MSAs, Medicare Eligibility and Review Thresholds

Medicare Set-Aside Blog on April 22, 2003 | Posted by



After reviewing incoming questions about MSAs, Medicare eligibility, and review thresholds, CMS  published the following memo to address some of the increasing concerns about adequately protecting Medicare’s interests through WC MSAs.

As MSAs were becoming more common, questions were being raised about which types of administrative costs can be included in an MSA? What happens to unspent money from the account? What are some of the issues that arise when a settlement has been approved by a state court or administrative agency? This memo attempts to deal with some of the basic MSA issues that had not been addressed in the past. Furthermore, this memo includes a list of the CMS regions and the corresponding states.


Some of the questions and answers provided in this memo include:

What statutory law, regulations, or Federal case law supports/allows CMS to review proposed settlements of injured workers who are not Medicare beneficiaries?

When dealing with a WC case, what is “a reasonable expectation” of Medicare enrollment within 30 months?

When a state WC judge approves a WC settlement, will Medicare accept the terms of that settlement?

May administrative fees/expensees for administration of the Medicare set-aside arrangement and/or attorney costs specifically associated with establishing the Medicare set-aside arrangement be charged to the set-aside arrangement?


If a beneficiary or injured individual’s physical condition substantially improves, may the administrator of the Medicare set-aside arrangement release or reduce the amounts of the set-aside?

If Medicare rejects a proposed Medicare set-aside arrangement, how can the parties to a WC settlement appeal this rejection?

You may read the full memo/PDF file on their site.


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