The National Vaccine Injury Compensation Program fits the definition of a 'third party' under Medicaid recovery rules, and thus an award under the program is subject to a Medicaid lien. Kain v. California Dept. of Health Services (Cal. App., 2 Dist., No. B144391, August 2, 2001).
Lorrin Kain was seriously injured by a routine childhood vaccination. Her parents received a lump sum payment of $841,174.65 and an annuity of more than $3 million under the National Childhood Vaccine Injury Act (NVICP), a no-fault system for compensating individuals who are injured by routine vaccinations. While the NVICP claim was still pending, Lorrin received Medi-Cal (California Medicaid) benefits from the California Department of Health Services (DHS). The Kains did not inform DHS that they had filed a claim under the NVICP and the NVICP award did not include an allowance for any of the expenses paid by Medi-Cal. After judgment was entered in the NVICP action, DHS sought reimbursement and placed a lien on the money recovered. The trial court entered judgment in favor of DHS for $75,500.95. The Kains appealed, contending that a Medi-Cal lien may be asserted only against a negligent third-party tortfeasor or an insurance carrier that contracts to pay for services covered by Medi-Cal, and that the NVICP fits neither category.
California's Court of Appeal rules that although the Medi-Cal statutes do not define "third party" for purposes of reimbursement, when construed with the relevant federal statutes and regulations the term is broad enough to cover an award under the NVICP. Federal regulations, the court notes, define a "third party" from whom reimbursement may be sought as "any individual, entity or program that is or may be liable to pay all or part of the expenditures for medical assistance . . . ." (42 C.F.R., § 433.136 (2000). The court holds that although the acts of the NVICP did not cause the claimant''s physical injuries, it is the entity financially responsible for those injuries on behalf of the vaccine manufacturers. The court adds that DHS should not be penalized because the Kains did not take the steps necessary to include an allowance for Medi-Cal expenditures in the NVICP award.
For the full-text of this decision, go to: https://www.courtinfo.ca.gov/opinions/documents/B144391.PDF
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