{"data":{"id":"us-ok/okla.-stat.-tit.-12-12-994.2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 12, § 12-994.2","heading":"Medicaid recovery - Oklahoma Health Care Authority","body":"recovery - Calculations.\n\nA. Recovery against the party that received payment.\n\n1. General rule. Medicaid reduces its recovery to take account\n\nof the cost of procuring the judgment or settlement, as provided in\n\nthis section, if:\n\na. procurement costs are incurred because the claim is\n\ndisputed, and\n\nb. those costs are borne by the party against which the\n\nOklahoma Health Care Authority seeks to recover.\n\n2. Special rule. If the Oklahoma Health Care Authority must\n\nfile suit because the party that received payment opposes the\n\nAuthority's recovery, the recovery amount is as set forth in\n\nsubsection E of this section.\n\nB. Recovery against the third-party payer. If the Oklahoma\n\nHealth Care Authority seeks recovery from the third-party payer, the\n\nrecovery amount will be no greater than the amount determined under\n\nsubsection C, D or E of this section.\n\nC. Medicaid payments are less than the judgment or settlement\n\namount. If Medicaid payments are less than the judgment or\n\nsettlement amount, the recovery is computed as follows:\n\n1. Determine the ratio of the procurement costs to the total\n\njudgment or settlement payment;\n\n2. Apply the ratio to the Medicaid payment. The product is the\n\nMedicaid share of procurement costs;\n\n3. Subtract the Medicaid share of procurement costs from the\n\nMedicaid payments. The remainder is the Medicaid recovery amount.\n\nD. Medicaid payments equal or exceed the judgment or settlement\n\namount. If Medicaid payments equal or exceed the judgment or\n\nsettlement amount, the recovery amount is the total judgment or\n\nsettlement payment minus the total procurement costs.\n\nE. The Oklahoma Health Care Authority incurs procurement costs\n\nbecause of opposition to its recovery. If the Oklahoma Health Care\n\nAuthority must bring suit against the party that received payment\n\nbecause that party opposes the Authority's recovery, the recovery\n\namount is the lower of the following:\n\n1. Medicaid payment; or\n\n2. The total judgment or settlement amount, minus the party's\n\ntotal procurement cost.\n\nF. Medicaid recovery worksheet. The amount to be recovered\n\nfrom the beneficiary is the amount Medicaid paid, less a\n\nproportionate share of the costs of procuring the judgment or\n\nsettlement. The amount to be refunded is determined as follows:\n\nIf the Medicaid payment is less than the amount of judgment or\n\nsettlement:\n\na. determine the ratio of the Medicaid payments to the\n\ntotal amount of the judgment or settlement,\n\nb. apply this ratio to the costs of procuring the\n\njudgment or settlement, including attorney fees, and\n\nc. subtract the Medicaid share of procurement costs from\n\nMedicaid payments. The remainder is the amount of\n\nreimbursement to be refunded to the Medicaid Program.\n\nStep 1:\n\n$__________________ / $___________________ = ___________________\n\nMedicaid Payment Judgment/Settlement Ratio\n\nCarry out 6 digits\n\nStep 2:\n\n___________________ X $___________________ = ___________________\n\nRatio from Step 1 Procurement Costs Medicaid Share of\n\nCarry out 6 digits Procurement Costs\n\nStep 3:\n\n$__________________ - $___________________ = ___________________\n\nMedicaid Payment Medicaid Share of Refund to Medicare\n\nProcurement Costs\n\nG. If the Medicaid payments equal or exceed the amount of the\n\njudgment or settlement, subtract the total procurement costs from\n\nthe judgment or settlement. The remainder is the amount of\n\nreimbursement to be refunded to the Medicaid Program. The\n\nindividual will not be required to refund more than the liability\n\ninsurance payment minus the procurement costs.\n\n$__________________ - $___________________ = $__________________\n\nJudgment/Settlement Procurement Costs Refund\n\nH. The Oklahoma Health Care Authority is authorized to seek\n\nfrom the Centers for Medicare and Medicaid Services any waivers or\n\namendments to existing waivers or to amend the state Medicaid plan\n\nin order to accomplish the purposes outlined in this section.","path":["OK Code","Title 12"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os12.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"6a57d51b0d9af8017f8f269606896ec13c668fef4144234a90fb67bf6979f1fe","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-12-12-994","next":"us-ok/okla.-stat.-tit.-12-12-994.3"},"notice":"GroundRules: Original legal text. Not legal advice."}