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NC Injury Lawyers: Ahlborn Resources for Medicaid

This post is a collection of important links for anyone dealing with an Ahlborn issue in relation to a Medicaid lien on a personal injury settlement.  Ahlborn allows an attorney to argue that Medicaid should not receive full reimbursement of a lien for payment of medical bills if the lien exceeds the portion of the settlement "allocated" for medical costs.

The "thumbnail" legalese version of the Ahlborn holding is this:

1) Arkansas statute automatically imposing lien in favor of ADHS on tort settlement proceeds was not authorized by federal Medicaid law, to extent that statute allowed encumbrance or attachment of proceeds meant to compensate recipient for damages distinct from medical costs, and

2) anti-lien provision of federal Medicaid law precluded Arkansas statute's encumbrance or attachment of proceeds related to damages other than medical costs

The OYEZ summary of the case (one page) can be viewed HERE.

My "practical" version of the implications of Ahlborn can be found here:
NC Trial Law Blog on Ahlborn

The Ahlborn Supreme Court Decision .pdf link

Click HERE for the Rich Text Format of the Ahlborn case from Westlaw as posted by the Alaska Trial Lawyers which contains "hotlinks" to all cited authority and briefs.  You can dowload the case for free but to link to the other authority and briefs you will need a Westlaw password.

Here is the list of all the lawyers involved and all of the Supreme Court filing milestones.

The Petitioner's Brief (Arkansas Medicaid)

The Respondent's Brief (Ahlborn)

The Petitioner's Reply Brief (Arkansas Medicaid)

The Amicus Brief by ATLA/Center for Constitutional Law at Arkansas Supreme Court.(I need a copy of this brief, so if anyone has it, please send me a link or an upload)

The SC Amicus Brief by the United States in Support of Arkansas

Hat Tip to Steve Bricker of the Bricker Law Firm in Richmond, VA for sending me a New York case where the NY Supreme Court (their highest trial court, like NC's Superior Court) used Ahlborn the way it was intended.  Hopefully this will be a good "go-by" for other courts.

Click Here to Download Lugo_v_Beth_Israel_NY_42_USC_1396p.pdf

The Center for Constitutional Law's memo on "How to Use Ahlborn".  These are the folks that wrote the Amicus brief that was quoted by the Supreme Court in the majority opinion.  This is written by Lou Bograd from CCL and is a great guide.Download ahlborn_opinion_letter.pdf

This highly useful memo from the Department of Health and Human Services dated July 3, 2006,  provides the summary of how DHHS (The Fed. department charged with overseeing Medicare and Medicaid) interprets the Ahlborn decision in light of their own statutes.  This is a GREAT memo because it is the Fed's own instructions to "All Associate Regional Administrators for Medicaid and State Operations". This is a downloadable Word document that will allow you to argue against the State's probably "stricter" interpretation of the rules.  In North Carolina we have seen our Medicaid office argue "we have to get paid in full, the Federal Government mandates that."  No they don't.  Read it.

Social Services Law Bulletin # 41from the North Carolina Institute of Government by John Saxon. (.pdf download) This law bulletin was written as a "review" of the Ahlborn case to provide guidance to NC Medicaid.  The issue also addresses a NC Supreme Court opinion in the matter Ezell and explains how the author does not see how the two opinions can be squared with each other.  I wrote the Amicus in the Ezell case.

Medicaid Letter (Ohlahoma) Setting Out Ahlborn Criteria.  This letter appears to be a letter from Oklahoma Medicaid to a lawyer setting out what Oklahoma wants/needs to make a reduction in a Medicaid lien.  I think this is helpfu information to "guide" lawyers in jurisdictions where Medicaid has not figured out what they want or need to accomodate Ahlborn.  The link downloads the letter in word or allows for HTML viewing.

National Association of State Medicaid Directors Website.  This link takes you to the Medicaid Directors website where you will find all sorts of interesting information. Take a loom at the "insiders view".  The Oklahoma letter above came from the bowels of this website.

If you have any useful links to add to this collection, please email them to me or simply post below in the comments.  I'll make sure to credit you and provide a link to your blog/website if you want.

Chris Nichols 1.800.906.5984


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Question: Currenlty settling a minor's case. State Medicaid is asserting a lien on settlement for full amount of medical expenses paid. Most of the medical expenses are not related to the tort. We argue that Medicaid has burden to prove its expenses are causally related to tort. Medicaid says no that it met the threshold of establishing that they are medical expenses. If Medicaid had brought suit against the liable third party it would have had to have proved causation, is there something that allows them to bypass this requirement if there's a settlement in place?

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