Do You Lose Medicaid if You Get a Settlement

Getting a settlement from a lawsuit or a personal injury claim does not automatically mean losing Medicaid coverage. It depends on how the settlement is structured and used. Medicaid has rules and limits regarding income and asset levels. If the settlement results in significant increase in income or assets, it may affect Medicaid eligibility. However, if the settlement is used to pay for medical expenses, it may still be possible to keep Medicaid coverage. It’s important to notify the state Medicaid agency about the settlement and work with them to determine how it will impact Medicaid eligibility. It’s recommended to discuss with an attorney and Medicaid agency to ensure the settlement is structured in a way that preserves Medicaid coverage.

Medicaid and Qualifying for Benefits

To be eligible for Medicaid, you must meet income and asset requirements. The limits vary from state to state, but generally, your income and assets must be below certain levels to qualify.

Impact of Settlements on Medicaid Eligibility

If you receive a settlement, it may affect your Medicaid eligibility. Whether or not a settlement affects your Medicaid eligibility depends on how much money you receive, how the money is used, and the type of settlement.

Medicaid and Asset Limits

Medicaid has asset limits for both individuals and families. These limits include cash, bank accounts, stocks, bonds, and other investments. A settlement that pushes your assets above the Medicaid limits could make you ineligible for benefits.

Medicaid and Lump Sum Payments

Medicaid considers lump-sum payments, such as settlements, as resources and counts them toward your asset limit. How this affects your eligibility depends on several factors, such as the amount of the payment and how you use the money.

Protecting Your Medicaid Eligibility

  • If you receive a settlement and are concerned about losing your Medicaid eligibility, there are steps you can take to protect your benefits:
  • Set aside the money in a special needs trust.
  • Purchase a home or vehicle that meets Medicaid asset limits.
  • Spend the money on qualified medical expenses.
  • Contact your state Medicaid office for guidance.

Special Needs Trust

A special needs trust is a legal document that allows you to set aside money for a person with a disability without affecting their eligibility for government benefits, like Medicaid.

Individual Asset LimitCouple Asset Limit
New York$16,800$25,200

Settling a Lawsuit While on Medicaid

If you’re in a situation where you’re receiving Medicaid benefits and have a cause of action for a lawsuit, it’s important to understand how any potential settlement funds could affect your Medicaid eligibility. Medicaid is a government-funded health insurance program that provides coverage to millions of low-income and disabled individuals in the United States. One of the stipulations of Medicaid is that beneficiaries must meet specific income and asset limits to be eligible for coverage.

Qualified Settlement Accounts

To protect Medicaid benefits while receiving a lump sum settlement, you can establish a Qualified Settlement Account (QSA). A QSA is a special bank account that allows you to hold your settlement funds without impacting your Medicaid eligibility. Funds in a QSA can be used to pay for a variety of Medicaid-approved expenses, ensuring you continue to receive essential medical coverage.

  • Benefits of a QSA:
    • Protects Medicaid eligibility
    • Allows for the accumulation of funds for future medical expenses
    • Provides flexibility in managing funds
  • Restrictions on QSA Funds:
    • Cannot be used for non-medical expenses
    • Funds cannot be withdrawn in a lump sum
    • Withdrawals must be used for qualified medical expenses

To set up a QSA, you must obtain approval from the Medicaid agency in your state. This typically involves submitting an application and providing documentation of your Medicaid eligibility and the settlement agreement.

Other Considerations

  • Medicaid Liens: In some cases, Medicaid may place a lien on your settlement funds to recover the cost of medical expenses they have paid on your behalf. To avoid this, it’s important to negotiate with the Medicaid agency to reduce or waive the lien.
  • Medicaid Spend-down: If your settlement funds exceed the Medicaid asset limit, you may need to “spend down” the funds on Medicaid-approved expenses before becoming eligible for coverage again.
  • Estate Planning: If you have a QSA, it’s important to consider estate planning strategies to ensure that the funds are properly distributed upon your death.
Medicaid and Qualified Settlement Accounts (QSAs)
Medicaid EligibilityQSA
Income and Asset LimitsDoes not count as an asset
Use of FundsMust be used for Medicaid-approved expenses
WithdrawalsCannot be withdrawn in a lump sum
Estate PlanningSpecial considerations for distribution upon death

It’s crucial to consult with an attorney who specializes in Medicaid planning and an experienced financial advisor before making any decisions about settling a lawsuit while receiving Medicaid benefits. Proper guidance can ensure that your settlement is structured in a way that protects your Medicaid coverage and allows you to access the funds for necessary medical expenses.


Medicaid and Personal Injury Settlements

If you are receiving Medicaid benefits and you receive a personal injury settlement, you may be worried about how it will affect your Medicaid coverage.

The good news is that, in most cases, you will not lose your Medicaid coverage if you receive a personal injury settlement. However, there are some important things you need to know about how settlements can affect your Medicaid benefits.

Medicare Set-Asides

  • If your personal injury settlement is large enough to cover your medical expenses for the next 36 months, you may be required to set aside a portion of the settlement in a Medicare Set-Aside (MSA) account.
  • The MSA is used to pay for your Medicare-covered medical expenses.

If you have an MSA, you can continue to receive Medicaid benefits, but the amount of your Medicaid benefits may be reduced.

The amount of your Medicaid benefits will be reduced by the amount of money that is in your MSA.

How to Protect Your Medicaid Benefits

  • There are a few things you can do to protect your Medicaid benefits if you receive a personal injury settlement.
  • First, you should talk to your Medicaid caseworker about the settlement.
  • Your caseworker can help you determine if you need to set up an MSA and how the settlement will affect your Medicaid benefits.
  • You should also consider hiring an attorney to help you negotiate your personal injury settlement.
  • An attorney can help you get the best possible settlement and protect your Medicaid benefits.


If you are receiving Medicaid benefits and you receive a personal injury settlement, it is important to take steps to protect your Medicaid coverage. By talking to your Medicaid caseworker and hiring an attorney, you can help ensure that you continue to receive the Medicaid benefits you need.

Medicaid and Personal Injury Settlements
Medicaid CoverageMSA RequiredMedicaid Benefits
Small SettlementYesNoNo change
Large SettlementYesYesReduced by amount in MSA

So, there you have it, folks! Hopefully, this article has helped you navigate the complexities of Medicaid and settlements. Remember, every situation is unique, so it’s always best to consult with an expert before making any decisions. Thanks for sticking with me until the end. If you have any more questions, don’t hesitate to drop me a line. I’ll be here, ready to help. In the meantime, feel free to browse through our other articles on various legal and financial matters. Keep learning, keep growing, and I’ll see you again soon with more insightful content. Take care and keep your financial future secure!