The Centers for Medicare and Medicaid Services (CMS) recently announced that their Medicare Set-Aside review process may be expanded to include liability and no-fault insurance claims.

What is Medicare Set-Aside Review?

Medicaid Set-Aside occurs when an individual who receives a settlement from an injury that will cause increased costs for Medicare when that individual becomes eligible for Medicare. When such a settlement occurs, the individual is required to “set-aside” a certain portion of that settlement in order to compensate Medicare for future added expenses.

CMS, the agency that runs Medicare and Medicaid, reviews some settlements in order to approve of the designated Medicare Set-Aside amount. These reviews, however, currently only occur in workers’ compensation cases. Even in workers’ compensation settlements review is only required in certain cases where the settlement is large enough and the person receiving the settlement is eligible, or soon to be eligible, for Medicare.

What the Expansion May Mean

The expansion of reviews to include settlements from liability and no-fault insurance would likely apply Medicare Set-Aside review to settlements from personal injury cases. As is the case with workers’ compensation cases, these reviews would likely only occur in cases where the settlement is large enough and the recipient is receiving or can soon receive Medicare benefits.

What is next in the process?

Currently this is just a proposal with no definite timetable. A similar review expansion was proposed several years ago, but that proposal was withdrawn after a lack of budgetary support. To follow up on the current proposal and to gauge the interest of potential stakeholders, CMS will likely seek comments and hold town hall meetings at some point in the coming months.