Do Medicare and Medicaid Get Paid From My Georgia Injury Settlement?

Yes. If Medicare or Georgia Medicaid paid for treatment related to your accident, the law gives them the right to be repaid from your settlement. The amount is not fixed, though. It can often be lowered, and Medicare is required to lower it for its share of your attorney’s fees and costs. Here is how each one works and what you can do about it.

Why Medicare and Medicaid Have a Right to Your Settlement

When someone else causes your injuries, Medicare treats the bills it paid as conditional payments. They are made on the condition that Medicare is paid back once you recover from the person or insurer responsible. That right comes from the federal Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2).

Georgia Medicaid has its own repayment rights. Under O.C.G.A. §§ 49-4-148 and 49-4-149, the Department of Community Health has a lien and a right to be repaid what Medicaid paid for accident-related care. Most members are in a managed care plan. As of late 2026 those are Amerigroup, CareSource and Peach State Health Plan, a list expected to change after mid-2027. If you are in a plan, the plan handles repayment. If not, DCH’s Subrogation Unit does.

Medicare never files anything at a courthouse, because its right comes from federal law. Georgia Medicaid’s right also exists by law, but DCH can file a lien with the court clerk within one year after care ends. Both work differently from how hospital liens work in Georgia.

Medicare vs. Medicaid at a Glance

	Medicare	Georgia Medicaid
Legal basis	Medicare Secondary Payer Act, 42 U.S.C. § 1395y(b)(2)	O.C.G.A. §§ 49-4-148 and 49-4-149
Who handles recovery	Benefits Coordination & Recovery Center (BCRC), or the Commercial Repayment Center if Medicare bills the insurer directly	Your managed care plan, or DCH’s Subrogation Unit
What it can recover	Payments for care related to the accident	Payments for care related to the accident, limited by federal law to the medical-expense part of the recovery
Reduction for attorney’s fees and costs	Required by regulation (42 C.F.R. § 411.37)	Negotiable, not automatic
If it is ignored	Interest, referral to the U.S. Treasury, and possible double damages	Enforcement of the lien and possible effects on benefits

How the Medicare Repayment Process Works

1. Report the claim. You or your attorney notify the BCRC that you have an injury claim.
2. Get the Conditional Payment Letter. Medicare lists every payment it believes is related to the accident.
3. Dispute unrelated charges. These lists often include care for older or unrelated conditions. Disputes go in with supporting records, and Medicare generally allows about 45 days to review them.
4. Settle and report the details. Medicare needs the settlement date, the amount, and the attorney’s fees and costs you paid. If the case is reported only after settling, send these within 30 days, or the demand will come with no reduction for fees.
5. Receive the final demand. Medicare issues a final demand letter that reduces its claim for its share of those fees and costs.
6. Pay from the trust account. Interest runs from the date of the demand letter but is charged only if the debt isn’t resolved within 60 days. It keeps running during a waiver request or appeal, so many people pay first and get a refund if they win.

How Georgia Medicaid Recovery Works

Georgia law requires your lawyer to notify the Department of Community Health before pursuing an injury claim for a Medicaid member (O.C.G.A. § 9-2-21). You must also cooperate with Medicaid in identifying who caused your injury. The lien covers only care related to the accident.

Federal law also limits how much Medicaid can take. Under Arkansas Department of Health & Human Services v. Ahlborn (2006) and Gallardo v. Marstiller (2022), Medicaid can recover only from the part of a settlement that represents medical expenses, past and future, and never more than it actually paid. That matters most when you settle for less than your case is worth, such as when the at-fault driver has only a minimum policy.

The Department of Community Health may agree to reduce its lien but does not have to. It is best to ask once you know the settlement amount, before any money is paid out. Requests usually point to how much of the full value the settlement actually covers, the risk of trial, any shared fault, and the fees and costs it took to recover the money.

How These Liens Change What You Take Home

Say you settle for $100,000. Attorney’s fees are $33,333 and case costs are $3,000, so your procurement costs total $36,333, or about 36% of the settlement. Medicare’s conditional payments related to the accident come to $18,000.

Medicare must reduce its claim by the same 36% share. Its final demand would be about $11,460 instead of $18,000. This is an example only. Your actual numbers come from Medicare’s letters and depend on which charges are disputed successfully.

That is also why what your case is worth and what you actually receive are not the same number.

Mistakes That Cost People Money

• Ignoring the Conditional Payment Letter and letting unrelated charges stay on it
• Paying Medicare before the final demand, which can mean paying the wrong amount
• Settling without knowing what Medicare or Medicaid will claim
• Assuming a lien has gone away because no one has called about it
• Signing a release that makes you personally responsible for every lien without knowing their size (see what a release gives up)

What About Medicare Advantage and Employer Health Plans?

Medicare Advantage plans and many employer health plans also ask to be repaid from injury settlements. Their rights depend on the plan’s terms and on federal law, and some are much stronger than others. Ask for the plan documents before you agree to repay anything.

Frequently Asked Questions

Questions About a Medicare or Medicaid Lien?

If Medicare or Medicaid paid for your treatment, talk with Jonathan Flack before you settle. He can look at what they claim and what can be reduced. Request a free consultation.