The state of North Carolina wants its money back and it's dragging a 12 year-old girl into the United States Supreme Court to get it. The child is severely disabled; blind, unable to speak, unable to move. She suffers frequent seizures and needs constant attention. Her disabilities resulted from a botched Caesarian section delivery performed by a doctor with a history of drug abuse who ultimately surrendered his medical license. North Carolina says it spent $1.9 million in Medicaid funds on the girl, and it wants to recover one-third of a $2.6 million malpractice award she received in 2006. State law allows recovery of one-third or the settlement or the total amount of Medicaid funding spent, whichever is lower.
The nine justices have to resolve a conflict between federal law, which bars liens on Medicaid patient's property, and the North Carolina statute. State lawyers defended the one-third share requirement but the justices wondered why one-third, and how to determine exactly how much of the settlement is exclusively for medical expenses. The family's attorney argues that a one-size-fits-all requirement is wrong, and each case must be heard in court separately in the name of fairness. Further complicating the issue is the Supreme Court itself previously ruled that Medicaid liens can only be attached to the portion of the settlement that doesn't cover medical care.
North Carolina's attorney took a particularly tough verbal pounding from Justice Sandra Sotomayor. "How can you predict, especially with a statute that wasn't based on any empirical data, that 30 percent is normally the right amount?" she demanded. "You just picked it out of the air? You could pick 40, 50, 60. How do we draw the line?" At the same time, several justices expressed doubt about holding a hearing for each Medicaid recovery case. The child's settlement does not specify how much money is for medical care and how much is for other things like punitive damages.
It will probably be June before the court renders its decision. The young girl at the center of this important dispute turns 13 next month, a milestone that will most likely come and go unnoticed, like every other day in this profoundly injured child's life.
Source: Miami Herald, "Supreme Court weighs case of disabled child and medical malpractice," Michael Doyle, Jan. 8, 2013