Any plaintiff’s lawyer who has successfully resolved a case for a Medicaid beneficiary knows the importance of the United States Supreme Court’s opinion Wos v. E.M.A., 568 U.S. ___ (2013), released this week. State Medicaid programs will no longer be able to enforce statutes that arbitrarily designate the amount of a settlement that they are entitled to recover. Instead, Medicaid reimbursement is limited to the amount of the settlement that is “designated as payments for medical care.” To the extent the plaintiff can show that the settlement is for amounts other than payments for past medical care, those payments are beyond the reach of a Medicaid lien.
The 6-3 opinion authored by Justice Kennedy explains that North Carolina’s statute, which arbitrarily “designated” one-third of every settlement as reimbursable to Medicaid, is a violation of the Federal Medicaid anti-lien provision and is contrary to the Court’s prior ruling in Ahlborn. The Court rejected North Carolina’s assertion that, by statute, North Carolina could define in every case the amount of the settlement that represents payment for medical expenses. As the Court explained the “proper analysis requires consideration of what the state law in fact does, not how the litigant might choose to describe it.” Id. at __ (slip op., at 8).
Now, based on Wos, Medicaid reimbursement statutes must set forth “a process for determining what portion of a beneficiary’s tort recovery is attributable to medical expenses.” Id. at __ (slip op., at 7). Otherwise, the statute conflicts with Federal law and is pre-empted.
In Florida, where the Medicaid reimbursement statute allows for Medicaid to arbitrarily recover one-half of the settlement after paying attorney’s fees and costs, the Wos decision will finally level the playing field. Medicaid beneficiaries in Florida will now be heard when they seek to assert equitable distribution arguments, limiting Medicaid’s claim to the amount of the settlement that actually reflects past medical payments, and no more. The fifty percent provision in Florida's Medicaid lien statute is rendered a nullity.
Wos will resolve the issues raised recently by the 4th DCA in Roberts v. Albertson’s et al. 37 FLW D2515 (Fla. 4th DCA 2012) decision. (For a blog I wrote on that case, click here.)
This was a good week for Florida Medicaid beneficiaries seeking to protect their tort recoveries from Florida Medicaid’s overarching grip.