The Connecticut Supreme Court in a lengthy and detailed opinion has just ruled In the case of Rathbun et al v, Health Net of the Northeast, Inc.  that  HealthNet a Managed Medicaid program, (

can be the designated assignee  of the State’s Statutory Third Party Recovery rights and that Health Net, thru its agent the Rawlings Company, can recover from Members directly proceeds recovered  from third party litigation even if the proceeds were not specifically designated as repayment of Medicals.

The Plaintiffs in this class action argued that not only did Connecticut’s anti-subrogation rules apply to Managed Care Plans,  but that without a specific finding as to the amount of Medicals included in the settlement, that Health Net had an Ahlborn problem and  would be prohibited from collecting anything. The Ct Supreme Court dismissed each or these arguments and allowed the Medicaid Managed Care Plan to collect directly from the participant.

Third Circuit Appeals Court slams the door on Plaintiffs attempt to allocate settlement

Third Circuit Appeals Court slams the door on Plaintiffs attempt to allocate settlement.

The Third Circuit court of appeals today expressly held that even though Plaintiffs counsel had received from a state court Judge a zero allocation of a settlement to Medicare’s conditional payment. Medicare none the less had a right to its Conditional payment under the MSP regulations.

Arizona CA holds Medicare Advantage plans preempt/can subrogate

In a very well detailed opinion the Arizona Court of appeals has followed the NY courts in Trezza v.Trezza in clearly outlining in exacting detail in the matter of the Estate of Ethridge v. Recovery Management Systems, that Medicare Advantage Plans preempt Arizona ( and presumably all other) State Common law anti-subrogation doctrines.

see opinion

Bipartisan Budget 2013 Overules Ahlborn

On December 26, 2013, President Obama signed the Bipartisan Budget Act of 2013. Section 202
of the Act is entitled “Strengthening Medicaid Third-Party Liability.” The new law amends
portions of the federal Medicaid Act in an attempt to override the application of the allocation
theory derived from Arkansas Dept. of Health & Human Srvs. v. Ahlborn, 547 U.S. 268 (2006).
There are three main amendments to the statutes which take effect on October 1, 2014.

Full Article PDF

Courtesy of PAUL