WCMSA Threshold

Posted by John Cattie

Question:
If a settlement is under $25,000, no need to worry about Medicare/Medicaid, right? It's been so long since I've had to deal with these now, I wanted to make sure. Do you remember what year they changed the requirement from $250,000 to $25,000 for the Trust requirement?

-Ohio Attorney

Answer:
In the CMS Memo dated 4/25/06, CMS raised the low dollar threshold level in WCMSAs from $10,000 to $25,000. As you will see, this amount represents a workload review threshold, not a safe harbor amount. Medicare’s interests must be taken into consideration in a WC case no matter what the settlement total. If there is going to be a permanent shift of the burden of future injury-related costs of care from the WC carrier to Medicare as a result of the settlement, and the claimant will have future injury-related costs of care otherwise covered by Medicare, a WCMSA is appropriate per the guidance we have received from CMS for WC settlements. I am happy to discuss this and related topics with you further at your convenience. Please let me know how I can assist.