Medicaid is not a lien.  The US Supreme Court modified NY's Medicaid statute (104-b Social Services Law) in May, 2006 and effectively ruled that Medicaid's claim is limited to medical expenses they paid that are related to the injuries claimed in the personal injury accident.  If the attorney timely puts Social Services on notice and does not make a claim for medical expenses paid by the County, then it is likely that the entire settlement, minus attorney fees, will go the the client.  JMH