department of Human Services from recovering from the political subdivision, …, the cost of medical assistance benefits…"  More recently, HB 471, effective 7/1/00, changed the reference to the Department of Human Services to the Department of Job and Family Services.

 

Effect of State ex rel. Ohio Academy of Trial Lawyers v. Sheward (Sheward) on ORC 2744.05 and ODM's subrogation rights.

 

In 1999, the Ohio Supreme Court ruled in Sheward that HB 350 (the Tort Reform Act) was unconstitutional because it violated the one-subject provision of section 15(D), Art. II of the Ohio Constitution.  Accordingly, any amendments to the revised code effected by HB 350 would be null and void.  However, as discussed above, the HB 350 amendment to ORC 2744.05 did not address the subrogation rights of ODM.  The subsection to ORC 2744.05 that addressed ODM's subrogation rights was enacted by HB 215.  Consequently, the unconstitutionality of HB 350 had no effect on ODM's recovery rights relative to ORC 2744.05.

 

 

 

Ohio Tort Recovery Unit

350 Worthington Rd, Suite G,

Westerville, Ohio 43082

Local: 614-242-1045

Toll Free: 888-245-9019

Fax:614-242-1051

Email: ohiotort@hms.com

 

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