Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1263diff_868c.pdf
Page Number: 22

Cite as:  596 U. S. ____ (2022) 

5 

SOTOMAYOR, J., dissenting 

as  they  must,  that  Florida  cannot  recover  anticipated  ex-
penses for services it has not furnished, but may pursue re-
imbursement only for expenses it has paid (i.e., Florida can 
recover  no  more  than  $1,000).  The  parties  further  agree
that Florida can recover these expenses from the portion of
the  beneficiary’s  settlement  allocated  for  these  expenses 
(i.e., the $200), and that Florida can challenge the allocation
of the settlement if it contends that too low a portion was 
designated for past medical expenses.  The parties also do
not dispute that Florida cannot recover from the $800 rep-
resenting  nonmedical  expenses.
  The  only  dispute  is
whether  Florida  also  may  recover  its  past  medical  costs 
from the distinct portion of the beneficiary’s settlement rep-
resenting  future  medical  expenses  (i.e.,  the  $500)—ex-
penses it has not paid and might never pay.  Under a proper 
reading  of  the  applicable  statutory  provisions  in  context,
Florida may not do so.

As Ahlborn explains, Florida’s ability to seek reimburse-
ment  from  Gallardo’s  settlement  hinges  on  establishing 
that an exception to the anti-lien and anti-recovery provi-
sions  applies.    Several  provisions,  enacted  over  a  span  of 
decades,  set  forth  the  exception  relevant  here.    The  first, 
§§1396a(a)(25)(A) and (B) (collectively, the third-party lia-
bility provision), was enacted three years after the Medicaid 
Act  and  the  anti-lien  and  anti-recovery  provisions.  The 
third-party liability provision authorizes a State only to re-
cover for “medical assistance” that “has been made availa-
ble on behalf of the individual,” and only “after medical as-
§1396a(a)(25)(B)
sistance  has  been  made  available.” 
(emphasis added).  And it authorizes recovery only “to the 
extent  of,”  ibid.,  “the  legal  liability  of  third  parties  . . .  to 
pay  for  care  and  services  available  under  the  plan,” 
§1396a(a)(25)(A).  In this context, the provision’s reference 
to care “available under the plan” can only be understood to 
refer to care that is available by virtue of having been paid 
under the plan, not care that theoretically may or may not