Wos v. E.M.A. et al. (2012)
- Docket
- 12-98
- Decided
- 2012-01-01
Summary
Question: Does federal Medicaid law prohibit North Carolina's third-party liability statutes from mandating reimbursement of medical expenses from a patient's lump-sum settlement? Conclusion: Yes. Justice Anthony M. Kennedy, writing for a 6-3 majority, affirmed the lower court. The North Carolina law is preempted by federal law to the extent that it would allow the state to recover part of a Medicaid beneficiary's tort judgment or settlement not designated for medical expenses. Arbitrarily designating one-third of a judgment as recoverable medical expenses lacks any limiting principle. If upheld, nothing could stop a state from arbitrarily designating one-half or all of a judgment as medical expenses. Calculating the actual amount of medical expenses in each case may be more difficult than the one-third rule, but similar allocation procedures are already used other circumstances, such as worker's compensation and separating compensatory and non-compensatory damages for tax purposes. Justice Stephen G. Breyer concurred, stating that he agreed with the majority because the Centers for Medicare and Medicaid Services had already reached the same conclusion. Chief Justice John G. Roberts, Jr. dissented, arguing that no regulation or prior case law requires a specific allocation of damages recovered for medical expenses. States should be allowed more leeway to come up with a workable regulation to recoup Medicaid payments. Justice Antonin Scalia and Justice Clarence Thomas joined in the dissent.