Gallardo v. Marstiller, 596 U.S. ___ (2022)
Gallardo suffered catastrophic injuries resulting in permanent disability when a truck struck her as she stepped off her Florida school bus. Florida’s Medicaid agency paid $862,688.77 to cover Gallardo’s initial medical expenses and continues to pay her medical expenses. Gallardo’s suit against the truck’s owner and the School Board resulted in an $800,000 settlement, with $35,367.52 designated as compensation for past medical expenses. The settlement did not specifically allocate any amount for future medical expenses.
The Medicaid Act requires participating states to pay for certain individuals’ medical costs and to make reasonable efforts to recoup those costs from liable third parties, 42 U.S.C. 1396k(a)(1)(A). Under Florida’s Medicaid Third-Party Liability Act, a beneficiary who accepts medical assistance from Medicaid automatically assigns to the state any right to third-party payments for medical care; Florida was entitled to $300,000--presumptively representing the portion of the recovery that is for past and future medical expenses.
The Supreme Court affirmed the Eleventh Circuit. The Medicaid Act permits a state to seek reimbursement from settlement payments allocated for future medical care. The Act’s anti-lien provision, prohibiting states from recovering medical payments from a beneficiary’s “property,” does not foreclose recovery from settlement amounts other than those allocated for past medical care paid for by Medicaid. Florida’s statute is expressly authorized by section 1396k(a) and is within the recognized exception to the anti-lien provision. The relevant distinction is between medical and nonmedical expenses, not between past and future medical expenses. Section 1396k(a)(1)(A) does not authorize a “lifetime assignment” covering any rights acquired in the future but covers only rights the individual possesses while on Medicaid.
The Medicaid Act permits a state to seek reimbursement from tort lawsuit settlement payments allocated for future medical care.
SUPREME COURT OF THE UNITED STATES
Syllabus
GALLARDO, an incapacitated person, by and through her parents and co-guardians VASSALLO et al. v. MARSTILLER, SECRETARY OF THE FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION
certiorari to the united states court of appeals for the eleventh circuit
No. 20–1263. Argued January 10, 2022—Decided June 6, 2022
Petitioner Gianinna Gallardo suffered catastrophic injuries resulting in permanent disability when a truck struck her as she stepped off her Florida school bus. Florida’s Medicaid agency paid $862,688.77 to cover Gallardo’s initial medical expenses, and the agency continues to pay her medical expenses. Gallardo, through her parents, sued the truck’s owner and driver, as well as the Lee County School Board. She sought compensation for past medical expenses, future medical expenses, lost earnings, and other damages. That litigation resulted in a settlement for $800,000, with $35,367.52 expressly designated as compensation for past medical expenses. The settlement did not specifically allocate any amount for future medical expenses.
The Medicaid Act requires participating States to pay for certain needy individuals’ medical costs and then to make reasonable efforts to recoup those costs from liable third parties. 42 U. S. C. §1396k(a)(1)(A). Under Florida’s Medicaid Third-Party Liability Act, a beneficiary like Gallardo who “accept[s] medical assistance” from Medicaid “automatically assigns to the [state] agency any right” to third-party payments for medical care. Fla. Stat. §409.910(6)(b). Applied to Gallardo’s settlement, Florida’s statutory framework entitled the State to $300,000—i.e., 37.5% of $800,000, the percentage the statute sets as presumptively representing the portion of the tort recovery that is for “past and future medical expenses,” absent clear and convincing rebuttal evidence. §§409.910(11)(f )(1), (17)(b). Gallardo challenged the presumptive allocation in an administrative proceeding. She also brought this lawsuit seeking a declaration that Florida was violating the Medicaid Act by trying to recover from portions of the settlement compensating for future medical expenses. The Eleventh Circuit concluded that the relevant Medicaid Act provisions do not prevent a State from seeking reimbursement from settlement monies allocated for future medical care. 963 F.3d 1167, 1178.
Held: The Medicaid Act permits a State to seek reimbursement from settlement payments allocated for future medical care. Pp. 5–12.
(a) Gallardo argues that the Medicaid Act’s anti-lien provision—which prohibits States from recovering medical payments from a beneficiary’s “property,” §1396p(a)(1)—forecloses recovery from settlement amounts other than those allocated for past medical care paid for by Medicaid. But this Court has held that the provision does not apply to state laws “expressly authorized by the terms of §§1396a(a)(25) and 1396k(a)” of the Medicaid Act. Arkansas Dept. of Health and Human Servs. v. Ahlborn, 547 U.S. 268, 284. Here, Florida’s Medicaid Third-Party Liability Act—under which Florida may seek reimbursement from settlement amounts representing “payment for medical care,” past or future—“is expressly authorized by the terms of . . . [§]1396k(a)” and thus falls squarely within the “exception to the anti-lien provision” that this Court has recognized. Ibid.
The plain text of §1396k(a)(1)(A) decides this case. Nothing in §1396k(a)(1)(A) limits a beneficiary’s assignment to payments for past “medical care” already paid for by Medicaid. To the contrary, the grant of “any rights . . . to payment for medical care” most naturally covers not only rights to payment for past medical expenses, but also rights to payment for future medical expenses. §1396k(a)(1)(A); see United States v. Gonzales, 520 U.S. 1, 5. The relevant distinction is thus “between medical and nonmedical expenses,” Wos v. E. M. A., 568 U.S. 627, 641, not between past and future medical expenses.
Statutory context reinforces that §1396k(a)(1)(A)’s reference to “payment for medical care” is not limited as Gallardo suggests. For example, when the Medicaid Act separately requires state plans to comply with §1396k, it describes that provision as imposing a “mandatory assignment of rights of payment for medical support and other medical care owed to recipients.” §1396a(a)(45) (emphasis added). Section 1396a(a)(45) thus distinguishes only between medical and nonmedical care, not between past (paid) medical care payments and future (unpaid) medical care payments. If Congress had intended to draw such a distinction, “it easily could have drafted language to that effect.” Mississippi ex rel. Hood v. AU Optronics Corp., 571 U.S. 161, 169. In fact, Congress did include more limiting language elsewhere in the Medicaid Act. Section 1396a(a)(25)(H), which requires States to enact laws granting themselves automatic rights to certain third-party payments, contains precisely the limitation that Gallardo would read into the assignment provision. Thus, if §1396k(a)(1)(A)’s broad language alone were not dispositive, its contrast with the limiting language in §1396a(a)(25)(H) would be. Pp. 5–7.
(b) Gallardo’s arguments that §1396k(a)(1)(A) has a different meaning are unconvincing. Gallardo construes the prefatory clause to §1396k(a)(1)(A)— which provides that the “purpose” of the assignment provision is to “assis[t] in the collection of medical support payments and other payments for medical care owed to recipients of medical assistance under the State plan”—to limit the assignment provision to payments that are already “owed” for “past medical care provided under the [state] plan.” Brief for Petitioner 30. But the prefatory clause defines to whom the third-party payments are “owed”—“recipients of medical assistance under the State plan.” It does not specify the purpose for which those payments must be made, referring to “medical support” and “medical care” payments, consistent with the adjacent language in §1396k(a)(1)(A).
Gallardo also proposes that the Court read the assignment provision to incorporate the more limited language in §1396a(a)(25)(H). But the Court must give effect to, not nullify, Congress’ choice to include limiting language in some provisions but not others, see Russello v. United States, 464 U.S. 16, 23. Ahlborn, which Gallardo contends eliminated any daylight between §1396a(a)(25)(H) and §1396k(a)(1)(A), was clear that these two provisions “ech[o]” or “reinforc[e]” each other insofar as they both involve “recovery of payments for medical care,” 547 U. S., at 282, and not “payment for, for example, lost wages,” id., at 280. Ahlborn did not suggest that these provisions must be interpreted in lockstep. Gallardo’s idea that one of these two complementary provisions must “prevail” over the other is therefore mistaken. The complementary provisions concern different requirements; they do not conflict just because one is broader than the other.
Gallardo and the United States also argue that §1396k(a)(1)(A) should be interpreted consistently with §§1396a(a)(25)(A) and (B), which require a State to seek reimbursement “to the extent of ” a third party’s liability “for care and services available under the plan.” But the relevant language—“pay[ment] for care and services available under the plan”—could just as readily refer to payment for medical care “available” in the future. Regardless, Congress did not use this language to define the scope of an assignment under §1396k(a)(1)(A), implying again that the provisions should not be interpreted the same way. This implication is strengthened by the fact that §1396k(a)(1)(A) was enacted after §§1396a(a)(25)(A) and (B), and Congress did not use the existing language in §§1396a(a)(25)(A) and (B) to define the scope of the mandatory assignment.
Finally, Gallardo’s two policy arguments for her preferred interpretation both fail. First, citing a footnote from Ahlborn, she contends that it would be “ ‘absurd and fundamentally unjust’ ” for a State to “ ‘share in damages for which it has provided no compensation.’ ” 547 U. S., at 288, n. 19. But the Court’s holding there was dictated by the Medicaid Act’s “text,” not by the Court’s sense of fairness. Id., at 280. Second, Gallardo speculates that the Court’s reading of §1396k(a)(1)(A) would authorize a “lifetime assignment” covering not only the rights an individual has while a Medicaid beneficiary but also any rights acquired in the future when the individual is no longer a Medicaid beneficiary. Not so. The provision is most naturally read as covering those rights “the individual” possesses while on Medicaid. And given background legal principles about the scope of assignments, §1396k(a)(1)(A) cannot be read to cover the sort of “lifetime assignment” Gallardo invokes. Pp. 8–12.
963 F.3d 1167, affirmed.
Thomas, J., delivered the opinion of the Court, in which Roberts, C. J., and Alito, Kagan, Gorsuch, Kavanaugh and Barrett, JJ., joined. Sotomayor, J., filed dissenting opinion in which, Breyer, J., joined.
Adjudged to be AFFIRMED. Thomas, J., delivered the opinion of the Court, in which Roberts, C. J., and Alito, Kagan, Gorsuch, Kavanaugh and Barrett, JJ., joined. Sotomayor, J., filed dissenting opinion in which, Breyer, J., joined. |
Adjudged to be AFFIRMED. Thomas, J., delivered the opinion of the Court, in which Roberts, C. J., and Alito, Kagan, Gorsuch, Kavanaugh and Barrett, JJ., joined. Sotomayor, J., filed dissenting opinion in which, Breyer, J., joined. |
Argued. For petitioner: Bryan S. Gowdy, Jacksonville, Fla.; and Vivek Suri, Assistant to the Solicitor General, Department of Justice, Washington, D. C. (for United States, as amicus curiae.) For respondent: Henry C. Whitaker, Solicitor General, Tallahassee, Fla. |
Reply of Gianinna Gallardo submitted. |
Reply of petitioner Gianinna Gallardo filed. (Distributed) |
CIRCULATED |
Motion of the Solicitor General for leave to participate in oral argument as amicus curiae, for divided argument, and for enlargement of time for oral argument GRANTED. |
Brief amici curiae of National Conference of State Legislatures, National League of Cities, U.S. Conference of Mayors, Government Finance Officers Association filed. |
Amicus brief of States of Utah, Ohio, and 12 Other States submitted. |
Amicus brief of National Conference of State Legislatures, National League of Cities, U.S. Conference of Mayors, Government Finance Officers Association submitted. |
Brief amici curiae of States of Utah, Ohio, and 12 Other States filed. |
Brief amici curiae of National Conference of State Legislatures, et al. filed. |
Motion of United States for leave to participate in oral argument and for divided argument submitted. |
Motion of the Solicitor General for leave to participate in oral argument as amicus curiae, for divided argument, and for enlargement of time for oral argument filed. |
Record requested from the U.S.C.A. 11th Circuit |
The record from the 11th Circuit is electronic and located on Pacer. |
ARGUMENT SET FOR Monday, January 10, 2022. |
Brief of Simone Marstiller submitted. |
Brief of respondent Simone Marstiller filed. |
Amicus brief of American Academy of Physician Life Care Planners submitted. |
Amicus brief of United States submitted. |
Brief amicus curiae of United States filed. |
Brief amici curiae of American Association for Justice and Florida Justice Association filed. |
Amicus brief of American Association for Justice and Florida Justice Association submitted. |
Brief amicus curiae of American Academy of Physician Life Care Planners in Support of Neither Party filed. |
Brief of Gianinna Gallardo submitted. |
Joint Appendix submitted. |
Joint appendix filed. (Statement of costs filed) |
Brief of petitioner Gianinna Gallardo filed. |
Motion to extend the time to file the briefs on the merits granted. The time to file the joint appendix and petitioner's brief on the merits is extended to and including September 15, 2021. The time to file respondent's brief on the merits is extended to and including November 15, 2021. |
Motion for an extension of time to file the briefs on the merits filed. |
Motion of Gianinna Gallardo for an extension of time submitted. |
Petition GRANTED. |
DISTRIBUTED for Conference of 7/1/2021. |
DISTRIBUTED for Conference of 6/24/2021. |
Reply of petitioner Gianinna Gallardo filed. (Distributed) |
Response to petition from respondent Simone Marstiller filed. |
Letter waiving the 14-day waiting period for the filing of a reply pursuant to Rule 15.5 filed. |
Motion to extend the time to file a response is granted in part and the time is extended to and including June 1, 2021. |
Motion to extend the time to file a response from May 27, 2021 to July 26, 2021, submitted to The Clerk. |
Response to motion from petitioner Gianinna Gallardo filed. |
Motion to extend the time to file a response is granted and the time is extended to and including May 27, 2021. |
Motion to extend the time to file a response from April 12, 2021 to May 27, 2021, submitted to The Clerk. |
Petition for a writ of certiorari filed. (Response due April 12, 2021) |