Super Lawyers
Justia Lawyer Rating
North Carolina Bar Association
Avvo Rating
Legal Elite

How Much Must I Reimburse Medicaid From My Accident Claim

Medicaid and Medicare are very important considerations for North Carolina accident victims. If Medicaid or Medicare have paid for medical care that is the result of an accident, Medicaid and Medicare are entitled to repayment from any settlement or resolution of the claim.

Medicaid is a state and federally funded health insurance program that is administered solely by the state. Medicaid was created through the Social Security Act, 42 U.S.C. 1396, to offer medical care to those who cannot afford to pay for medical care. As part of the funding process, the state must do whatever it can to seek reimbursement from the Medicaid recipients whenever possible. North Carolina General Statutes 108A-57 and 108A-59 states that State of North Carolina is subrogated to all rights of recovery of the beneficiary/recipient of Medicaid benefits against any liable third party. This subrogation claim applies to ALL rights of recovery including contractual rights which would include recovery for Medical Payments coverage under a beneficiary/recipient’s personal automobile insurance policy.

Sounds Like Alot of Legal Stuff, so What Does This Mean to You?

It means you must pay the State of North Carolina back for your medical bills! But there are limitations. Pursuant to N.C.G.S. 108A-57, the most that Medicaid can take from the settlement is 1/3 of the recovery. if you have other unpaid meidcal bills and these medical care providers have liens on the recovery, then Medicaid is prorated with the other medical care providers and the total payment to Medicaid and the medical providers is still capped at 1/3.

What if I try to ignore Medicaid and do not tell anyone about it? Not a good idea. N.C.G.S. 108A-57 makes it a Class I misdemeanor to fail to disclose the possible existence of a Medicaid claim on settlement funds.

These same rules apply to medical expenses paid by the North Carolina Health Choice Program as well as Medicaid.

Medicaid reimbursement is handled by the Third-Party recovery section at the North Carolina DHHS. You can contact them at 919-814-0000 or go to their website.

In the midst of the statutory requirements regarding Medicaid, there is on-going litigation that may influence how your particular Medicaid claim should be handled.

If you have a question about how much you must re-pay Medicaid from your North Carolina accident case, call the lawyers at Hendren, Redwine & Malone.

Client Reviews
★★★★★
Mike Malone was absolutely fabulous to work with. He represented my daughter in a case and we could not have been happier! He was upfront from the beginning about expectations, honest through out the case and above all.. caring! Even though I lived 2 hours away, he was more than willing to accommodate us in any way, even if it meant driving out of his way! Mike is one of the smartest lawyers you will find. I recommend him to everyone! I have known him now over 8 years and we still keep in touch. Thanks Mike. - Christy Smith
★★★★★
Mike Malone is the attorney for an estate wrongful death claim. Mike has helped me through every single step. Mike is intelligent, trustworthy and thorough, and responds quickly and personally to questions. I would highly recommend this firm to anyone who needs an attorney. Mike Malone has proven to work diligently to assist you in every way as well as make sure you understand what is happening. - Jason
★★★★★
Thank you Mike for doing an exceptional job. You were not only extremely professional but also kind,patient and understanding through an extremely difficult time. Thank you again. - Bryan
★★★★★
Mike is very sharp when it comes to understanding a case and how the legal system works. He also has integrity and a strong moral conviction which you won't always find when trying to find good legal counsel. - Camp Davis
★★★★★
Mike Malone was a pleasure to work with on a case involving negligence of another attorney in a real estate transaction. Mike was very eager to help us recover money lost in our case. Highly recommended! - Mariusz Stanczyk