Term: 2012
Docket: 12-98
Aldona Wos, Secretary, North Carolina Department Of Health And Human Services, Petitioner v. E. M. A., A Minor, By And Through Her Guardian Ad Litem, Daniel H. Johnson, Et Al.
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12-98 WOS V. E.M.A. DECISION BELOW: 674 F.3d 290 CERT. GRANTED 9/25/2012 QUESTION PRESENTED: The Medicaid Act requires participating States to seek reimbursement from third-party tortfeasors for health-care expenditures they made to Medicaid recipients who are tort victims. 42 U.S.C. §§ 1396a(a)(25), 1396k(a) (2006). To enforce that requirement when the recipient and a third- party resolve their tort dispute through judgment or settlement, North Carolina law provides that the State has a subrogation right to, and may assert a lien upon, the lesser of one-third of the recipient's recovery or the State's actual medical expenditures. N.C. Gen. Stat. § 108A-57 (2011). 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. LOWER COURT CASE NUMBER: 10-1865
In the 2012 case Aldona Wos v. E.M.A., the U.S. Supreme Court ruled in favor of E.M.A., a minor who was severely disabled at birth due to medical malpractice. The North Carolina Department of Health and Human Services (NCDHHS) had sought to recover from her settlement funds that were intended for future medical expenses, arguing that state law allowed them to claim one-third of any malpractice settlements as reimbursement for Medicaid payments made on behalf of recipients like E.M.A.. However, the court held that this flat-rate recovery scheme conflicted with federal Medicaid law, which only allows states to recoup funds specifically allocated for past medical costs rather than those meant for future care. Therefore, NCDHHS could not automatically take one-third of E.M.A.'s settlement but would have to prove what portion actually represented compensation for past medical expenses covered by Medicaid.
In the dissenting opinion for Aldona Wos v. E.M.A., Justice Antonin Scalia, joined by Justices Thomas and Chief Justice Roberts, argued that the majority's decision was inconsistent with previous rulings of the Court. He contended that North Carolina’s statute is not preempted by federal law because it does not directly conflict with federal Medicaid statutes or frustrate their purpose. The state law merely provides a method to determine what portion of a settlement represents payment for medical expenses - an issue on which federal law is silent. Furthermore, he criticized the majority's use of "the rule against absurd results" as an interpretive tool in this case, stating it should only be used when there are clear drafting errors or oversight by Congress rather than policy disagreements between courts and lawmakers.
