Frequently Asked Questions
Workers Comp and Medicare Set-asides


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Q13. Effect of WCMSA on Medicaid Eligibility

Does a WCMSA have an effect on Medicaid resources for purposes of eligibility to Medicaid?
A13. Medicare set-aside arrangements are not subject to any special treatment under Medicaid resource rules. These funds should be evaluated to determine if they meet the legal definition of a resource for Supplemental Security Income (SSI), and therefore Medicaid, purposes, i.e., "cash or other assets that an individual owns and could convert to cash to be used for his or her support and maintenance." The funds must be in interest-bearing accounts. These funds may meet the SSI/Medicaid resource definition.
There may be cases in which funds in a Medicare set-aside arrangement are placed into trusts, possibly trusts that would satisfy the definition of "special needs trusts" under Section 1917 of the Social Security Act. In those cases, the funds might not be a countable resource, but that result would be solely on the basis of Medicaid, not Medicare, rules.