Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1263diff_868c.pdf
Page Number: 7.0

2 

GALLARDO v. MARSTILLER 

Opinion of the Court 

I 
A 
States participating in Medicaid “must comply with [the
Medicaid Act’s] requirements” or risk losing Medicaid fund-
ing.  Harris  v.  McRae,  448  U. S.  297,  301  (1980);  see  42 
U. S. C. §1396c.  Most relevant here, the Medicaid Act re-
quires a State to condition Medicaid eligibility on a benefi-
ciary’s assignment to the State of “any rights . . . to support 
. . .  for  the  purpose  of  medical  care”  and  to  “payment  for
medical  care  from  any  third  party.”    §1396k(a)(1)(A);  see
also  §1396a(a)(45)  (mandating  States’  compliance  with 
§1396k).  The State must also enact laws by which it auto-
matically acquires a right to certain third-party payments
“for  health  care  items  or  services  furnished”  to  a  benefi-
ciary.  §1396a(a)(25)(H).  And the State must use these (and
other) tools to “seek reimbursement” from third parties “to 
the extent of [their] legal liability” for a beneficiary’s “care 
and services available under the plan.”  §§1396a(a)(25)(A)–
(B).

The Medicaid Act also sets a limit on States’ efforts to re-
cover their expenses.  The Act’s “anti-lien provision” prohib-
its States from recovering medical payments from a benefi-
ciary’s  “property.”    §1396p(a)(1);  see  also  §1396a(a)(18) 
(requiring  state  Medicaid  plans  to  comply  with  §1396p). 
Because a “beneficiary has a property right in the proceeds 
of [any] settlement,” the anti-lien provision protects settle-
ments  from  States’  reimbursement  efforts  absent  some 
statutory  exception.    Wos  v.  E. M. A.,  568  U. S.  627,  633 
(2013).  State laws “requir[ing] an assignment of the right 
. . .  to  receive  payments  [from  third  parties]  for  medical 
care,”  as 
terms  of 
§§1396a(a)(25) and 1396k(a),” are one such exception.  Ar-
kansas Dept. of Health and Human Servs. v. Ahlborn, 547 
U. S. 268, 284 (2006).  Accordingly, a State may seek reim-
bursement from the portion of a settlement designated for 
the “medical care” described in those provisions; otherwise, 

“expressly  authorized  by 

the