Anyone who is a victim of an accident and has Medicaid must be aware of the Medicaid rules for reimbursement. A failure to follow the Medicaid rules can lead to criminal chagres against the Medicaid recipient.
The amount that Medicaid can seek in reimbursement is controlled by North Carolina law. In general, the amount of money that you must re-pay Medicaid is limited to 1/3 of your gross recovery. However, there are many issues that must be considered when determining how much Medicaid is entiled to (another way of saying this is what is Medicaid’s “lien.”)
You must consider what other medical care providers are entitled to. You must also consider whether all of the treatment for which Medicaid is claiming a reimbursment is truly related to the accident. We have handled numerous cases where the statement from medicaid included charges that were not related in any way to the accident claim. For instance, an accident victim with a broken leg should not need to reimburse Medicaid for a doctor’s visit related to an ear infection.