Short Answer

In North Carolina, you get your Medicaid lien total by requesting an itemized lien statement from the N.C. Department of Health and Human Services (DHHS), Division of Health Benefits (Medicaid), Third Party Recovery. The lien covers what Medicaid paid for injury-related care and must be verified and finalized before you disburse settlement funds. If there’s a disagreement about what portion of your recovery is for medical expenses, a court can determine the amount under state law.

How North Carolina Law Applies

North Carolina Medicaid has a statutory right to be repaid from your personal injury recovery for payments it made for injury-related treatment. To find out the lien amount, you (or your attorney) must ask DHHS’s Third Party Recovery unit for an itemized statement of all Medicaid payments tied to your accident. Review that list carefully and challenge any services that are unrelated to the injury. When your case is close to settlement, you can request a final lien amount so you know exactly what must be repaid at disbursement. If the settlement or judgment does not clearly allocate what portion represents past medical expenses, North Carolina law allows you to seek a court determination of the proper Medicaid repayment.

Key Requirements

• You, your legal guardian, or your attorney must authorize DHHS to release lien information (a signed HIPAA-compliant authorization is typically required).
• Provide identifiers: full name, date of birth, Medicaid ID (if known), accident date, and involved insurers/claim numbers.
• Ask for an itemized, injury-related paid-claims report and a final lien amount before distributing any funds.
• Be prepared to show why any listed charge is unrelated to the accident (e.g., pre-existing condition, routine care, different body part).
• If there is a dispute over how much of your recovery represents medical expenses, you may ask a court to determine the Medicaid repayment amount.

Process & Timing

1. Gather information: your personal details, Medicaid ID (if available), accident date, provider names, claim/settlement details, and a signed authorization.
2. Request the lien: contact DHHS Division of Health Benefits, Third Party Recovery, and ask for an itemized Medicaid lien statement for your injury claim.
3. Review and dispute: compare DHHS’s paid-claims list to your medical records. Promptly dispute items that are not injury-related and supply supporting records.
4. Update as the case progresses: if treatment continues, request updated statements so you always know the current lien amount.
5. Request a final lien amount before disbursement: once settlement is imminent, ask DHHS for a final lien figure. Provide settlement details and attorney fee/cost information, if requested, so DHHS can finalize.
6. If needed, seek a court determination: when the parties disagree about how much of the recovery represents past medical expenses, file a motion asking the court to set the Medicaid reimbursement under North Carolina law.

What the Statutes Say

• N.C. Gen. Stat. § 108A-57 explains Medicaid’s lien and right to reimbursement from personal injury recoveries and provides a process to have a court determine the amount attributable to medical expenses when needed.
• N.C. Gen. Stat. § 44-49 and § 44-50 are separate medical provider lien statutes that may also affect settlement distributions; they are distinct from Medicaid’s lien.

Exceptions & Pitfalls

• No authorization, no information: DHHS will not release lien details without proper authorization.
• Unrelated charges: Medicaid claims unrelated to the accident sometimes appear. Dispute them with records (billing notes, imaging reports, or physician letters).
• Managed care periods: if you were in a Medicaid managed care plan, ensure DHHS has complete data for those claims; provide plan details if asked.
• Timing: do not disburse settlement funds until you have a final lien amount. Interim figures can change as claims are processed.
• Allocation disputes: when a settlement does not specify amounts for medical expenses, you may need a court order to set Medicaid’s share.
• Other liens: Medicare, ERISA plans, or provider liens may also apply. Coordinate all liens to avoid double payment and delays.

Helpful Hints

• Ask for an itemized paid-claims list and review CPT/diagnosis codes to spot unrelated entries.
• Keep a simple spreadsheet of every bill, balance, and payer to reconcile with DHHS’s statement.
• Submit disputes in writing with supporting records, and follow up until you receive a corrected statement.
• Request the final lien amount before you sign disbursement checks; build in time for DHHS to finalize.
• If a minor or incapacitated adult is involved, plan early for court approval and possible allocation orders that address Medicaid’s claim.

Sources & References

• N.C. Gen. Stat. § 108A-57 (Medicaid lien and reimbursement from personal injury recoveries), current version available at the North Carolina General Assembly website.
• N.C. Gen. Stat. §§ 44-49 and 44-50 (medical provider liens), current versions available at the North Carolina General Assembly website.

Disclaimer: This article is general information about North Carolina law, not legal advice. Reading it does not create an attorney–client relationship.

Talk to a Personal Injury Attorney

If you’re dealing with a Medicaid lien on a North Carolina personal injury settlement, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at 919-313-2737.