health care

Ark. Dep't of Human Servs. v. Ahlborn

Issues

If a party receives Medicaid benefits for an injury, and later receives a settlement payment from a third party, can the state force the party to use the entire settlement to repay the state's Medicaid expenses?

 

Medicaid provides certain needy individuals with funds for medical treatment. The program is administered by the states with federal funding and statutory guidelines. Federal Medicaid law generally forbids states from placing liens on the "pre-death" property of Medicaid beneficiaries. The Arkansas Medicaid program requires beneficiaries to sign over their interest in any future legal claim before receiving benefits. Technically, this case will decide whether the federal statutes prohibit states from doing this. More importantly, the decision will determine to what extent states can recoup Medicare expenses from private tort judgments and settlements, and could have a profound effect on how the costs of the Medicaid are distributed between the states and private parties.

Heidi Ahlborn suffered severe, permanently disabling injuries in a 1996 car accident. Ahlborn v. Arkansas Dep't of Human Services, 397 F.3d 620, 622 (8th Cir. 2005). She sought and received roughly $215,000 in medical benefits through Arkansas's Medicaid program. Id.

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Coventry Health Care of Missouri, Inc. v. Nevils

Issues

Does the Federal Employees Health Benefits Act (“FEHBA”) preempt state anti-subrogation law and does 5 U.S.C. § 8902(m)(1) violate the Supremacy Clause? 

The Supreme Court will decide whether § 8902(m)(1) of the Federal Employees Health Benefits Act (“FEHBA”) allows insurance companies to collect reimbursements from the insured after personal injury claims or whether a “presumption against preemption” allows state anti-subrogation laws to prevail.  Petitioner Coventry Health of Missouri, Inc. argues that FEHBA unambiguously preempts state anti-subrogation laws; preemption comports with the Supremacy Clause; and the Office of Personnel Management’s new final rule, codified in § 8902(m)(1), should be granted Chevron deference. In contrast, Respondent Jodie Nevils argues that FEHBA’s language is ambiguous; Chevron deference does not apply; and allowing preemption of state anti-subrogation law violates the Supremacy Clause by encroaching on law traditionally left to the states to regulate. This case will clarify the potential for state anti-subrogation law preemption to influence the cost of health care coverage for FEHBA plan enrollees and will address federalism concerns regarding the balance of power between the federal government and the states for the administration and provision of health insurance to federal employees. 

Questions as Framed for the Court by the Parties

The Federal Employees Health Benefits Act (“FEHBA”), 5 U.S.C. § 8901 et seq., governs the health benefits of millions of federal workers and dependents, and authorizes the Office of Personnel Management (“OPM”) to enter into contracts with private insurance carriers to administer benefit plans. FEHBA expressly “preempt[s] any State or local law” that would prevent enforcement of “[t]he terms of any contract” between OPM and a carrier which “relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits).” In a 2015 regulation, OPM codified its longstanding position that FEHBA-contract provisions requiring carriers to seek subrogation or reimbursement “relate to . . . benefits” and “payments with respect to benefits,” and therefore FEHBA preempts state laws that purport to prevent FEHBA insurance carriers from pursuing subrogation and reimbursement recoveries. 5 C.F.R. § 890.106(h). Expressly disagreeing with multiple federal circuits and state appellate courts, the Missouri Supreme Court nevertheless construed FEHBA not to preempt state laws—explicitly refusing to accord any deference to OPM’s regulation. A majority of the court further concluded that Section 8902(m)(1) violates the Supremacy Clause of the U.S. Constitution. The questions presented are:

  1. Whether FEHBA preempts state laws that prevent carriers from seeking subrogation or reimbursement pursuant to their FEHBA contracts.
  2. Whether FEHBA’s express-preemption provision, 5 U.S.C. § 8902(m)(1), violates the Supremacy Clause. 

In 2006, Respondent Jodie Nevils, a federal employee working for the United States Postal Service, was injured in a car accident. See Brief for Respondent, Jodie Nevils at 11. Nevils was covered by a health insurance plan through the petitioner Coventry Health Care of Missouri, Inc.

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Gobeille v. Liberty Mutual Insurance Company

Issues

Does the Employee Retirement Income Security Act of 1974 (ERISA) preempt Vermont data reporting laws, which require companies that process insurance claims to report certain medical claims data to the state?

 

Vermont enacted legislation that created a “unified health care database” designed to improve the affordability and quality of health care in Vermont by collecting and analyzing statewide data on insurance claims.  See Liberty Mut. Ins. Co. v. Donegan, 746 F.3d 497, 500–01 (2d Cir. 2014); see also Vt. Stat. Ann. tit. 18 § 9410(a)(1). Liberty Mutual offers a health insurance benefit plan to Vermont residents; the Employee Retirement Income Security Act of 1974 (“ERISA”) governs benefit plans. See id. ERISA requires benefits plans to make claim data reports to the Department of  Labor,  and generally preempts any state laws that relate to an employee benefit plan.  See id. at 503. In August 2011, the Vermont Department of Banking, Insurance, Securities and Health Care Administration (the “Department”) subpoenaed claims data from Blue Cross and Blue Shield of Massachusetts, the company that administers Liberty Mutual’s Plan. See id. at 502. In  district  court, Liberty Mutual sought to enjoin the subpoena, arguing ERISA preempted Vermont’s reporting requirements. See id. On appeal, the Court of Appeals for the Second Circuit held that ERISA did preempt the reporting requirements. See id. But Alfred Gobeille, chair of the Vermont Green Mountain Care Board, maintains that ERISA does not preempt Vermont’s law, because (1) Vermont’s law falls under the traditional state power to regulate health care, (2) the law does not infringe any core function of ERISA, and (3) Congress intended for states to retain the ability to collect health care data. See Brief for Petitioner, Alfred Gobeille at 25. Liberty Mutual counters, arguing that Vermont’s reporting requirements conflict with Congress’s intent to create a uniform federal reporting regime, and thus constitute precisely the kind of state law that Congress intended ERISA to preempt. See Brief for Respondent, Liberty Mut. Ins. Co. at 13. The Supreme Court’s resolution of this case will impact the cost to consumers of purchasing health care, the quality of that care, and the resources that the insurance companies must spend on claims data reporting procedures. See Brief of Amici Curiae AARP et al., in Support of Petitioner at 9-10, 11; Brief of Amici Curiae The American Benefits Council et al., in Support of Respondent at 24, 27-28.

Questions as Framed for the Court by the Parties

May Vermont apply its health care database law to the third-party administrator for a self-insured ERISA plan?

Liberty Mutual Insurance Company administers a health plan, the Liberty Mutual Medical Plan (the “Plan”), which covers 84,000 people nationwide and 137 people in Vermont. See Liberty Mut. Ins. Co. v. Donegan, 746 F.3d 497, 501 (2d Cir.

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