Court questions whether Maine has money to expand Medicaid
U.S. Court News
Maine's high court is weighing whether to allow the LePage administration to continue to block federal funding for voter-approved Medicaid expansion.
Justices on Wednesday heard the administration's arguments against a court order requiring the submission of paperwork needed for $500 million in annual federal funding. Justices questioned whether Maine can rely on existing state funds for Maine's share of expansion or whether lawmakers must specifically set aside funding.
Nearly three out of five voters last fall voted to expand Medicaid to 80,000 people by July 2. Advocates are encouraging people to sign up.
LePage vetoed legislation to fund Maine's expansion costs and suggests new hospital taxes could cover expansion.
LePage recently said he'd risk jail before expanding Medicaid and putting Maine in "red ink."
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.