Nursing Home Litigation Case Note
Arkansas Department of Health and
Human Services v. Ahlborn
Ron M. Landsman T
he Supreme Court’s unanimous decision in Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268, 164 L.Ed.2d 459, 126 S.Ct. 1752
(2006) seemed to portend a new day in dealing with Medicaid agencies’ claims against the personal injury recoveries of Medicaid beneficiaries. It did, but not the one the trial bar or disability law attorneys hoped for or expected. Since Ahlborn there has been a small avalanche of decisions largely hostile to limiting Medicaid agency recovery claims, permitting States to establish recovery presumptions heavily in their favor. Among them is one from Maryland, Special Needs Trust
for K.C.S. v. Folkemer,
S.D.Md., No. 08:10-CV-1077–AW, decided March 28, 2011, app. pend’g. Ahlborn itself came before the Court on a narrow issue.
Heidi Ahlborn suffered serious injuries in an automobile collision and qualified for Medicaid as a result. She subsequently settled a personal injury action for $550,000. Te Arkansas Medicaid agency asserted that its Medicaid lien statute entitled it to recover its entire outlay of $215,645.30, although it stipulated that “only $35,581.47 of [the] settlement proceeds properly are ... for medical costs.” 547 U.S. at 288. Te Supreme Court rejected Arkansas’ claim that its broad
lien statute was consistent with or authorized by the recovery activities that Congress required of State Medicaid agencies.
Te Arkansas statute imposed a lien on the entire settlement but, the Court said, the Medicaid agency was only entitled to recover from the beneficiary what she recovered from the defendant for her past medical expenses; Medicaid stood in the plaintiff ’s shoes and, because of the anti-lien statute, could not recover from the plaintiff ’s other property, including the other elements of the personal injury claim, such as lost wages and pain and suffering. Tus, a lien like Arkansas’ against the entire settlement or recovery was unauthorized. Given the parties stipulation as to what the plaintiff recovered for medical expenses in that case, the Court did not have to resolve those facts but noted that courts had more than ample means for doing so, without precluding States from developing “rules and procedures for allocating tort settlements.” 547 U.S. at 288. In K.C.S., a child who suffered a debilitating birth injury
settled a medical malpractice claim for $3 million; the balance after attorneys fees of $1 million and expenses of $53,245.07 funded a special needs trust. Maryland Medicaid claimed its entire expenditure of $298,585.75 from the net settlement under Maryland Health General Code, §15-109 and 15-120. When the parties failed to agree, the trustee and others filed suit in Federal district court for declaratory and other relief; on cross motions for summary judgment, Maryland Medicaid prevailed on the four issues presented, resolving all claims. Te court rejected the plaintiff ’s anti-lien claim. Ahlborn
held that the federal recovery provision is an exception to the anti-lien rule. Te Maryland statute, the court noted,
Legal Nurse Resource Team
Build a better case with the experts doctors rely on.
Valerie Strockbine RN Certified Legal Nurse Consultant
vstrockbine@gmail.com 443-864-8089
Trial Reporter / Fall 2011 9
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60