In re E.B.
229 W. Va. 435
W. Va.2012Background
- DHHR appealed a circuit court order allocating a $3.6 million third-party settlement for infant E.B. in a WV infant settlement proceeding; dispute over Medicaid subrogation under W. Va. Code § 9-5-11 and Ahlborn allocation; court applied Ahlborn proportional to full value of the claim to determine DHHR’s reimbursement and directed the rest to a special needs trust; DHHR argued for full reimbursement under state law with a pro rata reduction of fees; circuit court found full value of the claim at $25,373,937.95 and allocated DHHR $79,040.82 with future damages treated under Ohio law; both WV and Ohio liens and damages were considered, with future Medicare/Medicaid considerations central to the decision; the WV Supreme Court affirmed in part, reversed in part, and remanded to refine the DHHR reimbursement amount and allocation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether W. Va. § 9-5-11 is preempted by federal law as applied to unallocated settlements. | DHHR contends Ahlborn limits recovery to medical-expense portion; state statute conflicts. | Holly G. asserts § 9-5-11 permits broader recovery and avoids allocation requirements. | Preempted to extent conflicting with Ahlborn. |
| How to allocate an unallocated settlement between past medical and nonmedical damages. | DHHR supports Ahlbom’s need for allocation; argues against fixed ratio in every case. | Holly G. supports ratio method or statutorily defined allocation to medical expenses. | Allocation required; DHHR entitled to portion allocated to past medical expenses. |
| Whether Ohio non-economic-damages cap applies to E.B.’s noneconomic damages. | Ohio cap should control noneconomic damages; circuit court erred in exceeding cap. | Ohio cap applies to noneconomic damages; court must follow Ohio limits. | Ohio cap applicable; noneconomic damages capped at $500,000. |
| Whether Dr. Yarkony’s future medical expenses testimony was admissible. | Evidence should be admissible if tied to life-care plan; challenge preserved. | Testimony unpreserved; expert qualifications and methods not adequately challenged. | Challenges not preserved; evidence not reversible error; calculation upheld under allocation framework. |
Key Cases Cited
- Arkansas Department of Health & Human Services v. Ahlborn, 547 U.S. 268 (U.S. 2006) (limits state recovery to medical-expense portion; anti-lien provision)
- Grayam v. Dep't of Health and Human Res., 201 W. Va. 444 (West Virginia 1997) (limits of subrogation; makes DHHR recover full reimbursement absent Ahlborn guidance)
- Anderson v. Wood, 204 W.Va. 558 (West Virginia 1999) (pro rata share of costs and attorney fees for Medicaid reimbursement)
- E.M.A. ex rel. Plyler v. Cansler, 674 F.3d 290 (4th Cir. 2012) (interprets Ahlborn; limits state recovery to medical-expense portion; supports allocation hearing)
- Price v. Wolford, 608 F.3d 698 (10th Cir. 2010) (discusses adversarial allocation and burden of proof in Medicaid lien context)