Applying for Medicaid After a Car Accident

Applying for Medicaid After a Car Accident

If you were injured in a car accident, the most important first step is to seek prompt medical attention. Unfortunately, emergency medical treatment can be incredibly expensive, especially if you do not carry health insurance. Without health insurance, medical bills can rapidly accumulate. These medical bills remain your responsibility, even though you may receive compensation in a personal injury settlement. If, after a car accident, you require medical treatment but do not have health insurance, Medicaid may be another option.

What is Medicaid? 

Medicaid is a government-funded health insurance program that provides health benefits for medical expenses for eligible individuals and their families. Medicaid coverage is based on several factors, with income being the most important. Medicaid is designed to help low-income individuals and their families have access to necessary medical treatment. 

A nurse kneels next to a woman wearing a hospital gown sitting in a wheelchair in a hospital hallway

What Does Medicaid Do?

In general, Medicaid covers the costs of medical treatment after a car accident, including hospitalization, medications, and other necessary medical services. Medicaid coverage is available to eligible individuals and their families, regardless of fault. To determine if you are eligible for Medicaid, you should contact Colorado’s Medicaid program and provide information about income, assets, and other relevant factors.

What If I Don’t Have Insurance?

Medical bills can pile up very quickly. If you do not have health insurance, you will be personally responsible for all medical costs, even if the accident was not your fault. Most medical providers will not wait for the outcome of your personal injury case to collect their fees. Your case may take years to resolve, and your doctors will want to get paid long before that. 

Medical Bills & Your Personal Injury Claim

Your personal injury claim will take time to develop. This is because your personal injury lawyer will seek compensation for all damages over the course of your treatment. The extent of your damages will not be known until you have recovered, and your treatment has stopped. Settling your case too early could leave significant compensation on the table instead of in your pocket. 

Medical bills accrue much faster than the conclusion of your personal injury matter. If you have unpaid medical bills, it is likely they will be sent to collection agencies, which could result in significant interest and negative impacts on your credit score. Our experienced personal injury lawyers will keep track of your medical bills and make sure your bills are processed through the appropriate channels.

A depiction of a person reviewing online documents

Benefits of Medicaid After An Accident

Processing medical costs through Medicaid will drastically reduce, or even eliminate, your personal responsibility for these bills. For all covered services, Medicaid will reimburse providers directly pursuant to their contracted terms. All you may need to pay yourself is a nominal co-pay. Moreover, Health First Colorado does not have deductibles, so covered services will be reimbursed immediately. 

Am I Eligible for Medicaid?

Colorado’s Medicaid program is known as “Health First Colorado.” To be eligible for Health First Colorado, you must be a resident of the state, a U.S. national, citizen, permanent resident, or legal alien whose financial situation would be characterized as low income or very low income. You must also be eligible if you qualify as one of the following categories: 

  • Pregnant;
  • Be responsible for a minor child;
  • Blind;
  • Have a disability or a family member in your household with a disability; or
  • Be 65 years of age or older.

As previously mentioned, there are income requirements. The income requirements depend on the size of your household. The chart below outlines the income requirements based on specific household size:

Household SizeMaximum Income Level Per Year

Applying for Medicaid after a Car Accident

This question is the reason we decided to draft this article. It is not uncommon for uninsured parties to require medical treatment following an accident. Unfortunately, emergency rooms are not the best place for these parties to receive advice that could help cover medical bills. Hospitals are for-profit organizations. Often, billing departments do not share information regarding Medicaid retroactively applying to bills once a party is approved. 

Retroactive Coverage

If you did not carry health insurance on the date you were injured, but presented to the emergency room, you could still apply and may be eligible. In Colorado, eligibility can be made retroactive up to three months prior from the application date. This means that your emergency room visit and subsequent treatment may be covered by Medicaid even if you did not have such insurance at the time of the accident. 

It is, however, absolutely imperative that you act fast. An experienced personal injury lawyer can help you through the Medicaid application process and make sure your bills get processed properly. If approved for retroactive coverage, you must inform your previous medical providers. If you do not notify your providers, you will not be reimbursed for any fees you already paid and will be obligated to cover outstanding bills. Upon notification of retroactive coverage, a Medicaid-participating provider must return any fees you paid, minus required co-pays, and bill Medicaid for the covered services.

Medicaid For Non-U.S. Citizens

Colorado offers Emergency Medicaid for qualified non-U.S. citizens. Emergency Medicaid provides short-term health coverage for non-citizens who have suffered a “life or limb threatening emergency.” Medicaid defines an “emergency medical condition” as a condition that manifests itself by acute symptoms of sufficient severity, such that the absence of immediate medical attention could reasonably be expected to result in:

  • Placing the patient’s health in serious jeopardy;
  • Serious impairment to bodily function; or
  • Serious dysfunction of any bodily organ or part.

A physician must complete a written statement certifying the presence of an emergency medical condition. If approved, coverage will be limited to care and services necessary to treat the emergency medical condition(s). These “emergency services” may include transportation, emergency room care, and urgent care outpatient services.

Emergency Medicaid applicants must also meet all other eligibility requirements as other Medicaid participants. You may apply for Emergency Medicaid at the emergency room or after discharge for up to three months. You can apply for Emergency Medicaid by mail, in-person, online, or over the phone. More information on how to apply can be found here.

Disenrollment from Medicaid Without Warning

A depiction of a person signing online documents

At the beginning of the COVID-19 Pandemic, the federal government declared a public health emergency (“PHE”) that ensured anyone enrolled in Health First Colorado was guaranteed to keep their health coverage even if their income changed during the PHE. This was also known as the “continuous coverage requirement” and it safeguarded against disenrollment. 

In 2023, the public health emergency was declared over. Subsequently, states began the process of redetermining Medicaid eligibility. By September 2023, seven million people had lost Medicaid coverage, with a total of 15 million eventually expected to be kicked off the plan by year’s end. As these disenrollments continued, troubling data emerged. By the spring of 2023, it became apparent many eligible participants had lost coverage due to procedural and administrative issues. 

If that was not bad enough, computer issues in nearly 30 states caused eligible participants to suddenly lose their coverage. Many states had used computer programs to determine whether individuals should automatically be re-enrolled in Medicaid. If eligibility was unclear, states then attempted to contact people for more information. If there was no response, states dropped these patients as a “procedural termination.”

In August 2023, it was discovered some states were flagging and subsequently disenrolling entire households, instead of reviewing each individual separately. In response, Centers for Medicare and Medicaid Services (CMS) required states to retroactively restore Medicaid coverage and halt procedural terminations until the computer issues were fixed.

These massive disenrollments also prompted a letter from Health and Human Services Secretary Xavier Becerra to the country’s governors. Secretary Becerra urged the states to adopt available practices to minimize avoidable coverage losses among otherwise eligible participants. In the letter, Secretary Becerra wrote:

Nobody who is eligible for Medicaid or the Children’s Health Insurance Program should lose coverage simply because they changed addresses, didn’t receive a form, or didn’t have enough information about the renewal process…We encourage states to utilize all available flexibilities to ensure children and families don’t lose coverage. We also urge states to join us in partnering with local governments, community organizations, and schools to reach people eligible for Medicaid and CHIP where they are.”

In June 2023, Health and Human Services announced new flexibilities states could adopt to prevent the disenrollment of eligible Medicaid patients. Among them included:

  • Allowing managed care plans to assist Medicaid patients with completing renewal forms.
  • Letting states delay an administrative termination of coverage for one month while the state conducted additional targeted outreach.
  • Allowing pharmacies and organizations to facilitate reinstatement of coverage for those who had lost it due to procedural issues.

Many of the Medicaid recipients did not even know they were disenrolled. If you fall into this category, you may have had an unpleasant surprise when you were at the doctor and told you no longer had Medicaid benefits. If this happens and you are the victim of a car accident, it is beneficial to contact an experienced personal injury lawyer.

Children are Especially at Risk of Losing Medicaid Coverage

There has been growing concern children are losing Medicaid coverage even though they are eligible. Children are generally eligible for Medicaid at higher income levels than adults. Parents who no longer believe they are Medicaid eligible decide not to file renewal applications. They do not realize this could impact their children’s coverage, who may indeed still be eligible. Too often, parents take their children to the doctor believing they are on Medicaid, only to learn they are no longer covered.

Consult a Personal Injury Lawyer

The aftermath of a car accident is overwhelming. Navigating the claim process and keeping track of your medical bills can be impossible to do alone. If you have been injured due to the fault of another driver, consult with the personal injury lawyers at Bowman Law to understand how to manage your medical bills and discuss whether applying for Medicaid may be your best option. Our experienced personal injury lawyers can help you ensure you receive the compensation you deserve. 

Contact or call Bowman Law today. We serve Colorado’s Front Range including Denver, Colorado SpringsBoulderFort Collins, and Aurora.