Jan242026
Wrongful Death

How do my medical bills get handled if I have Medicaid and I bring a claim against the driver? – North Carolina

Short Answer

In North Carolina, Medicaid typically pays covered treatment up front, but the State can seek reimbursement from the part of any settlement or judgment that represents payment for medical care related to the crash. North Carolina law sets presumptions that often cap Medicaid’s recovery at no more than one-third of the gross recovery unless a court determines a different (usually smaller) medical portion. After a settlement or judgment, there are strict notice and payment timelines, so the Medicaid claim should be identified and addressed before money is disbursed.

Understanding the Problem

When an injured pedestrian in North Carolina has Medicaid and also makes a claim against the at-fault driver, the key question is how the medical bills are handled while treatment is ongoing and what happens to those bills if the claim resolves by settlement or judgment. The decision point is whether Medicaid has a right to be repaid from the recovery and, if so, how much of the recovery must be set aside for that repayment. The issue usually comes up when emergency room care, imaging, and physical therapy are involved and the claim is being negotiated with an insurance company or filed in court.

Apply the Law

North Carolina treats Medicaid as a program that can step into the injured person’s shoes (to a limited extent) to recover what Medicaid paid for injury-related medical care from a liable third party. In practice, that means Medicaid may assert a “Medicaid claim” against the recovery, and the settlement process needs to account for it before funds are distributed. North Carolina also uses statutory presumptions to determine what portion of a recovery is considered payment for Medicaid-covered medical care, with a court process available to challenge those presumptions in the right case.

Key Requirements

  • Medicaid paid for crash-related care: The reimbursement issue generally applies to Medicaid payments for treatment tied to the injuries from the incident (for example, emergency transport, ER care, imaging, and therapy).
  • A recovery from the driver (or insurer): The repayment question is triggered when money is recovered by settlement, judgment, or other payment from the at-fault party or their insurer.
  • Allocation and compliance steps: North Carolina law sets presumptions about how much of the recovery is treated as payment for the Medicaid claim, allows a court determination to dispute that amount, and requires notice and timely payment after proceeds are received.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Here, Medicaid coverage means many emergency and follow-up bills may be paid at Medicaid rates rather than left entirely unpaid. If a claim is made against the driver and money is recovered, North Carolina law generally treats the recovery as including a “Medicaid claim” component for the care Medicaid paid for, and the State can seek reimbursement from that medical portion. Because the injuries described involve emergency transport, imaging (including a brain MRI), and physical therapy, the Medicaid claim can be meaningful and should be identified early so it does not delay settlement distribution.

Process & Timing

  1. Who files: The injured person (or counsel) pursues the bodily injury claim; the State may assert a Medicaid claim for reimbursement. Where: If a lawsuit is filed, it is typically in the North Carolina trial courts (often Superior Court or District Court depending on the case). What: The settlement process should include requesting and confirming the Medicaid paid-amounts tied to the injury and addressing any other medical liens. When: After settlement proceeds are received, North Carolina law requires notice to the Department within 30 days and sets payment timing tied to the same 30-day window in many situations. See N.C. Gen. Stat. § 108A-57(a4)–(a5).
  2. Figure out the amount Medicaid can claim: North Carolina uses a one-third presumption structure. If the Medicaid claim is less than or equal to one-third of the gross recovery, the presumption generally treats the recovery as including the full Medicaid claim; if the Medicaid claim is more than one-third, the presumption generally treats one-third of the gross recovery as the Medicaid portion. See N.C. Gen. Stat. § 108A-57(a1).
  3. Dispute or negotiate the medical portion if appropriate: If the presumed amount does not fit the facts (for example, the settlement is driven mostly by pain and suffering or lost wages rather than medical expenses), North Carolina allows a court application to determine the portion of the recovery that represents compensation for the Medicaid claim. That application must generally be filed and served no later than 30 days after the settlement is executed (and approved if required) or within 30 days after judgment. See N.C. Gen. Stat. § 108A-57(a2). The statute also allows an agreement with the Department on the portion representing the Medicaid claim. See N.C. Gen. Stat. § 108A-57(a3).

Exceptions & Pitfalls

  • Assuming Medicaid “goes away” because coverage exists: Medicaid coverage can reduce what providers are owed directly, but it can also create a reimbursement claim against the recovery that must be resolved before funds are safely distributed.
  • Missing the 30-day court-application window: If disputing the one-third presumption, the statute sets a short deadline to file and serve the application after settlement execution (or after judgment). Missing it can remove a key tool for reducing the Medicaid portion.
  • Overlooking other liens: Hospitals, ambulance providers, and other entities may assert liens under North Carolina law, and the final distribution often requires coordinating multiple claims. See generally N.C. Gen. Stat. § 44-49.
  • Valuing the case using billed charges instead of amounts actually paid/owed: Medical damages discussions often turn on what was paid or required to be paid in full satisfaction of the charges, which can differ from the original bill. See N.C. Gen. Stat. § 8-58.1.

Conclusion

In North Carolina, Medicaid can pay covered medical care after a pedestrian crash, but the State may seek reimbursement from the portion of any settlement or judgment that represents payment for that medical care. North Carolina law uses a one-third presumption framework and provides a court process to dispute the presumed medical portion in the right case. The most important next step is to identify the Medicaid claim early and, after proceeds are received, provide the required notice and handle payment within 30 days under N.C. Gen. Stat. § 108A-57.

Talk to a Wrongful Death Attorney

If Medicaid paid for treatment after a crash and a claim is being made against the driver, lien and reimbursement issues can affect both settlement timing and the amount that can be safely disbursed. Our firm has experienced attorneys who can help explain the process, confirm what Medicaid actually paid, and map out the deadlines that apply. Call us today at 919-341-7055.

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

Category: Wrongful Death

Author: Pierce Law

Pierce Law Group is a North Carolina law firm focused on probate administration, real estate partition matters, and surplus funds claims across North Carolina. We know these situations often come with stress, family dynamics, and time-sensitive decisions—so we prioritize clear communication, steady guidance, and a practical plan from day one. Our goal is to make a complicated process feel manageable, while protecting what matters most to you.