Georgia Legal Guide: What Will Medicaid Pay for After a Car Accident? 

Key Points:

• Medicaid can cover your medical expenses after a Georgia car accident, but the Georgia Department of Community Health has the legal right to be reimbursed from any settlement or recovery you receive from the at-fault driver. 
• Medicaid’s reimbursement is limited only to the portion of your settlement that represents medical expenses—they cannot take money allocated for pain and suffering, lost wages, or other damages. 
• Whether you have auto insurance or not, Medicaid will typically cover eligible medical expenses—but you must cooperate with Medicaid’s right to seek reimbursement from any liable third party. 
• You must notify Medicaid at least 10 days before settling any personal injury claim, or you could face legal complications when Medicaid seeks reimbursement. 

Will Medicaid Help Pay My Medical Bills After My Car Accident? 

If you have Medicaid in Georgia, good news. They will pay for your medical care if you’ve been injured in a car accident. However, you may need to pay them back if you receive any personal injury settlements afterward. 

That alarms many Medicaid recipients, but don’t worry. Georgia law prevents Medicaid from taking the entire settlement if you get one, and more importantly, Medicaid will still cover your bills no matter what happens in a personal injury lawsuit. 

What Expenses Will Medicaid Cover After a Car Accident? 

Medicaid covers the same medical expenses after a car accident as it would for any other medical condition. The Department of Community Health (DCH) provides eligible recipients with medically necessary treatments related to the accident, including: 

• Hospital stays and emergency room visits 
• Doctor visits and specialist appointments 
• Surgical procedures 
• Prescription medications 
• Diagnostic tests (X-rays, MRIs, CT scans) 
• Physical therapy and rehabilitation services 
• Chiropractic care (when medically necessary) 
• Ambulance services 

Treatment must be medically necessary and related to your injuries from the accident. 

What Issues Might I Face Getting Medicaid to Pay? 

Medicaid is no different than any other insurance. Victims may have issues getting their medical care approved and covered, just as they would with private insurance. Common problems may include: 

Issue #1: Finding Providers Who Accept Medicaid 

Most facilities and physicians accept Medicaid, but not all. Emergency treatment is usually covered by Medicaid, but after that you may need to find providers and therapists within the network who will treat you. 

Issue #2: Coordinating With Other Insurance 

If you have other medical insurance coverage, such as MedPay, through your auto insurance, you will need to coordinate who pays first, which company pays what, and how the benefits and payments are received.  

Issue #3: Pre-Authorization Approval 

As with private insurance, some treatments may require pre-authorization or second opinions from Medicaid. This can cause treatment delays. 

Issue #4: Medicaid’s Reimbursement Claims 

After an accident, Medicaid places a reimbursement lien on any future settlement. Medicaid gets paid first after any settlement or court award. 

Issue #5: The “Complete Compensation” Rule Doesn’t Apply if You Have Medicaid 

Georgia’s “complete compensation rule,” which prevents insurers from requesting repayment until all your losses have been paid, does not apply to Medicaid. You must still reimburse Medicaid, even if you are not fully compensated. 

Will Medicaid Cover Physical Therapy and Chiropractic Visits? 

Yes. Physical therapy and chiropractic care can be covered by Medicaid as long as they are medically necessary for treating your injuries. 

Under Georgia law (O.C.G.A. § 24-9-921) medical expense evidence at trial can include:  

• Physicians, including doctors, dentists, orthodontists, or other practitioners 
• Chiropractors or physical therapists 
• Psychiatrists and psychologists 
• Nurses, social workers, professional counselors 
• Marriage and family therapists 

All these services are recognized medical expenses by Georgia law. Medicaid coverage depends only on the specific service being deemed medically necessary and meeting Medicaid’s coverage guidelines. 

Does Medicaid Have a Right to Be Repaid from My Settlement? 

Medicaid has a legal right to be repaid from any settlement or award you receive from the at-fault driver or their insurer. When Medicaid pays medical expenses for a recipient’s injuries, DCH places a lien on any money you may receive because of that injury. 

DCH has a right of subrogation, meaning they can “step into your shoes” and sue the other driver on your behalf to recover any money spent for your injuries. This includes filing after the death of a party. 

Are There Limits on Medicaid’s Reimbursement Rights? 

Yes. Medicaid cannot take your entire settlement. The U.S. Supreme Court ruled in Arkansas Department of Health and Human Services v. Ahlborn (547 U.S. 268 (2006)) that the law could not require a claimant to pay out more than the “portion of a settlement that represents payments for medical care.” 

In other words, Medicaid cannot take any portion of the settlement paid for lost wages, pain and suffering, or other losses due to the accident. 

Will Medicaid Cover My Expenses If the At-Fault Driver Has No Insurance? What if I Don’t Have Auto Insurance? 

Yes. Medicaid will cover all eligible medical expenses. If you are a Medicaid recipient, regardless of whether the other driver has insurance or not, your medical costs will be covered. This is also true if you have no insurance of your own (such as MedPay). 

Medicaid exists to provide medical coverage regardless of the recipient’s ability to repay it. The reimbursement right exists only if the recipient can recover compensation. The victim is not required to recover compensation. 

Keep in mind that: 

• If the at-fault driver does not have any insurance, you may need to file a claim with your own UM/UIM insurance. Medicaid can still place a lien on any settlement you receive from them. 
• If you do not have UM/UIM coverage and the other driver does not have insurance, you may be left out-of-pocket for any other expenses. 

However, Medicaid will always cover your medical costs. That is its purpose. 

How Must I Report A Personal Injury Claim to Medicaid? 

Because of the medical lien requirement, you must notify Medicaid as soon as you plan to file a personal injury claim against an at-fault third party (like the driver). There is a specific process for this notification (O.C.G.A. § 33-24-56.1(g)). 

• It must be sent by certified mail or overnight delivery 
• Not later than ten days before finalizing a settlement, or the start of any trial 
• It must contain a request for information about any reimbursement claim, including an itemized list of payments Medicaid is seeking,  

Once you send this notice, Medicaid must return a notice containing the information requested. 

Myths and Facts About Expenses Medicaid Covers for Car Accident Victims 

Medicaid is one of the most misunderstood public services of our time. Here are some common myths and facts about this public health insurance agency. 

Myth #1: “Medicaid only covers hospital bills.” 

FACT: Medicaid covers any medically necessary treatment, including physical therapy or chiropractic care. The only requirements are that the treatment be medically necessary and the injury be immediately connected to your accident. 

Myth #2: “I don’t have to tell Medicaid about my lawsuit or settlement.” 

FACT: You must tell the Department of Community Health at least ten days before finalizing any settlement or the start of any trial. Failure to do so can result in serious legal penalties.  

Myth #3: “Medicaid can’t do anything unless I sue the other driver first.” 

FACT: This is partially true; however, Medicaid has a “right of subrogation,” meaning they can “stand in your shoes,” and sue the other driver on your behalf. What this means is that you cannot make an agreement with the other driver not to sue. Medicaid can still sue them.  

Wrapping Up: What You Need to Remember About Medicaid and Car Accidents 

Navigating Medicaid coverage after a car accident in Georgia involves understanding both the benefits and the obligations that come with it. Here’s what matters most: 

Medicaid will help pay for your medical treatment after a car accident, including hospital care, doctor visits, physical therapy, and chiropractic care when medically necessary. 

Medicaid has a legal right under Georgia law (O.C.G.A. § 49-4-148 and § 49-4-149) to be reimbursed from any settlement or recovery you receive from the at-fault party. This includes a lien on your recovery and subrogation rights. 

Your settlement is protected in part because federal law limits Medicaid’s recovery to only the medical expense portion of your settlement—they cannot touch compensation for pain and suffering or lost wages. 

Whether you have auto insurance, and whether the at-fault driver has insurance or not, Medicaid will cover your eligible medical expenses if you’re a qualifying recipient. 

You must notify Medicaid at least 10 days before settling your claim. Your notification should request an itemized statement of their reimbursement claim. 

Understanding these rules is essential to protecting your rights and maximizing your recovery. If you’re a Medicaid recipient who’s been injured in a Georgia car accident, consider consulting with an attorney who understands both personal injury law and the complexities of Medicaid liens and reimbursement.