HB 982 Summary

• Modifies G.S. 108A-57 to establish presumptions for calculating Medicaid's share of third-party settlements and judgments based on the beneficiary's gross recovery.

• Creates a rebuttable presumption that if the Medicaid claim does not exceed one-third of gross recovery, it is fully compensated; if it exceeds one-third, then one-third of gross recovery represents compensation for the Medicaid claim.

• Requires medical assistance beneficiaries to notify the Department within 30 days of receiving settlement or judgment proceeds and allows beneficiaries to dispute presumptions by filing a court application within 30 days of settlement or judgment.

• Shifts burden to the beneficiary to prove by clear and convincing evidence that the presumed Medicaid share is incorrect, and permits court determination of the actual amount owed.

• Applies to Medicaid claims arising on or after the effective date (July 18, 2013) and to prior unpaid claims, with a 90-day window for beneficiaries to challenge prior claims in court.