Pivonka v. Corcoran (Slip Opinion)

2020 Ohio 3476, 165 N.E.3d 1098, 162 Ohio St. 3d 326
CourtOhio Supreme Court
DecidedJune 30, 2020
Docket2019-0084
StatusPublished
Cited by22 cases

This text of 2020 Ohio 3476 (Pivonka v. Corcoran (Slip Opinion)) is published on Counsel Stack Legal Research, covering Ohio Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pivonka v. Corcoran (Slip Opinion), 2020 Ohio 3476, 165 N.E.3d 1098, 162 Ohio St. 3d 326 (Ohio 2020).

Opinion

[Until this opinion appears in the Ohio Official Reports advance sheets, it may be cited as Pivonka v. Corcoran, Slip Opinion No. 2020-Ohio-3476.]

NOTICE This slip opinion is subject to formal revision before it is published in an advance sheet of the Ohio Official Reports. Readers are requested to promptly notify the Reporter of Decisions, Supreme Court of Ohio, 65 South Front Street, Columbus, Ohio 43215, of any typographical or other formal errors in the opinion, in order that corrections may be made before the opinion is published.

SLIP OPINION NO. 2020-OHIO-3476 PIVONKA ET AL., APPELLEES, v. CORCORAN,1 DIR., APPELLANT. [Until this opinion appears in the Ohio Official Reports advance sheets, it may be cited as Pivonka v. Corcoran, Slip Opinion No. 2020-Ohio-3476.] Class action—Subject-matter jurisdiction—Medicaid—R.C. 5160.37 established sole remedy for named plaintiffs and unnamed class members who reimbursed Ohio Department of Medicaid on or after September 29, 2007, pursuant to department’s right of recovery under former R.C. 5101.58— Common pleas court lacked subject-matter jurisdiction over class action for named and prospective class plaintiffs whose claims for recovery fall within R.C. 5160.37’s express language—Court of appeals’ judgment reversed and cause remanded to common pleas court. (No. 2019-0084—Submitted January 28, 2020—Decided June 30, 2020.) APPEAL from the Court of Appeals for Cuyahoga County, No. 106749,

1. Under S.Ct.Prac.R. 4.06(B), Maureen Corcoran, the current director of the Ohio Department of Medicaid, is automatically substituted for Barbara Sears, the former director, as a party to this action. SUPREME COURT OF OHIO

2018-Ohio-4866. _________________ FRENCH, J. {¶ 1} In this appeal, we are asked to determine whether the common pleas court had subject-matter jurisdiction over a class action filed by plaintiffs- appellees, Michael A. Pivonka and Lisa Rijos. That class action seeks a declaratory judgment that former R.C. 5101.58, which relates to Medicaid reimbursements, is unconstitutional and also seeks to recover all sums paid to the Ohio Department of Medicaid (the “Department”) under that statute. {¶ 2} Because R.C. 5160.37 now provides the sole remedy for Medicaid program participants to recover excessive reimbursement payments made to the Department on or after September 29, 2007, we conclude that the common pleas court lacked subject-matter jurisdiction over the class action for the named and prospective class plaintiffs whose claims for recovery fall within the statute’s express language. We therefore reverse the judgment of the Eighth District Court of Appeals affirming the trial court’s decision to certify the class. We remand this cause to the trial court to determine whether unnamed prospective class plaintiffs who reimbursed the Department before September 29, 2007, can maintain an action in the common pleas court. I. THE MEDICAID PROGRAM {¶ 3} The federal government established the Medicaid program in 1965 through Title XIX of the Social Security Act, as amended in 42 U.S.C. 1396 et seq. Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268, 275, 126 S.Ct. 1752, 164 L.Ed.2d 459 (2006). The program provides joint federal and state funding for medical care for individuals who cannot afford to pay their own medical costs. Id. States are not required to participate in the Medicaid program, but they all do. Id.; see also Medicaid.gov, Program History: Medicaid, https://www.medicaid.gov/about-us/program-history/index.html (accessed June

2 January Term, 2020

18, 2020) [https://perma.cc/D8C7-YRTE]. Through the program, the federal government pays the majority of the costs a state incurs providing medical care for Medicaid participants; the state pays the rest. Ahlborn at 275. Each state must create its own scheme to oversee and administer the Medicaid program. 42 U.S.C. 1396a. In doing so, a state must comply with all federal statutory requirements for making eligibility determinations, collecting and maintaining information, and administering the program. Id. {¶ 4} Federal law also requires that each participating state give itself subrogation rights to recover certain costs the state paid under the Medicaid program. This means that each state must enact legislation giving it the right to seek reimbursement from a third-party tortfeasor (that is, a third-party wrongdoer) for medical expenses the third-party wrongdoer caused and that the state paid on behalf of a Medicaid participant. 42 U.S.C. 1396a(a)(25)(H). The state must first take reasonable measures to determine whether a third party is liable to pay for a Medicaid participant’s medical costs. 42 U.S.C. 1396a(a)(25)(A). This third-party liability can arise when a health insurer is responsible for paying the participant’s medical costs. Id. But it can also arise if a third-party tortfeasor injures the Medicaid participant and the injury requires the participant to seek medical care. When a third party is liable to pay for the Medicaid participant’s medical costs, the state must seek reimbursement for the medical costs that it paid under the Medicaid program. 42 U.S.C. 1396a(a)(25)(B). The state may seek reimbursement directly from the third party. Id. It may also seek reimbursement from a Medicaid participant who received payment from the third party for the medical costs. 42 U.S.C. 1396k(a)(1) requires that all participating states expressly condition an individual’s eligibility for Medicaid on the individual’s assignment to the state of any rights the individual has to recover medical costs from a third party.

3 SUPREME COURT OF OHIO

II. OHIO’S MEDICAID SUBROGATION RIGHTS STATUTES {¶ 5} Ohio’s Medicaid subrogation rights statute was originally contained in former R.C. 5101.58, repealed in 2013 Am.Sub.H.B. No. 59. That statute gave the Ohio Department of Job and Family Services (“ODJFS” or “the Department”)2 a “right of recovery” against a third party’s liability to a Medicaid participant for medical services and care resulting from an injury, disease or disability caused by the third party. Under that statute and prior to September 29, 2007, if the Medicaid participant brought an action against a third-party tortfeasor, the entire amount the participant received under a settlement or court judgment was subject to the state’s right of recovery. 2003 Am.Sub.H.B. No. 95, 150 Ohio Laws, Part II, 1592-1594. The state could automatically recover up to the full amount of the costs it paid on behalf of the participant, even if the settlement, compromise, judgment or award excluded reimbursement for the medical costs or allocated a lesser amount to those costs. See id. {¶ 6} Other states, including Arkansas, had similar Medicaid subrogation statutes allowing those states to recover up to the entire amount of the medical costs they paid on the Medicaid participant’s behalf without regard to whether the settlement or court judgment allocated a lesser amount for reimbursement of medical expenses. In Ahlborn, 547 U.S. at 292, 126 S.Ct. 1752, 164 L.Ed.2d 459, the United States Supreme Court held that the federal Medicaid statute’s anti-lien provision, 42 U.S.C.

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Bluebook (online)
2020 Ohio 3476, 165 N.E.3d 1098, 162 Ohio St. 3d 326, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pivonka-v-corcoran-slip-opinion-ohio-2020.