Recovery and Reimbursement of Aid

ORS 416.540
Lien of department and authority

  • assignment of lien to prepaid managed care health services organization or coordinated care organization


(1)

Except as provided in subsection (2) of this section and in ORS 416.590 (Procedure when recipient is minor), the Department of Human Services and the Oregon Health Authority shall have a lien upon the amount of any judgment in favor of a recipient or amount payable to the recipient under a settlement or compromise for all assistance received by such recipient from the date of the injury of the recipient to the date of satisfaction of such judgment or payment under such settlement or compromise.

(2)

The lien does not attach to the amount of any judgment, settlement or compromise to the extent of attorney’s fees, costs and expenses incurred by a recipient in securing such judgment, settlement or compromise and to the extent of medical, surgical and hospital expenses incurred by the recipient on account of the personal injuries for which the recipient had a claim.

(3)

The authority may assign the lien described in subsection (1) of this section to a prepaid managed care health services organization or a coordinated care organization for medical costs incurred by a recipient:

(a)

During a period for which the authority paid a capitation or enrollment fee or a payment using a global payment methodology; and

(b)

On account of the personal injury for which the recipient had a claim.

(4)

A prepaid managed care health services organization or a coordinated care organization to which the authority has assigned a lien shall notify the authority no later than 10 days after filing notice of a lien.

(5)

For the purposes of ORS 416.510 (Definitions for ORS 416.510 to 416.610) to 416.610 (Action against recipient who fails to provide notice of claim), the authority may designate the prepaid managed care health services organization or the coordinated care organization to which a lien is assigned as its designee.

(6)

If the authority and a prepaid managed care health services organization or a coordinated care organization both have filed a lien, the authority’s lien shall be satisfied first. [Formerly 411.558; 2001 c.600 §4; 2009 c.595 §348; 2011 c.602 §51; 2012 c.8 §27]

Notes of Decisions

Where assistance grants were made to children, settlements due parents were subject to lien because "recipient" refers to family unit rather than individuals. Christensen v. AFSD, 122 Or App 71, 857 P2d 162 (1993)

Recovery against settlement of personal injury claim is prohibited except to extent that settling party's legal liability is related to need for Medicaid-funded treatment. AFSD v. Northland Ins. Co., 139 Or App 92, 911 P2d 942 (1996), Sup Ct review denied

Recipient of settlement for personal injury allegedly related to need for treatment may not assert lack of causation as defense against lien. AFSD v. Northland Ins. Co., 139 Or App 92, 911 P2d 942 (1996), Sup Ct review denied

Medical, surgical and hospital expenses are "incurred" by recipient only to extent that recipient has paid or is legally obligated to pay expenses at time of settlement. King v. Adult and Family Services Division, 142 Or App 444, 921 P2d 1326 (1996)

§§ 416.510 to 416.610

Atty. Gen. Opinions

Prior right of Motor Vehicles Accident Fund or Adult and Family Services Division to reimbursement for costs of medical services provided indigent, (1980) Vol 41, p 257


Source

Last accessed
Jun. 26, 2021