Delia v. E.M.A. (12-98)
argument 12-98Delia v. E.M.A.
Supreme Court of the United States
1h 1m
7 speakers
8 chapters
transcribed 4 days ago
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What does the Medicaid Act require states to do with third‑party recoveries?
We'll hear argument next in case twelve ninety eight, Delia versus EMA. Mr Madry?
Mr Chief Justice, and may it please the court. The Medicaid Act requires states to take reasonable measures to seek reimbursement from liable third parties. and that states require recipients to assign their rights for a to payment for medical care. The Act does not direct how a State must determine what portion of a recipient's third party recovery is properly attributable to past medical expenses. North Carolina's procedure established.
How could you ever know that ex ante? I mean without looking at the individual facts of a case, the thirty percent is going to be under inclusive in some circumstances, over inclusive in others. So, how do you deal with our holding that you're not entitled to um the over inclusive portion.
Uh Justice Sotomyor, the The answer to that depends on whether the State has to predict with certainty uh the amount of
life is never certain. And and um it's so I I don't even go to that issue. Um I go just simply to the question how can you ex ante uh predict, particularly with a statute that wasn't based on any empirical data. the thirty percent normally. is the right amount. You just pick Get out of the air you could pick forty, fifty, sixty, How do we draw the line?
Your Honor, the the statute doesn't predict, it defines. It tells the recipient how much out of a recovery they must allocate to satisfy the repayment obligation. If it were a prediction, that would make it a presumption. And you'd have to defend it as such. But here the the statute defines the portion that The State, as a condition of extending the Medicaid benefits, tells the recipient they must allocate.
Wait, they they must allocate? I mean are is the State saying you do not own that? thirty percent of the recovery. So you never get a property right in it. so that there's never any problem about asserting a lien against it. I thought that's what's going on here. And I I I think that sort of disguised by talking about allocation. I thought the State is saying as to thirty percent of the recovery, you have no property right in it. Is it is it not saying that? If I am I wrong?
Your Honor, the the State is saying that as to the amount of Medicaid benefits provided, the State has a right of recovery. And it says that of any third party.
That you have no property right. In the thirty percent.
The State has the right to recover that portion.
Let me ask my question again. Is the State saying that you have no property right in the thirty percent? I think that can be answered
yes or no. And yes, Your Honor, the situation B, there is no property right in that percentage that the State has conditioned the extension of benefits on.
Now how does it have a right to s to announce that in a FELA case? or in a Jones Act case, where those injured parties They have a property right in there. protection, but this statute applies to that recovery as well.
If those if those litigants are Medicaid recipients, it applies to them as a condition of having received the state Medicaid Uh
they can deny a re a litigant. a property right in that recovery. I don't know how you can go in and ask for something you don't own. I I I don't know how the plaintiff can go in and litigate a case if they don't have a property interest that they can then assign to someone else. I've never heard of such a thing. how they would have standing. to sue on your behalf if they have no property interest in the recovery.
Your Honor, I'm I'm confused by the question. I was how
do you sue for something you have no property interest in?
Uh uh. I I don't know how you sue for something you don't have a property interest in, Your Honor.
So go back to Justice Scalia's question.
The the thirty
there has to be some interest in the thirty percent. By the plaintiff.
V. The thirty percent attaches upon the recovery from a third party. The the cause of action is for Um Whatever sources of injury that individual would have. To the extent The recovery is for medical expenses. previously paid for by Medicaid.
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Chapters
8 chapters
1
What does the Medicaid Act require states to do with third‑party recoveries?
0:01–6:08
2
How does the North Carolina statute define the portion of a recovery that must be allocated to the state?
6:08–13:28
3
Do Medicaid recipients have a property right in the 30 % (or 33 %) portion of a settlement?
13:28–21:29
4
What is the difference between a judicial finding, a stipulation, and no determination at all for allocating medical expenses?
21:29–27:55
5
How do other states handle the allocation of medical expenses and what can we learn from their procedures?
27:55–35:46
6
Why was the 30 % (or 33 %) cap chosen historically, and could it be changed to a different percentage?
35:46–44:04
7
Is a bright‑line rule (like the 30 % cap) a reasonable presumption, or should courts use case‑by‑case analysis?
44:04–53:14
8
What procedural safeguards exist to ensure a fair allocation when a settlement is far below the jury’s potential award?
53:14–1:01:45