Wos v. E. M. A. Ex Rel. Johnson
133 S. Ct. 1391
| SCOTUS | 2013Background
- Medicaid anti-lien provision (42 U.S.C. §1396p(a)(1)) prevents states from placing liens on beneficiary property to recover non-medical settlement amounts.
- North Carolina enacts a statute (N.C. Gen. Stat. §108A-57) requiring up to one-third of tort recoveries to reimburse Medicaid medical expenses paid by the state.
- E.M.A. and parents settled a $2.8 million medical malpractice case in NC; $1.9 million of NC’s Medicaid expenditures were incurred.
- NC’s settlement was not allocated among claims; one-third escrow was used pending final lien determination.
- The North Carolina Supreme Court adopted Andrews’s interpretation, deeming the one-third share a conclusive presumption for medical expenses when expenditures exceed one-third of recovery.
- The Fourth Circuit and district court had held the statute compatible with Ahlborn, but the Supreme Court granted certiorari to address preemption issues.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether NC §108A-57 is pre-empted by the federal Medicaid anti-lien provision. | E.M.A. argues anti-lien blocks any non-medical recovery portion. | NC contends statute uses a traditional tort-regulation approach and is a reasonable allocation. | Pre-empted insofar as it assigns one-third of all recoveries to medical expenses. |
| Whether an irrebuttable one-third allocation can comply with Ahlborn’s framework. | Arbitrary allocation cannot satisfy Ahlborn’s required case-specific determination. | One-third allocation is a reasonable approximation in many cases. | Irrebuttable, across-the-board allocation conflicts with the anti-lien provision. |
| Does NC have alternative mechanisms to allocate medical vs nonmedical damages under federal law? | State could implement case-by-case allocations. | Statute provides administrative process and reasonable allocation. | Court suggests state may use alternatives but not an arbitrary rule; must align with federal constraints. |
Key Cases Cited
- Arkansas Dept. of Health and Human Servs. v. Ahlborn, 547 U. S. 268 (U.S. 2006) (medicaid anti-lien limits recovery to the designated medical expenses portion and protects the remainder)
- National Meat Ass’n. v. Harris, 565 U. S. 452 (U.S. 2012) (preemption requires looking at what the state law actually does, not how it is framed)
- PLIVA, Inc. v. Mensing, 564 U. S. 604 (U.S. 2011) (conflict preemption analysis when state law conflicts with federal statute)
- Silkwood v. Kerr-McGee Corp., 464 U. S. 238 (U.S. 1984) (state traditional tort regulation authority; not dispositive here but cited on state power)