Blanton v. DEPT. OF PUBLIC HEALTH SERVICES

2011 MT 110, 255 P.3d 1229, 360 Mont. 396
CourtMontana Supreme Court
DecidedMay 24, 2011
Docket10-0231
StatusPublished
Cited by1 cases

This text of 2011 MT 110 (Blanton v. DEPT. OF PUBLIC HEALTH SERVICES) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Blanton v. DEPT. OF PUBLIC HEALTH SERVICES, 2011 MT 110, 255 P.3d 1229, 360 Mont. 396 (Mo. 2011).

Opinion

255 P.3d 1229 (2011)
2011 MT 110
360 Mont. 396

Terry BLANTON, individually and on behalf of himself and all others similarly situated, Plaintiffs, Appellees, and Cross-Appellants,
v.
The DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES, a department of the State of Montana, Defendant and Appellant.

No. DA 10-0231.

Supreme Court of Montana.

Argued and Submitted March 2, 2011.
Decided May 24, 2011.
Rehearing Denied June 28, 2011.

*1230 For Appellant: Randy J. Cox (argued), Dean A. Stensland (argued); Boone Karlberg, P.C.; Missoula, Montana, Steve Bullock, Montana Attorney General; Katherine *1231 J. Orr, Assistant Attorney General, Agency Legal Services Bureau; Helena, Montana.

For Appellees and Cross-Appellants: Alan J. Lerner (argued), Linda C. Semrow; Lerner Law Firm; Kalispell, Montana, James A. Manley; Manley Law Firm; Polson, Montana.

Justice BETH BAKER delivered the Opinion of the Court.

¶ 1 The Department of Public Health and Human Services (the "Department") appeals from the judgment of the Lake County District Court in favor of Terry Blanton (Blanton) and the approximately 2,500 class members (the "Class"). Blanton and the Class cross-appeal. We consider the following issues on appeal:

¶ 2 1. Whether the District Court correctly determined the retroactive applicability of Ark. Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268, 126 S.Ct. 1752, 164 L.Ed.2d 459 (2006).

¶ 3 2. Whether the District Court's order requiring the Department to compile data on each class member's claim constituted an abuse of discretion.

¶ 4 3. Whether the District Court erred in determining that interest should be assessed from the date of collection on any amounts improperly collected by the Department.

¶ 5 4. Whether the District Court erred in determining that a Medicaid recipient's insurer is not a "third party" as that term is used in state and federal Medicaid reimbursement laws.

¶ 6 On cross-appeal, we consider whether the District Court erred by failing to apply the common law "made whole" doctrine.

FACTUAL AND PROCEDURAL BACKGROUND

¶ 7 This suit concerns the Department's collection on liens filed against other sources of financial support available to Medicaid recipients for the same or similar injury. State and federal laws require Medicaid (administered by the Department) to seek reimbursement for medical assistance from all third parties liable for the Medicaid recipient's medical expenses, in keeping with Medicaid's function as the payer of last resort. Under § 53-2-612, MCA, the Department holds a lien against payments made to Medicaid assistance recipients, so the Medicaid program can recoup costs paid on behalf of aid recipients when another source is legally liable for the same injury or condition.

¶ 8 Terry Blanton filed suit on February 14, 2006, individually and on behalf of a class of similarly situated plaintiffs who received Medicaid assistance and were subject to a Medicaid lien pursuant to § 53-2-612, MCA. The suit alleged that the Department had collected a greater amount than it was entitled from the plaintiffs' recoveries from other sources. Individually and on behalf of the Class, Blanton sought declaratory and injunctive relief, seeking a ruling that the Department's liens were invalid under federal Medicaid law and the Montana and U.S. Constitutions. Blanton claimed the Department was not entitled to reimbursement until he (or any given class member) had been "made whole." Blanton asked the court to order the Department to report on all subrogation recoveries, give class members an opportunity to contest these reports, and return to the Class monies improperly collected.

¶ 9 Soon after plaintiffs' complaint was filed, the United States Supreme Court held in Ahlborn that an Arkansas statute nearly identical to the Montana Medicaid lien statute violated federal Medicaid law, because it authorized the State to seek reimbursement from all settlement proceeds, rather than only those settlement proceeds representing compensation for medical expenses.

¶ 10 The Supreme Court explained that 42 U.S.C. § 1396p(a), the Medicaid "anti-lien provision," generally prohibits liens against the property of aid recipients, and "the exception carved out by §§ 1396a(a)(25) and 1396k(a) is limited to payments for medical care." Ahlborn, 547 U.S. at 284-85, 126 S.Ct. at 1763. The Court summarized, "Arkansas' statute finds no support in the federal third-party liability provisions, and in fact squarely conflicts with the anti-lien provision of the federal Medicaid laws." Id. at 280, 126 S.Ct. at 1760. Like its Arkansas counterpart, § 53-2-612, MCA (2005), provided *1232 that Medicaid liens attached to all money paid by a third party to the extent the Department had paid medical assistance for the same personal injury. Thus, the standard practice of agencies administering Medicaid in Montana and Arkansas was to place a lien on third party payments to the full extent Medicaid had expended funds on behalf of the recipient, even if that amount exceeded the portion of the recipient's settlement or judgment attributable to medical costs.

¶ 11 This was a common interpretation nationwide of the federal Medicaid statute, until Ahlborn. The U.S. Supreme Court's decision meant the Department had impermissibly collected settlement proceeds attributable to non-medical costs in thousands of instances in the past. For example, were an injured person to have received $60,000 worth of Medicaid assistance for an injury that later gave rise to a $20,000 settlement between the recipient and a third party, if half of the settlement amount was attributable to medical costs and half to damages for pain and suffering, the Department would be limited by the federal anti-lien provision to reimbursement from the $10,000 payment for medical expenses. Previously, however, the Department asserted liens to the full extent of its assistance paid, and against all settlement proceeds received by the recipient—in the above example, against the full $20,000. The Montana Legislature amended § 53-2-612, MCA, in 2009, to conform to Ahlborn's holding.

¶ 12 In response to Ahlborn, the Department and the Class filed motions for summary judgment and/or partial summary judgment addressing the effect the decision should have on this case. Both parties agreed Ahlborn would apply retroactively to some extent, given the clear requirement under federal law that rules of law must be applied evenly to all cases open and pending on direct review. Harper v. Va. Dept. of Taxation, 509 U.S. 86, 97, 113 S.Ct. 2510, 2517, 125 L.Ed.2d 74 (1993); Danforth v. Minnesota, 552 U.S. 264, 266, 128 S.Ct. 1029, 1032, 169 L.Ed.2d 859 (2008). The parties strongly disagreed on the interpretation of this mandate as applied to the case, and on February 20, 2009, the court heard oral argument. Plaintiffs contended that Ahlborn should be applied retroactively to all members of the Class.

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Cite This Page — Counsel Stack

Bluebook (online)
2011 MT 110, 255 P.3d 1229, 360 Mont. 396, Counsel Stack Legal Research, https://law.counselstack.com/opinion/blanton-v-dept-of-public-health-services-mont-2011.