Gallardo v. Marstiller
596 U.S. 420
SCOTUS2022Background
- In 2008 Gianinna Gallardo was catastrophically injured by a truck; Florida Medicaid paid $862,688.77 for initial medical care and continues to pay ongoing care.
- Gallardo’s tort case settled for $800,000; the settlement expressly allocated $35,367.52 to past medical expenses and made no specific allocation for future medical care.
- Florida’s Medicaid Third‑Party Liability Act automatically assigns a beneficiary’s rights to third‑party payments for medical care to the State and presumptively entitles the State to 37.5% of a tort recovery (after a 25% attorney‑fee deduction), here $300,000, unless rebutted by clear and convincing evidence.
- Gallardo challenged Florida’s attempt to recover from settlement funds that she contends were intended to compensate for future medical care; lower courts split, with the Eleventh Circuit allowing recovery from amounts allocated for future medical care.
- The Supreme Court held that 42 U.S.C. §1396k(a)(1)(A) (the mandatory assignment of “any rights … to payment for medical care”) permits a State to seek reimbursement from settlement payments allocated for future medical care, and affirmed the Eleventh Circuit.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether §1396k(a)(1)(A) permits states to recover from settlement amounts allocated for future medical care | Gallardo: the Medicaid Act’s anti‑lien rule (§1396p) and related provisions limit recovery to settlement funds actually allocated for past medical care Medicaid paid for | Florida: §1396k(a)(1)(A) assigns “any rights … to payment for medical care” and thus covers rights to payment for future medical care as well as past care | Court: §1396k(a)(1)(A) covers payments for medical care generally (past or future); State may seek reimbursement from amounts allocated for future medical care |
| Whether the assignment provision must be read as limited by narrower provisions (§1396a(a)(25)(H), §1396a(a)(25)(A)–(B)) | Gallardo: assignment should be read in lockstep with these provisions that reference payments for care “available under the plan” or “for which payment has been made” | Florida: the provisions are complementary; Congress used different language and the assignment’s broader text governs the assignment question | Court: different wording matters; §1396k(a)(1)(A) is broader and not cabined by the later, narrower provisions |
| Whether the assignment creates a “lifetime assignment” covering rights acquired after Medicaid eligibility | Gallardo: a broad reading would allow a State to claim rights to future unrelated recoveries indefinitely, which is absurd and unjust | Florida: assignment pertains to rights to payment for medical care and is not meant to be indefinite | Court: reading is naturally confined by background assignment law to rights the individual possesses while on Medicaid (not an unconstrained lifetime assignment) |
Key Cases Cited
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (2006) (establishes exception to Medicaid anti‑lien permitting recovery from portion of settlement representing payments for medical care)
- Wos v. E. M. A., 568 U.S. 627 (2013) (distinguishes medical from nonmedical elements of a recovery)
- United States v. Gonzales, 520 U.S. 1 (1997) (treats the word “any” as expansive in statutory interpretation)
- Russello v. United States, 464 U.S. 16 (1983) (presumption that Congress acts intentionally when including language in one provision but omitting it in another)
- Mississippi ex rel. Hood v. AU Optronics Corp., 571 U.S. 161 (2014) (if Congress intended a limitation it could have drafted it expressly)
- United States v. Central Gulf Lines, Inc., 974 F.2d 621 (5th Cir. 1992) (background principle that assignments generally cover rights possessed at the time of assignment)
- Harris v. McRae, 448 U.S. 297 (1980) (States must comply with Medicaid Act requirements to receive federal funding)