state medicaid agencies no longer require following tristani

Ever since May 1, 2006, when the United States Supreme Court issued a 9-0 decision in Arkansas Dept. of Health and Human Services v. Ahlborn, settling parties, state Medicaid agencies and state legislatures have been wrestling with the question of how to balance Medicaid lien recovery rights with property rights of their Medicaid beneficiaries. Following a federal class action brought in Pennsylvania challenging various aspects of that state’s Medicaid lien recovery rights, last week the Third Circuit in Tristani upheld both Pennsylvania’s statutory allocation formula and provided some clarity for settling parties to know what role Pennsylvania’s Dept. of Public Welfare (DPW) is to play in personal injury settlements. Some of the takeaways from this decision are relevant in all states, as some state legislatures have established default allocation rules in the wake of the Ahlborn decision, and other state legislatures have provided guidance that state Medicaid agencies are to administer their Medicaid programs consistent with Ahlborn.

The Garretson Resolution Group (“GRG”) specializes in settling health care liens and reimbursement claims with federal (Medicare), state (Medicaid) and private/ERISA health insurance providers in single event and mass tort settlements. In fact, GRG evaluated and resolved Medicare and Medicaid’s interest in over 50,000 cases last year alone. Simply put, we know the process.

We at GRG provide this practice tip to keep our clients informed of the latest developments that may impact Medicaid lien resolution.

Among the tips included in this pamphlet are:

  • What are the key takeaways from the Tristani II decision?
  • Is there a federal requirement for states to actively intervene in a beneficiary’s tort claim?
  • What does the decision mean for state default allocation rules?