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.