Creed & Gowdy and co-counsel filed the merits brief in the United States Supreme Court on behalf of their client, Ms. Gianinna Gallardo, a Medicaid beneficiary. The brief's introduction argues:
Many individuals require Medicaid's assistance because of injuries inflicted by third parties. [Ms.] Gallardo is one. When she was 13, a truck struck her after she stepped off her school bus, causing severe injuries requiring a lifetime of expensive care. Her parents sued those responsible, demanding compensation for her future medical expenses, lost earnings, and pain and suffering-and past medical expenses paid by Medicaid. Ms. Gallardo ultimately settled for a fraction of the damages she sought. Florida's Medicaid agency then imposed a lien to reimburse itself from the portions of the settlement representing both past and future medical expenses. Florida thereby sought to "pocket funds marked for things it never paid for." Pet. App. 28 (Wilson, J. dissenting).
The Medicaid Act proscribes such overreaching. Its anti-lien and anti-recovery provisions broadly prohibit States from seeking reimbursement for Medicaid expenditures from beneficiaries' tort recoveries and other property. Ark. Dep't of Health & Human Servs. v. Ahlborn, 547 U.S. 268, 285, 292 (2006). The Act's third-party provisions are an exception to that prohibition-but one strictly limited by the provisions' terms. The most relevant provision, 42 U.S.C. § 1396a(a)(25)(H), gives a State the right to third-party payments only insofar as they represent liability for "health care items or services" that have been "furnished" by Medicaid. The third-party provisions give a State no right to payments for medical expenses Medicaid has not paid.
To read the complete brief, click here.