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, (http://www.jud.state.ct.us/external/supapp/Cases/AROcr/CR315/315CR16.pdf)
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.