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Page Number: 15.0

10 

GALLARDO v. MARSTILLER 

Opinion of the Court 

United  States  as  Amicus  Curiae  28–29  (explaining  that,
prior  to  §1396a(a)(25)(H)’s  enactment,  insurers  were 
“thwarting  [§1396k(a)(1)(A)]  by  refusing  to  recognize  as-
signments and arguing that their insurance contracts for-
bade  assignments”  (internal  quotation  marks  omitted)).3 
Thus, the idea that one of these two complementary provi-
sions must “prevail” over the other is mistaken. 

Gallardo  and 

the  United  States  also 

invoke 
§§1396a(a)(25)(A) and (B), which require States to “take all
reasonable measures to ascertain the legal liability of third 
parties . . . to pay for care and services available under the 
[Medicaid] plan” and to “seek reimbursement . . . to the ex-
tent  of  such  legal  liability.”    They  argue  that  these  provi-
sions are the Medicaid Act’s “main” or “anchor” third-party 
liability provisions and limit the State’s recovery under any 
other provision “to the extent of ” a third party’s payments
“for  care  and  services  available  under  the  plan,” 
§§1396a(a)(25)(A)–(B), which they interpret to include only 
payments for medical care that Medicaid has already cov-
ered.  Reply Brief 6 (internal quotation marks omitted); see 
Brief for United States as Amicus Curiae 18. 

This argument suffers from several problems.  To begin, 

—————— 

3 The  United  States  makes  a  similar  argument  when  it  relies  on 
§1396a(a)(25)(I)(ii),  under  which  States  must  enact  laws  requiring 
health insurers to “accept the State’s right of recovery and the assign-
ment to the State of any right of an individual or other entity to payment
from the party for an item or service for which payment has been made
under  the  State  plan.”  We disagree  that  this  provision  “suggests  that
Congress understood the assignment of rights under Section 1396k to be 
limited to third-party payments for services covered by Medicaid.”  Brief 
for United States as Amicus Curiae 19.  Like §1396a(a)(25)(H), this pro-
vision targets specific attempts by health insurers to avoid making pay-
ments to state Medicaid programs.  Its narrower focus on health insur-
ers, who typically pay only once medical services are rendered, explains 
its application to a narrower category of third-party payments, and says 
little to nothing about the meaning of §1396k(a)(1)(A)’s broader scope.