Court Opinion

ID: 9594784
Source: CourtListenerOpinion
Date Created: 2023-08-22 00:32:59.132678+00
Date Added: 2024-06-11T09:40:26.751203
License: Public Domain

RUSSELL A. ANDERSON, Justice
(dissenting).
I respectfully dissent. At the time Martin settled the personal injury cause of action against multiple defendants on behalf of her disabled son, the state, at her request, had expended over $600,000 towards his medical treatment. The medical treatment and the payments of public money for that treatment continued. Yet the effect of the majority’s holding is that the state should not be able to recover on its lien for reimbursement of even a portion of the public money expended for *28medical treatment. Given the state’s significant expenditure on Hoffs behalf, the settlement funds at issue here belong to and should be returned to the public to the extent necessary to partially reimburse Medicaid.
The majority’s holding is contrary to the purposes of the federal Medicaid law. The majority purports to construe the federal statute as a whole and interpret the federal anti-lien provision in light of the surrounding sections, but ultimately fails to adequately address the federal requirement that states recoup their expenditures out of proceeds from liable third parties. In addition, despite the contrary results reached in every other court that has considered the question presented in this case, the majority fails to acknowledge even an ambiguity that would allow it to defer to the federal agency charged with day-today administration of this complex statute. Focusing on the anti-lien provision, the court allows parties to subvert the principle that Medicaid should be the payor of last resort and jeopardizes the state’s recovery of any of the significant funds extended for payment of medical expenses on behalf of Medicaid beneficiaries.
Although the federal anti-lien provision is broad, we must read related statutes in pari materia, keeping in mind the purposes of the entire federal scheme and the strong presumption against preemption of state law. See Erlenbaugh v. United States, 409 U.S. 239, 243-44, 93 S.Ct. 477, 34 L.Ed.2d 446 (1972); Forster v. R.J. Reynolds Tobacco Co., 437 N.W.2d 655, 658 (Minn.1989). In my view, the majority has lost sight of these important principles. Although appellant had a property right in her cause of action against the third party, she disposed of this property right to the extent of medical expenses paid when in her application for medical assistance benefits she agreed to apply all proceeds from a liable third party and when she assigned to the state any rights to third-party payments. See Minn.Stat. § 256B.056, subd. 6 (2000). The right to dispose of property has long been considered an inherent aspect of property ownership, see Congdon v. Congdon, 160 Minn. 343, 363, 200 N.W. 76, 83 (1924), and nothing in the federal or state Medicaid law, including the anti-lien provision, suggests the right to dispose of a cause of action through assignment to the state is impaired.
Once that broad assignment was made, the anti-lien provision was no longer operative because the recipient’s causes of action (to the extent of the state’s expenditures) were no longer his property,1 and the conflict between state and federal law the majority finds is irrelevant. By looking first and foremost at the anti-lien provision instead of construing all provisions together, the majority overlooks a construction of the statute that avoids preemption problems.
This construction is consistent with the third-party recovery provisions requiring states to recover the full amounts of their expenditures under Medicaid. The federal statutes prohibit a lien on the recipient’s property during the recipient’s lifetime, but at the same time require the recipient to give the state, “to the extent that payment has been made under the State plan * * * the rights of such individual to pay*29ment by any other party for such health care items or services.” 42 U.S.C. § 1396a(a)(25)(H) (Supp. Y 1999) (emphasis added). Under federal law, “the State is considered to have acquired the rights of such individual to payment by any other party for * * * health care items or services * * Id. The federal mandatory assignment provision requires states to enact laws that require recipients to assign “any rights * * * to support * * * and to payment for medical care from any third party.” 42 U.S.C. § 1896k(a) (1994).
The majority construes the third-party recovery provision as limited to the recipient’s right to recover payment for medical expenses. However, the statute requires a state to have in place laws:
that to the extent that payment has been made under the State plan for medical assistance in any case where a third party has a legal liability to make payment for such assistance, the State has in effect laws under which, to the extent that payment has been made under the State plan for medical assistance for health care items or services furnished to an individual, the State is considered to have acquired the rights of such individual to payment by any other party for such health care items or services.
42 U.S.C: § 1396a(a)(25)(H). A fair reading of the statute indicates that “such health care items or services” in the last clause refers to what the state has paid for, not what the recipient might recover through a settlement. Congress’ intent is to limit the recovery only “to the extent that payment has been made under the State plan,” not to amounts out of a third-party settlement that the recipient agrees to label payment for medical expenses.
Accordingly, the state’s assignment provision requires that the recipient apply or agree to apply “all proceeds received or receivable” from any third party liable for the costs of the medical care, and that the applicant assign to the state “any rights to medical support and third party payments.” Minn.Stat. § 256B.056, subd. 6 (2000) (emphasis added). This statute conforms with federal statutory requirements that state laws require a recipient to assign rights to the state for medical payment and that the laws give states the right to those payments to the extent that payment has been made under the state plan. 42 U.S.C. §§ 1396a(a)(25)(H) and 1396k(a). With respect to the state assignment provision, the state law does not conflict with federal law, but advances the purposes and objectives of the federal law.
Other state courts attempting to harmonize the federal anti-lien provision and the state’s right to recover from third parties have applied this reasoning. In Wallace v. Estate of Jackson, 972 P.2d 446 (Utah 1998), cert. denied, McNeil v. Utah, Medicaid Section, 528 U.S. 810, 120 S.Ct. 42, 145 L.Ed.2d 38 (1999), the Utah Supreme Court held that payments made by a third party do not legally become the property of the recipient until after settlement “ ‘because third party settlement proceeds have been specified by the recipient as belonging to the State Medicaid Agency as a precondition of the recipient’s eligibility.’ ” Id. at 448 (quoting state’s brief). The Utah court noted that the anti-hen provision has coexisted for many years with the requirement that states seek reimbursement from third parties who are legally liable for the medical payments, and noted that harmony between these provisions can be achieved if the assigned rights are not considered part of the recipient’s property. Id.
Likewise, in Wilson v. State, 142 Wash.2d 40, 10 P.3d 1061, 1064-65 (2000), the Washington Supreme Court held that all settlement proceeds belong to the state because they were assigned as such. The *30court stated, “due to the lien being placed on the settlement prior to it becoming the property of the Medicaid recipient, the [anti-lien provision] is irrelevant.” Wilson, 10 P.3d at 1065 n. 2; see also Cricchio v. Pennisi 90 N.Y.2d 296, 660 N.Y.S.2d 679, 683 N.E.2d 301, 305 (1997) (reasoning that because the recipient has assigned rights to the state to recover medical expenses from a third party, and the state is subro-gated to the recipient’s rights, the settlement proceeds are the property of the third party which are owed to the state). Thus, the Washington and Utah Supreme Courts treat all third-party settlement proceeds in the same fashion that the majority treats only third-party payments for medical expenses. Presented with the identical issue as is presented here, the Washington court concluded that, “the state is not limited to recovery from only that portion of the settlement specifically allocated to medical expenses. The federal statute states recovery is to the extent of payment made by the state for health care items or services.” 10 P.3d at 1066.2
Likewise, federal courts have not considered the federal anti-lien provision to bar states from pursuing settlement proceeds to satisfy a lien based on the state assignment and subrogation rights. Sullivan v. County of Suffolk, 174 F.3d 282, 286 (2d Cir.1999) (holding that, based on the assignment and subrogation scheme, the state may first satisfy its lien before the settlement proceeds are placed in a supplemental needs trust for the recipient); Norwest Bank of N.D., N.A. v. Doth, 159 F.3d 328, 333-34 (8th Cir.1998) (holding that the state may satisfy its lien from settlement proceeds before funds are placed in a special needs trust but declining to rule on the effect of the anti-lien provision).3 At a minimum, what the majority finds to be patently clear has eluded the Second and Eighth Circuits and the highest courts of three states, every court that has considered the issue.
Instead the majority here attempts to harmonize the federal statutes by limiting the effect of the assignment provision to payments for medical expenses. This construction frustrates the purpose of the Medicaid program, however. As the Eighth Circuit held, allowing Medicaid recipients to avoid reimbursing the state for amounts paid on the recipient’s behalf would “eviscerate Congress’s clearly expressed intention that these funds be repaid and negate the Social Security Act’s *31comprehensive scheme permitting states to place these liens.” Doth, 159 F.3d at 333 (internal quotation marks omitted). Thus, while the anti-lien provision is broadly written, equally clear from the entire context of federal Medicaid law is the principle that the state must be able to recoup what it has spent on medical care for Medicaid recipients.
Congress’ apparent intent is to replenish and preserve Medicaid funds, providing support only when no other resources are available. Consolidated Omnibus Budget Reconciliation Act, H.R. Conf. Rep. No. 99-453, at 542 (1985); Wilson, 10 P.3d at 1064. Federal statutes accomplish this policy by requiring that a recipient assign rights of recovery to the extent of a third party’s liability and that states retain the amount collected under the assignment to first reimburse Medicaid. 42 U.S.C. § 1396k (1994). To allow recipients to shield from recovery by the state amounts labeled “pain and suffering” or other elements of damage conflicts with the clear congressional intent that Medicaid be the payor of last resort, and that the state be able to recoup its expenditures from funds to which the beneficiary was entitled before the assignment.4
The majority’s willingness to parse out the “sticks” of Hoffs settlement is also inconsistent with our previous treatment of tort settlements as they relate to eligibility for Medicaid. In In re Welfare of K.S., 427 N.W.2d 653 (Minn.1988), we addressed whether a tort settlement was an available asset for purposes of determining eligibility for medical assistance. In that case an amicus curiae advocated a construction of the term “available assets” that would allow only that portion of a tort settlement intended to compensate the beneficiary for future medical expenses to be considered available, leaving compensation for pain and suffering or other claims not available. Id. at 659. We noted that the state’s subrogation right extends to “all portions of the cause of action, ‘notwithstanding any settlement * * * or apportionment that purports to dispose of portions of the cause of action not subject to subrogation.’” Id. (quoting MinmStat. § 256.37, subd. 1). In K.S., we found this statute demonstrated a clear legislative intent that the purpose for which a settlement was received, whether for medical expenses or pain and suffering, did not determine the availability of those funds for purposes of eligibility for medical assistance. 427 N.W.2d at 659. Today the majority makes the directly opposite conclusion, by holding that settlement funds must be parsed out according to purpose and the state’s right to recover its expenses is limited to those labeled as for medical costs.
Despite the fact that the highest courts of two states reached the opposite conclusion than that reached by the majority, and despite the purposes of the Medicaid law to allow the states to recover their expenditures, and despite our previous rejection of parsing out portions of a settlement fund depending on the purpose for which it was received, the majority refuses to acknowledge éven an ambiguity with respect to the anti-hen provision and the third-party recovery provisions. These provisions create at least an ambiguity with respect to the reach of the anti-hen provision, which should compel us to acknowledge the rulings of the federal agency charged with administering this complex statute. See Chevron U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837, 843-44, 104 S.Ct. 2778, 81 L.Ed.2d 694 *32(1984) (holding that if a court finds ambiguity in the federal statute, it must defer to the administrating agency’s interpretation if that interpretation is reasonable.)
The two adjudications5 referenced by the majority are entitled to deference, as they reflect the agency’s interpretation of the scope of the assignment and lien provisions. In the California decision, the Board upheld HCFA’s interpretation of Medicaid statutes as requiring full Medicaid reimbursement before the recipient may collect any third-party settlement proceeds. Cal. Dep’t of Health Servs., DAB No. 1504 (Dep’t of Health & Human Servs. Jan. 5, 1995). HCFA thereby disapproved of California’s practice of allowing recipients to retain portions of third-party settlements that did not represent payment for medical care. The Board stated:
HCFA’s position is directly supported by these provisions of the Act. Recipients, as a condition of eligibility, must assign their rights to payment for medical care. States are then charged with the responsibility of seeking third party recovery pursuant to such assignments. States are further required to seek as much reimbursement as possible, i.e., to the extent of the third party’s liability. Finally, when a recovery is made, the Act sets forth a distribution scheme which requires the Medicaid program to be reimbursed prior to distributing any funds to the recipient. While section 1912(a) refers to assignment only of “payment for medical care,” the statutory scheme as a whole contemplates that the actual recovery might be greater and, if it is, that Medicaid should be paid first.
DAB No. 1504, p. 4.
The Washington adjudication involved a state law that allowed the state to reduce the amount of its lien if the settlement amount was not sufficient to pay all medical expenses and other types of damages. Wash. State Dep’t of Soc. & Health Servs., DAB No. 1561 (Dep’t of Health & Human Servs. Feb. 7, 1996). HCFA maintained that, under the mandatory assignment provision, Medicaid must be reimbursed in full before the recipient receives any settlement proceeds. The Board concluded that HCFA reasonably characterized third-party recovery proceeds first as payments for medical care, stating, “[i]n cases where a third party has caused the need for medi*33cal care and is liable for its payment, the Act looks to that third party to reimburse the public.” DAB No. 1561, p. 5. The Board found that “[tjhis characterization prevents manipulation of tort awards by recipients who seek to prevent the public from being reimbursed for the funds it has advanced for their medical care (e.g., by suing for pain and suffering or lost wages rather than for medical costs).” Id.6
We may not impose our own construction of the statute and are bound by the agency’s interpretations established in adjudications if they are reasonable. Chevron, 467 U.S. at 843-44, 104 S.Ct. 2778. The agency’s interpretations recognize the conflict between seeking reimbursement to the full extent of a third party’s liability and the potentially limiting language of collecting “payments for medical care,” just as conflict appears at first glance between the third-party recovery statutes and the anti-lien provision. Relying on the overall scheme of the Medicaid statutes and the policy that Medicaid is to be the payor of last resort, the agency resolves any perceived conflict by interpreting the statutes to require that recipients assign to the state rights to any payments from a liable third party for purposes of reimbursing Medicaid. Because appellant thereby disposed of any property right she had in a third-party recovery (to the extent of medical expenses paid), the anti-lien provision was not operative.
The majority dismisses the agency adjudications as not addressing the anti-lien provision. However, in each case the state argued that the assignment provision was limited to payment for medical care, and that HCFA could not be reimbursed out of funds designated for other purposes, just as the majority holds. The agency soundly rejected that position in light of the very real possibility of manipulation of tort awards by recipients who seek to prevent the public from being reimbursed. Manipulation is exactly what the majority allows. Under the majority’s interpretation of this statute, appellant would be able to characterize the entire $220,000 as payment for pain and suffering, despite the significant damages in the form of medical expenses that have been incurred on Hoffs behalf. As the agency explained:
Contrary to what California argued, it is not unfair completely or substantially to deny Medicaid recipients access to their settlements. If Medicaid had not paid their medical expenses, these recipients would have both unrestricted access to their settlements and enormous medical debts to be paid from those settlements. As Medicaid recipients, they do not have such debts because the public has paid their medical expenses. Therefore, in cases where Medicaid has incurred the “debt” for recipients, it is not unfair for HCFA to require complete reimbursement from these liability funds.
DAB No. 1504, p. 8. In this case, appellant does not have over $600,000 in debt for medical expenses because the state Medicaid program has paid for Hoffs medical care. Yet under the majority’s theory the state is shackled from recovering any of its expenditures unless appellant designates payments out of a settlement as for medical expenses instead of pain and suffering *34or other elements of damages. Thus, the majority allows appellant’s labeling of her items of damages to control whether the government can recoup its expenditures. In this case, the state will continue to pay for Troy Hoffs medical expenses while appellant has at her disposal not insignificant funds from liable third-party tortfea-sors that might be used to satisfy that obligation. That result seems to me both absurd and contrary to congressional intent.
As the agency adjudications illustrate, the federal government is quick to penalize states for failure to recoup the amounts the federal government has expended on behalf of Medicaid recipients. The majority’s ruling jeopardizes Minnesota’s participation in the Medicaid program by making it nearly impossible for the state to recover from third parties responsible for injuries and disabilities of Medicaid recipients. At a minimum, the ruling will require the state to pursue third-party tort-feasors independently, notwithstanding the fact that the legislature has specifically allowed the attorney general to initiate and prosecute an independent action only if “no action has been brought” by the recipient. Minn.Stat. §§ 256.015, subd. 3, 256B.042, subd. 3 (2000). To that extent, the majority ruling is further contrary to legislative intent. Moreover, while the state can pursue third-party tortfeasors directly, nothing would prevent the recipient from intervening in that lawsuit and labeling a settlement pain and suffering so as to thwart the government’s recovery. Again, that cannot be what congress or the legislature intended.
I would hold, consistent with the decisions of other courts interpreting the federal Medicaid laws, that the federal Medicaid law does not preempt state law in cases where the state seeks reimbursement for a Medicaid recipient’s medical costs by placing a lien against third-party settlement proceeds.

. The majority accuses the highest courts of two sister states of failing “to grapple with the key issue” by concluding that the settlement proceeds are no longer the property of the recipient. Again, this is the same method by which the majority gives effect to the assignment provision, however. Like the Utah and Washington high courts, the majority also considers the assigned causes of action to not be the property of the recipient, but simply concludes that the assignment is more limited (to medical expenses) than the assignment as interpreted by the Utah and Washington Supreme Courts.

. The majority claims that Doth is here taken out of its context, which involves the placement of an entire recovery from third party tortfeasors in a special or supplemental needs trust (SNT) so as to avoid the state's lien.
The distinction the majority makes between shielding an entire recovery (not allowed) and shielding only part of a recovery (apparently allowable) eludes me. However, other than using the vehicle of a SNT, shielding the entire recovery is exactly what Martin seeks to do here. She claims she is entitled to the full $220,000 from the third party tortfeasor.
While the majority and I both acknowledge that Doth did not deal expressly with the anti-lien statute, the court in Doth did expressly reject a construction of the SNT statute that would "eviscerate Congress's clearly expressed intention that these funds be repaid and negate the Social Security Act’s comprehensive scheme permitting states to place these liens.” 159 F.3d at 333 (internal quotation marks omitted).

. The majority claims that this analysis fails to consider the objective of protecting a medical assistance recipient’s property during his lifetime. As explained herein, the anti-lien provision operates to give effect to this purpose for nonassigned property.

. I agree with the majority that agency letters, directives and approvals are not entitled to full deference because they do not reflect formal rules or adjudications. However, as the United States Supreme Court has recently made clear, Chevron did not eliminate a court's ability to give some lesser form of deference to agency interpretations appearing in other forms, "given the 'specialized experience and broader investigations and information’ available to the agency." United States v. Mead Corp., 533 U.S. 218, 121 S.Ct. 2164, 2167, 150 L.Ed.2d 292 (2001) (quoting Skidmore v. Swift & Co., 323 U.S. 134, 139, 65 S.Ct. 161, 89 L.Ed. 124 (1944)). The agency pronouncement may be due a "respect proportional to its ‘power to persuade’." Mead, 533 U.S. at 220, 121 S.Ct. at 2167 (quoting Skidmore, 323 U.S. at 140, 65 S.Ct. 161).
Of the various materials respondent directs us to, one memorandum from HCFA adequately describes the agency’s interpretation of the anti-lien provision and is entitled to this lesser form of deference. A 1994 memorandum from the HCFA regional administrator to state Medicaid directors stated that liens are valid against a tortfeasor's property or against funds set aside to settle litigation that are not the recipient's property. Health Care Financing Administration Regional Identical Letter No. 94-134 (Sept. 1994). The memo acknowledges the anti-lien provision and interprets it not to apply to recoveries from third-party tortfeasors because such funds are not the recipient’s property. This agency interpretation is consistent with the rulings in Wallace and Wilson, and while not accorded full Chevron deference, we should consider it to have some persuasive force.

. Rather than adopt in their entirety these board adjudications as the majority claims, I cite these adjudications only for the agency’s construction of the federal third-party recovery provision supporting its conclusion that the public should be repaid before a medicaid recipient enjoys the fruits of a settlement with a third-party tortfeasor. Whether the agency would view Minnesota’s one-third recovery provision in section 256B.042, subdivision 5 as depriving the federal Medicaid program of reimbursement dollars was not before the agency and is not now before the court.