The Pennsylvania Supreme Court issued a majority opinion yesterday, December 29, 2009, vacating the Superior Court’s Bowmaster holding and reinstating the Order of the Court of Common Pleas of Centre County dated November 6, 2006. E.D.B., v. Gerald Clair and Centre Community Hospital, No. 78 MAP 2008 (December 29, 2009), available at J-42-2009mo.pdf.
The Supreme Court’sE.D.B. opinion settles the “incompatible–indeed opposite—holdings” reached by the Superior Court in Bowmaster, 933 A.2d 86 (Pa.Super. 2007), and the Commonwealth Court in Shaffer-Doan v. Department of Public Welfare, 960 A.2d 500 (Pa.Cmwlth. 2008).
The Supreme Court majority sided with the Commonwealth Court by holding that a minor Medical Assistance (Medicaid) recipient has a cause of action against a third party tortfeasor to recover and reimburse the Department of Public Welfare for Medical Assistance benefits received during minority. Specifically, the Court majority found interpreted subsection 1409(b) of the Pennsylvania Fraud Abuse and Control Act to supersede, according to the dissent, “centuries’ worth of Pennsylvania jurisprudence which places the responsibility to raise a child upon her parents”. The Court majority favored the public interest of protecting taxpayers and the public fisc in the provision Medical Assistance benefits historically not considered in common law parental support principles.
Notably, the Supreme Court recognized that the General Assembly enacted subsection 1409(b), conferring upon the Department of Public Welfare a statutory right to reimbursement from the “entire amount of any settlement” “notwithstanding any other provision of law”, prior to the United States Supreme Court’s monumental Ahlborn decision. 547 U.S. 268 (2006). Because the operative facts of E.D.B.’s case arose pre-Ahlborn, the Court leaves the door open for post Ahlborn challenges to claims for reimbursement by the Department when the a beneficiary’s complaint unequivocally fails to assert damages for medical expenses incurred during minority. Notably, the Department of Public Welfare appears to be proactively preempting the opportunity for any such argument by actively intervening in minors’ actions that do not seek recovery for medical expenses during minority, as contemplated in 62 P.S. 1409(b).
Note: Thanks to Nora E. Gieg, Esq., of Tucker Arensberg, P.C., for contributing to this article, edited and expanded by Neil E. Hendershot, Esq. for this Blog.