Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1263diff_868c.pdf
Page Number: 26.0

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

9 

SOTOMAYOR, J., dissenting 

requirement (that a state plan condition eligibility on a ben-
eficiary’s assignment of rights to payment).  Id., at 276, 281. 
Ahlborn’s repeated recognition of the relationships between 
these three provisions cannot be squared with Florida’s pri-
mary argument, which would sever the provisions and read 
the  assignment  provision  to  eclipse  the  limitations  of  the
other two. 

Moreover,  Medicaid  is  an  insurance  statute,  and  Ahl-
born’s discussion of the unfairness that would ensue from a 
State’s “ ‘shar[ing] in damages for which it has provided no 
compensation,’ ” id., at 288, n. 19, tracks background prin-
ciples of insurance law.  Under those principles, recovery by
an insurer against a third party “is generally limited to the
same  elements  as  those  for  which  [the  insurer]  has  made
payment,” absent contractual terms to the contrary.  16 S. 
Plitt, D. Maldonado, J. Rogers, & J. Plitt, Couch on Insur-
ance §226:36 (3d ed. 2021); see Brief for United States as 
Amicus Curiae 21–22.  This, too, supports a cohesive read-
ing of these provisions as allowing States to recover their
past  expenses  only  from  sources  that  compensate  for  the
care and services state plans actually have furnished.3 

An  additional  absurdity  would  flow  from  an  overbroad 
reading of the assignment provision decoupled from its com-
panions.  Florida maintains that the assignment provision’s
reference  to  “any  rights  . . .  to  payment  for  medical  care 

—————— 

3 Much  as  an  insurer  might  modify  this  default  rule  under  contract,
Congress could do so by statute.  The parties agree that Congress did so 
as to Medicare, which, in the parties’ view, permits a  broader scope of
recovery for services (both furnished and to be furnished) from a third 
party’s  liability  in  tort.    See  Brief  for  Respondent  41;  Reply  Brief  8–9. 
The difference, if any, between the two programs reflects Medicaid’s fo-
cus on the needy, as well as the fact that individuals may lose and regain
Medicaid eligibility over time based on changes in their circumstances, 
whereas most Medicare enrollees are seniors entitled to coverage for the 
rest of their lives.