In April 2025, the Centers for Medicare & Medicaid Services (CMS) implemented a sweeping change to how it oversees Workers’ Compensation Medicare Set-Asides (WCMSAs). For the first time, CMS began directly notifying Medicare beneficiaries about the details of their approved WCMSAs, down to the dollar amount and guidelines for how the funds should be spent.
This policy shift signals a new era of transparency, and scrutiny, in post-settlement fund management. For injured workers this development may feel empowering, but it also adds new complexity. With clearer visibility into what CMS expects, there’s far less room for error when it comes to spending MSA funds. The consequences for non-compliance, jeopardizing future Medicare benefits, are too significant to ignore.
At Ametros, we’ve long believed that injured workers deserve more than a check and a binder at settlement. They deserve a true partner. The new CMS policy underscores exactly why professional administration matters now more than ever.
The CMS Change: A Closer Look
Previously, injured workers with WCMSAs often received minimal direction after settlement, with the assumption that they would self-administer their funds correctly. But self-administration is challenging. It requires a clear understanding of CMS rules, strict record-keeping, and annual reporting; tasks that can be overwhelming for someone already managing a life-altering injury.
Now, CMS is actively sending two types of letters to beneficiaries with WCMSAs:
- One outlines the total approved MSA amount, instructions on how the funds must be used, annual reporting requirements, and the possibility of CMS requesting receipts and documentation.
- The second, a “Notice of Settlement Received” letter, is triggered when CMS receives confirmation of a settlement involving an MSA. This letter reiterates the importance of proper fund use and alerts the beneficiary that CMS will be monitoring their MSA for compliance.
This proactive outreach is a welcome improvement in many ways, but it also raises the stakes. Injured workers need to be confident that they’re using their settlement funds in full compliance with Medicare guidelines.
We recommend that payers or Responsible Reporting Entities (RREs) take an active role in setting expectations. At the time of settlement, inform injured workers and their counsel that they will receive these letters, and that CMS will be monitoring the MSA. Doing so will reduce confusion, build trust, and reinforce the importance of professional administration.
The Risk of Going It Alone
Let’s be candid, self-administering an MSA is like managing a miniature Medicare plan. It involves:
- Ensuring funds are only spent on Medicare-covered, injury-related care
- Verifying providers are Medicare-enrolled
- Tracking every transaction
- Reporting annually to CMS
- Avoiding co-mingling of funds
Failure to follow these steps can result in CMS denying payment for future care, or worse, requiring repayment of misused funds. Most injured individuals don’t have the expertise or bandwidth to manage this responsibility effectively.
Unfortunately, we see it far too often, someone tries to self-administer their funds, makes an innocent mistake, and winds up in a compliance mess. That’s not just financially damaging, it’s emotionally draining.
How Ametros Protects Injured Workers
Ametros offers a better way forward. Our CareGuard service takes over the administrative burden entirely. We act as the professional custodian of an injured worker’s MSA, ensuring every dollar is managed in compliance with CMS requirements. Here’s what that means in practical terms:
- Payments managed directly: We pay the bills for Medicare-covered, injury-related treatments, ensuring correct use of funds.
- Discounted pricing: CareGuard users get access to our discounts on their treatment, reducing the cost of prescriptions and medical services, and extending the life of their settlement.
- Real-time tracking and support: Members and their families have 24/7 access to an online portal to see exactly how their funds are being used and can contact our team of over 100 for support.
- Full compliance assurance: We handle all CMS reporting and documentation, protecting future Medicare eligibility.
We take the guesswork and risk out of post-settlement fund management. We provide peace of mind that’s hard to quantify, knowing that you’ll never have to debate with CMS over whether your care was compliant.
Professional Administration: A Win for All Stakeholders
What’s often overlooked is how professional administration benefits everyone involved in a workers’ compensation claim, not just the injured worker.
- For payers and attorneys, it reduces the risk of post-settlement disputes or MSA mismanagement that could reflect poorly on the settlement process.
- For Medicare, it ensures settlement funds are used appropriately and that the program isn’t footing the bill for care that should be covered by the MSA.
- For families and caregivers, it removes the administrative burden and stress of managing complex medical expenses for your loved one.
At Ametros, we see ourselves as a neutral partner committed to the integrity of the settlement process and the well-being of the injured worker. The new CMS outreach confirms what we’ve known all along: compliance can’t be an afterthought; it must be built into the solution.
The Bottom Line
CMS has raised the bar for post-settlement oversight. Injured workers now receive clear instructions, and potential consequences, for managing their MSA funds. That’s a good thing for the system, but a potential source of stress and confusion for individuals.
Professional administration bridges the gap between regulatory compliance and real-world challenges. It ensures injured workers are protected, payers are covered, and Medicare’s interests are honored.
As the industry continues to evolve, one thing is certain: no one should have to navigate this process alone. At Ametros, we’re proud to stand beside injured individuals, not just at settlement, but every step of the way thereafter.
