Medicaid And Public Assistance Lien Review-Deferral-Reduction Request

MEDICAID AND PUBLIC ASSISTANCE LIEN REVIEW/DEFERRAL/REDUCTION REQUEST. This form is used to request a review, deferral, or reduction of Medicaid and Public Assistance liens related to settlements received by clients. It includes fields for case information such as caption, index number, courthouse, client's details including name, date of birth, and social security number, as well as details of the accident, injuries sustained, and settlement amounts. The purpose of the form is to gather information necessary for Westchester County to assess whether Medicaid and/or Public Assistance liens can be deferred or reduced based on specific criteria. It requires supporting documentation, including bills of particulars and a letter signed by an attorney stating the basis for the request (such as incorrect lien amount or hardship justification). The form provides options for different types of requests: Claims review if disputing the lien amount. Medicaid lien deferral based on the case value. Public Assistance lien reduction with justification of hardship or other need. www.FormsWorkflow.com