High Court Agrees to Resolve Conflict Between Medicaid's Anti-Lien Provision and State Recovery Law

The U.S. Supreme Court will decide whether the Medicaid Act's anti-lien provision supersedes a state’s ability to impose a lien on a Medicaid recipient's personal injury settlement.  Delia v. E.M.A.

To comply with the federal requirement that it recoup some Medicaid payments to tort victims, North Carolina asserts a lien on one-third of the recipient's settlement or the state's actual expenses, whichever is lower.  The parents of an infant who was severely disabled during delivery won a $2.8 million medical malpractice settlement.  The state paid $1.9 million in medical care for the child and asserted a lien on one-third of the settlement proceeds.  The parents argued that the lien was forestalled by the federal Medicaid law’s “anti-lien provision.”

A U.S. district court ruled in favor of the state, but the U.S. Court of Appeals for the Fourth Circuit vacated that ruling, holding that “the unrebuttable presumption inherent in the one-third cap on the state’s recovery imposed by the North Carolina third-party liability statutes is in fatal conflict with federal law.”   

As characterized by the U.S. Supreme Court in its grant of certiorari, “The question presented is whether N.C. Gen. Stat. § 108A-57 is preempted by the Medicaid Act's anti-lien provision as it was construed in Arkansas Department of Health & Human Services v. Ahlborn, 547 U.S. 268 (2006), an issue on which the North Carolina Supreme Court and the United States Court of Appeals for the Fourth Circuit are in conflict.”

For a Courthouse News article on the Court’s decision to hear the case, click here.


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