Supreme Court Allows States to Get Money from Lawsuits to Cover Future Medicaid Costs

– The U.S. Supreme Court ruled in favor of Florida’s Medicaid program in the case of Gallardo v. Marstiller, allowing states to recoup future medical expenses from Medicaid beneficiaries who receive tort settlements.
– The court’s decision was based on the interpretation of the Medicaid Act, which requires beneficiaries to assign the state any rights to payment for medical care from third parties.
– Medicaid programs can now recoup not only past medical expenses, but also future medical costs from tort recoveries obtained by beneficiaries. 1. The ruling in Gallardo v. Dudek allows Medicaid State Plans to claim a significant portion of tort settlements through a personal injury recovery lien.
2. The ruling may force both plaintiff’s attorneys and victims to factor in anticipated future medical costs in negotiations for settlements.
3. Injured people may need to demand that the tortfeasor pay past medical expenses in full in addition to funds necessary to compel the injured to forgo trial.
4. The ruling may not have an immediate impact on private insurance providers, but the state now has broader power to reach into settlement funds.
5. Reimbursement continues to be central to the work of providers, with changes to how Medicare and Medicaid reimbursements occur. Other states may follow Florida’s lead in allowing recovery for future medical expenses. – Arkansas Dept. of Health and Human Servs. v. Ahlborn, 547 U. S. 268 (2006) resulted in an opposite decision from the majority.
– FDA v. Brown & Williamson Tobacco Corp., 529 U. S. 120  (2000) also had an opposite result from the majority.
– National Assn. of Mfrs. v. Department of Defense, 583 U. S. ___, ___ (2018) went against the majority’s decision.
– Russello v. United States, 464 U. S. 16, 23 (1983) had an opposite outcome from the majority.
– United Sav. Assn. of Tex. v. Timbers of Inwood Forest Associates, Ltd., 484 U. S. 365, 371 (1988) resulted in an opposite decision from the majority.

https://www.hklaw.com/en/insights/publications/2022/06/supreme-court-expands-states-ability-to-recoup-future-medicaid-costs