Short Answer

In North Carolina, having Medicaid usually helps you get treatment while your pedestrian injury claim is pending, but it can also create a Medicaid repayment claim (often called a Medicaid lien) against part of any settlement or judgment. North Carolina law sets presumptions that often cap what Medicaid can recover to a portion of the gross recovery, and it gives you a way to ask a court to reduce Medicaid’s share in some cases. The key is to identify the Medicaid claim early and handle notice and repayment correctly when the case resolves.

Understanding the Problem

If you were hit as a pedestrian in North Carolina and Medicaid paid for your emergency room care, imaging, or physical therapy, you may be asking: “Can I still pursue a claim against the driver, and will I have to pay Medicaid back out of my settlement?”

Apply the Law

North Carolina treats Medicaid as a payer that can seek reimbursement when a third party (like an at-fault driver or their insurer) is legally responsible for the injury. The State has subrogation rights, meaning it can step into the injured person’s shoes to recover Medicaid payments tied to the injury from the third-party recovery. Practically, that means a portion of a settlement or judgment may need to be set aside and paid to the North Carolina Department of Health and Human Services (the “Department”) to satisfy the Medicaid claim.

North Carolina also uses statutory presumptions to determine how much of a gross recovery is treated as compensation for the Medicaid-paid medical care. If you disagree with the presumed amount, the law provides a court process (with strict timing) to ask for a different allocation.

Key Requirements

• Medicaid paid injury-related care: The repayment issue generally applies only to Medicaid payments for health care items or services connected to the injuries from the crash.
• There is a third-party recovery: Repayment is triggered when money is recovered from the at-fault driver (or another liable party) by settlement, judgment, or similar resolution.
• The “Medicaid claim” is part of the case: North Carolina law treats a beneficiary’s third-party claim as including the Medicaid claim for the medical assistance paid because of the injury.
• Presumptions control unless challenged: If the Medicaid claim is not more than one-third of the gross recovery, it is presumed the recovery includes the full Medicaid claim; if it is more than one-third, it is presumed one-third of the gross recovery represents compensation for the Medicaid claim.
• Notice and payout deadlines apply: After receiving settlement or judgment proceeds, the beneficiary (or the beneficiary’s attorney) must notify the Department and then distribute the amount due under the statute within the required timeframes.
• Court challenge has a short fuse: If you want to dispute the presumptions, you must apply to the proper court within a set deadline after settlement execution (or after judgment entry).

What the Statutes Say

• N.C. Gen. Stat. § 108A-57 (Medicaid subrogation; presumptions; notice and distribution) - Creates the State’s subrogation rights, sets presumptions for how much of a recovery is attributable to the Medicaid claim, and sets deadlines for challenging and paying the claim.
• N.C. Gen. Stat. § 130A-13 (Assignment of third-party benefits; priority and limits) - Treats applying for certain Department medical payment programs as an assignment of third-party benefits to the State and describes an order of priority and limits in recovery.
• N.C. Gen. Stat. § 8-58.1 (Proof of medical charges; amounts paid vs. amounts billed) - Addresses evidence about medical charges and the amounts paid or required to be paid in full satisfaction of those charges, which can matter when insurance (including public coverage) is involved.

Analysis

Apply the Rule to the Facts: Here, Medicaid (public health insurance) appears to have covered at least some of the emergency room evaluation, imaging, and follow-up care after the pedestrian crash. If the driver (or the driver’s insurer) pays money to resolve the claim, North Carolina law generally requires that the Medicaid claim be addressed from the recovery, using the statutory presumptions unless they are timely challenged. Because the injuries are described as ongoing and limiting, it is especially important to confirm which charges are crash-related and which payments Medicaid actually made, since repayment is tied to those payments.

Process & Timing

1. Who files: The injured person (or their attorney) typically gathers Medicaid payment information and communicates with the Department about the Medicaid claim. Where: If a dispute is needed, the application is filed in the court where the injury claim is pending, or otherwise in a court of competent jurisdiction in North Carolina. What: A written application asking the court to determine what portion of the gross recovery represents compensation for the Medicaid claim (if disputing the statutory presumptions). When: If you dispute the presumptions, file and serve the application no later than 30 days after the settlement agreement is executed (and, if required, approved) or no later than 30 days after entry of judgment.
2. Notice after money is received: After settlement or judgment proceeds are received, the beneficiary or the beneficiary’s attorney must notify the Department within 30 days of receipt.
3. Distribution/payment: The amount due to the Department is generally paid within 30 days after the applicable trigger (for example, after the time to file a court application expires with no filing, after a court order, or after an agreement with the Department), as described in the statute.

Exceptions & Pitfalls

• Missing the 30-day challenge deadline: If you wait too long to seek a court determination, the statutory presumptions may control the repayment amount even if you believe they overstate the medical portion of the recovery.
• Not separating “billed” vs. “paid” amounts: In injury cases, the amount a provider billed is not always the amount that was actually paid or required to be paid in full satisfaction. Keeping clear records helps avoid confusion when valuing medical damages and resolving repayment issues.
• Failing to notify and resolve the Medicaid claim at settlement: If settlement funds are disbursed without addressing Medicaid’s claim, it can create avoidable disputes and delay closing the case.
• Assuming Medicaid repayment equals all medical bills: Medicaid repayment is generally tied to Medicaid payments for injury-related care, and North Carolina’s statute uses presumptions that can limit the portion of a gross recovery treated as the Medicaid claim.
• Overlooking other potential payers: If there are other medical liens or subrogation claims, North Carolina’s Medicaid statute contemplates proration with other medical subrogation rights or medical liens, which can affect the final distribution.

Conclusion

In North Carolina, Medicaid does not prevent a pedestrian from bringing an injury claim, but it can require repayment from part of any settlement or judgment for Medicaid-paid, injury-related medical care. North Carolina law applies presumptions that often limit Medicaid’s share to a portion of the gross recovery, and it allows a court challenge if you act quickly. The most important next step is to identify the Medicaid claim and, if you plan to dispute the presumed amount, file the court application within 30 days after the settlement agreement is executed.

Talk to a Personal Injury Attorney

If you're dealing with a pedestrian injury claim where Medicaid paid for some of your treatment, our firm has experienced attorneys who can help you understand how repayment works, what deadlines apply, and how to protect your recovery while the claim is resolved. Reach out today. Call [CONTACT NUMBER].

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.