Q&A: Recoupment Following an Adverse Medicaid Appeal

Executive Summary

Legal Director Jane Perkins provides guidance on a question regarding Medicaid managed care plans’ abilities to recoup costs of health services following an adverse Medicaid appeal. Medicaid applicants and recipients have rights to notices and administrative hearings when their claims for medical assistance are denied or not acted on with reasonable promptness. The due process rights of applicants and recipients are explained pursuant to case law, Medicaid regulations and guidance from the Centers for Medicare & Medicaid Services (CMS).