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NC Medicaid and Ahlborn: Ezell not fixed by NC Supreme Court

Just a quick post for anyone following the ongoing saga of the Ezell case in NC.  Our Supreme Court denied the Motion for Rehearing on Friday, December 15th.  You can view the depressing Order here.

Here is the link to the posts on this Blog that discuss Ahlborn and Ezell.

So what does it mean that Ezell stands as the law in NC? Well, it means that we have the Dissenting Court of Appeals opinion in Ezell which I believe is directly contracdictory to the SCOTUS opinion in Ahlborn.  Yet, our NC Supreme Court either refused to recognize that, or I'm just misunderstanding a lot of law.

I would consider the later, but John Saxon of the UNC Institute of Government seems to agree with me in a great article he wrote.  You can read the .pdf version by following this link.
If you would like a hard copy of Saxon's article, you can order it for five dollars here.

In his article, John summarizes the relevant case law on Medicaid liens and provides an excellent analysis of the Ahlborn and Ezell opinions.  He sums up his research this way:

Like Arkansas’ Medicaid third party liability statutes, [NC]G.S. 108A-57 and G.S. 108A-59, read literally, apply broadly to all of a Medicaid beneficiary’s rights of recovery against tortfeasors, insurance companies, andother third parties.77 G.S. 108A-57, for example, provides that the state Medicaid program is
“subrogated to all rights of recovery, contractual or otherwise, of the [Medicaid] beneficiary … against any person.” Similarly, G.S. 108A-59 requires the
assignment of a Medicaid beneficiary’s “right to third party benefits, contractual or otherwise,” without any express limitation as to the type or scope of these rights or benefits. And the North Carolina Supreme Court’s decision in Ezell only reinforces this reading.

But to the extent that G.S. 108A-57 and G.S. 108A-59 apply to a Medicaid beneficiary’s right to recover payments from a third party for claims other than those for medical expenses that have been, or will be, covered by the State’s Medicaid program, they
suffer from the same defect as Arkansas’ Medicaid third party liability statutes and are therefore invalid under the federal Medicaid statute and the Ahlborn decision.

Similarly, to the extent that the North Carolina Supreme Court’s decision in Ezell and the North Carolina Court of Appeals’ decision in Campbell hold that a Medicaid TPL claim may be asserted against the portion of a personal injury settlement that compensates a Medicaid beneficiary for damages other than medical expenses, they are inconsistent with the U.S. Supreme Court’s decision in Ahlborn and therefore are not good law.

So it looks like at least one other person agrees with me that Ahlborn and Ezell can not be reconciled.  Looks like lawyers in North Carolina will have to pursue a new remedy in the Legislature, or in Federal Court.

Does anyone else have a different take on this?  Can Ezell be limited to only the facts of that case?

Chris Nichols
Nichols Law Firm 1.800.906.5984


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I think the state of Texas has a recent law which makes impossible for planned parenthood to obtain there additional funds from the state's Medicaid agency !


I think the people must preserve the rights of parenthood as they have more impact on kids!

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