Sentenza

SUPREME COURT OF THE UNITED STATES. GALLARDO, AN INCAPACITATED PERSON, BY AND THROUGH HER PARENTS AND CO - GUARDIANS VASSALLO ET AL. v. MARSTILLER, SECRETARY OF THE FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

6 GALLARDO v. MARSTILLER
SOTOMAYOR, J., dissenting
be made available in the future. Put differently, as a tex-
tual matter, this provision extends only to a third party's
liability to pay for services actually furnished by a state
plan.
Congress subsequently enacted two legal tools for a State
to use when seeking reimbursement, consistent with the
third-party liability provision, for services paid.
The first of these tools is the assignment provision,
§1396k(a)(1)(A), enacted in 1977 and made mandatory in
1984. In that provision, to "assis[t] in the collection of . . .
payments for medical care," §1396k(a), Congress required
each state Medicaid plan to condition eligibility on assign-
ment of "any rights" of the beneficiary "to payment for med-
ical care from any third party," §1396k(a)(1)(A). Florida
rests its argument on the understanding that this language
confers upon it a right to recover payments designated for
medical care regardless of whether those payments com-
pensate for medical care for which Florida actually has
paid.
Several textual signals foreclose Florida's interpretation
of the assignment provision. For one, the provision, by its
terms, does not stand alone. Instead, Congress enacted it
"[f]or the purpose of assisting in [a State's] collection of "
payments for medical care owed to beneficiaries. §1396k(a).
It would be anomalous, then, to read the provision to reach
beyond the third-party liability provision it "assist[s]" in im-
plementing. Ibid.; see Guam v. United States, 593 U. S. ___,
___ (2021) (slip op., at 6) (similarly interpreting a statutory
provision in light of an earlier "anchor provision"). Support-
ing that understanding, Congress later amended the stat-
ute containing the assignment provision to require benefi-
ciaries "to cooperate with the State in identifying . . . any
third party who may be liable to pay for care and services
available under the plan." §1396k(a)(1)(C) (the cooperation
provision). The cooperation provision echoes the third-
party liability provision's focus on care "available under the
7Cite as: 596 U. S. ____ (2022)
SOTOMAYOR, J., dissenting
plan." Ibid. It would be bizarre for Congress to mandate a
more far-reaching assignment of a beneficiary's right to
payment for all medical support, paid or unpaid, but limit
the beneficiary's duty to cooperate only to services paid. Fi-
nally, another provision of the Act directs each State to pass
laws requiring insurers to "accept . . . the assignment to the
State of any right of an individual or other entity to pay-
ment . . . for an item or service for which payment has been
made under the State plan." §1396a(a)(25)(I)(ii). In this
insurer acceptance provision, Congress described the as-
signment provision's mandate as specific to third-party
payments for services the State plan has funded. Taken
together, these textual indicators establish that the assign-
ment provision reaches only a third party's liability for ser-
vices made available by Medicaid, not liability for services
for which Medicaid has not paid and may never pay.
The second tool Congress enacted to implement the third-
party liability provision is the acquisition provision,
§1396a(a)(25)(H). A 1990 General Accounting Office report
found that some health insurers were "thwart[ing]" the as-
signment provision by "refusing to pay [States] for any of
several reasons," including by declining to recognize Medi-
caid assignments or by insisting that such assignments con-
flicted with their insurance contracts. Medicaid: Legisla-
tion Needed to Improve Collections From Private Insurers
5 (GAO/HRD–91–25, Nov.). Congress addressed this in
1993 by directing each State to enact laws under which the
State automatically acquires a beneficiary's rights to third-
party payments specifically "for health care items or ser-
vices furnished" to the beneficiary, without the need for sep-
arate assignments. §1396a(a)(25)(H). The text of this ac-
quisition provision, too, clearly restricts a State's
acquisition to the portion of a third-party payment pertain-
ing to "health care items or services" for which "payment
has been made under the State plan" and does not extend
8 GALLARDO v. MARSTILLER
SOTOMAYOR, J., dissenting
to third-party payments for services the plan has not fur-
nished. Ibid.; see ante, at 7.
This Court's task is to interpret these provisions " 'as a
symmetrical and coherent regulatory scheme' " while
" 'fit[ting] . . . all parts into an harmonious whole.' " FDA v.
Brown & Williamson Tobacco Corp., 529 U. S. 120, 133
(2000). Doing so here leads to only one "symmetrical and
coherent" conclusion: that the assignment and acquisition
provisions work in tandem to effectuate the third-party lia-
bility provision. As explained by the United States as ami-
cus curiae in support of Gallardo, Congress "added the belt"
(the acquisition provision) "because it feared that the sus-
penders" (the assignment provision) "were not doing their
job." Brief for United States as Amicus Curiae 29. The two
provisions take different paths toward the same goal, and
each reinforces the other. All of the provisions enable a
State to reimburse itself for expenses it has paid, not for
expenses it may or may not incur in the future. None of the
provisions authorize a State to seek such reimbursement
from the portions of a beneficiary's tort settlement repre-
senting payments for care for which the State has not paid.
This interpretation is also consistent with the structure
of the Medicaid program as a whole, under which a State's
recovery from a beneficiary's compensation in tort is per-
missible under a narrow exception to the general, asset-pro-
tective rule established by the anti-lien and anti-recovery
provisions. Ahlborn further explained that the third-party
liability provision and acquisition provision both "rein-
force[d] the limitation implicit in the assignment provi-
sion." 547 U. S., at 280. In particular, the Court described
the acquisition provision's requirement (that a State enact
laws under which it acquires a beneficiary's rights to third-
party payments for "health care items or services furnished
to an individual" "under the State plan," §1396a(a)(25)(H))
as "reiterat[ing]" and "echo[ing]" the assignment provision's
9Cite as: 596 U. S. ____ (2022)
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 appears to permit a broader scope of recovery for
services (both furnished and to be furnished) from a third party's liability
in tort. 42 U. S. C. §2651(a); see Brief for Respondent 41; Reply Brief 8–
9. But see §2652(c) (providing that "[n]o action taken by the United
States . . . shall operate to deny to the injured person the recovery for
that portion of his damage not covered" under Medicare). Any difference
between the two programs reflects Medicaid's focus 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.
10 GALLARDO v. MARSTILLER
SOTOMAYOR, J., dissenting
from any third party," §1396k(a)(1)(A), permits recovery
from settlement funds compensating for all medical ex-
penses, past or future. If this provision were interpreted in
isolation to sweep so broadly, however, its text would place
no temporal limitation on the rights assigned to the State.
For example, if Medicaid were to fund an individual's med-
ical care as a teenager, the State would be entitled to re-
cover the costs of that care from any unrelated future tort
settlement for medical expenses, regardless of whether the
individual remained on Medicaid or the state plan fur-
nished any services related to those future injuries. Such a
nonsensical "lifetime assignment," Brief for Petitioner 32,
would constitute an "unfair" erosion of the anti-lien provi-
sion, Ahlborn, 547 U. S., at 288, contravening Congress'
careful design. In contrast, a harmonious reading of the
statute, consistent with Ahlborn, limits the funds from
which a State may recover to those awarded for expenses
paid and therefore presents no such concern.
III
Despite the foregoing, the Court reads the assignment
provision standing alone to establish, unlike all the other
provisions of the Act at issue, a substantially broader right
to recover from payments for all medical care, whether paid
by the State or not. The Court commits several errors on
the path to its holding, which departs from the statutory
scheme as understood in Ahlborn and forces the Court to
adopt an implausible workaround in order to mitigate the
absurd consequence, discussed above, of its acontextual
reading.
A
The Court's analysis starts off backward. The Court
states first that the Act requires a State to condition Medi-
caid eligibility on assignment of rights, and only then notes
11Cite as: 596 U. S. ____ (2022)
SOTOMAYOR, J., dissenting
that the anti-lien provision "also" limits States' recovery ef-
forts. Ante, at 2. In fact, the anti-lien and anti-recovery
provisions establish a general rule, and the subsequently
enacted third-party liability provision and its companions
create a limited exception. That exception, in turn, should
not be construed "to the farthest reach of [its] linguistic pos-
sibilit[y] if that result would contravene the statutory de-
sign." Maracich v. Spears, 570 U. S. 48, 60 (2013). The
Court's misframing, however, causes it to displace the back-
ground principle of the anti-lien and anti-recovery provi-
sions by relying on language in the assignment provision
that is vague at best.
The Court places great weight on the assignment provi-
sion's use of the word "any" in its reference to "rights . . . to
payment for medical care." §1396k(a)(1)(A); see ante, at 6.
The Court presumes that " '[t]he word "any" has an expan-
sive meaning.' " Ibid. But whether the word "any" indicates
an intent to sweep broadly "necessarily depends on the stat-
utory context." National Assn. of Mfrs. v. Department of
Defense, 583 U. S. ___, ___ (2018) (slip op., at 11). Here, as
explained, statutory context establishes that the word "does
not bear the heavy weight the [Court] puts upon it." Ibid.
To the extent the Court suggests the word "any" supersedes
all other contrary contextual indications, it ignores prece-
dent. See, e.g., United States v. Alvarez-Sanchez, 511 U. S.
350, 356–358 (1994) (relying on context to interpret " 'any
law-enforcement officer or law-enforcement agency' " as
limited to those making arrests under federal law).
The Court also repeatedly relies on the fact that the ac-
quisition provision and third-party liability provision use
specific language to limit the pool from which a State may
recover to funds that compensate for expenses Medicaid has
paid, whereas the assignment provision uses different lan-
guage. See ante, at 7, 9, 11. The Court invokes the pre-
sumption that " '[w]here Congress includes particular lan-
guage in one section of a statute but omits it in another
12 GALLARDO v. MARSTILLER
SOTOMAYOR, J., dissenting
section of the same Act, it is generally presumed that Con-
gress acts intentionally and purposely in the disparate in-
clusion or exclusion.' " Russello v. United States, 464 U. S.
16, 23 (1983). This is unpersuasive. Putting aside the
many contextual clues that support Gallardo's reading of
the assignment provision, see supra, at 6–7, the presump-
tion the Court cites is " 'strongest' in those instances in
which the relevant statutory provisions were 'considered
simultaneously when the language raising the implication
was inserted.' " Gómez-Pérez v. Potter, 553 U. S. 474, 486
(2008). It has less force where, as here, different Con-
gresses enacted the provisions at issue over the course of
multiple decades. The presumption is especially unhelpful
in this case because it cuts both ways: Since 1965, the anti-
lien provision has specified that a State may not impose a
lien against a beneficiary's property "on account of medical
assistance paid or to be paid on his behalf." §1396p(a)(1)
(emphasis added). Accepting the Court's logic, Congress
should have required an assignment that unambiguously
reached payments for both furnished and unfurnished care
using this existing "paid or to be paid" language, but it
failed to do so in the assignment provision. See ante, at 11.
Meanwhile, the Court fails to give due regard to the clear
textual limitations imposed by the Act as a whole. For in-
stance, as to the assignment provision's mirror image in the
insurer acceptance provision, see supra, at 7, the Court rea-
sons that the latter's "narrower focus on health insurers,
who typically pay only once medical services are rendered,
explains its application to a narrower category of third-
party payments," ante, at 10, n. 3. This is beside the point.
In the assignment provision, Congress required beneficiar-
ies to assign certain rights to the State; in the insurer ac-
ceptance provision, it required insurers to accept that as-
signment. It makes no sense that Congress would require
insurers to accept only a sliver of the mandatory assign-
ment, regardless of how insurers typically pay.
13Cite as: 596 U. S. ____ (2022)
SOTOMAYOR, J., dissenting
Ultimately, "[s]tatutory construction . . . is a holistic en-
deavor." United Sav. Assn. of Tex. v. Timbers of Inwood
Forest Associates, Ltd., 484 U. S. 365, 371 (1988). Yet ra-
ther than reading the assignment provision in a manner
"compatible with the rest of the law," ibid., the Court dis-
connects it from much of the Act. The Court does not hold
that the third-party liability provision extends as far as its
reading of the assignment provision. See ante, at 10–11;
see also supra, at 5–6. The Court also agrees that the ac-
quisition provision is "more limited," meaning that the
scope of that provision, too, "differ[s]" from that of the as-
signment provision. Ante, at 9. To justify these anomalies,
the Court asserts that Congress, in enacting the acquisition
provision, saw fit to "provid[e] a more targeted statutory
right for when the assignment might fail." Ibid. The Court
offers little explanation, however, for why Congress might
have narrowed such a necessary backstop in this way. The
statutory hodgepodge the Court perceives contrasts sharply
with the reasonable scheme Congress actually crafted.
B
The Court's reasoning also contradicts precedent. The
Court distinguishes Ahlborn because that case did not
squarely hold that the relevant provisions "must" be inter-
preted in "lockstep," and it reduces Ahlborn's concern about
fairness to a disfavored "policy argumen[t]" that must yield
to text. Ante, at 9, 11. But Ahlborn's analysis reflected the
Court's view of the text and context of the Act as a cohesive
whole. It is not only "our sense of fairness," ante, at 11, but
Congress' sense of fairness, as codified in the Act's anti-lien
and anti-recovery provisions and recognized in Ahlborn,
that demonstrates the Court's error.
The Court itself appears to recognize that its textual
analysis leads to unfair and absurd results, leading it to
suggest an unpersuasive workaround. The Court responds
to the lifetime-assignment quandary, see supra, at 9–10, by
14 GALLARDO v. MARSTILLER
SOTOMAYOR, J., dissenting
reasoning that the assignment provision's use of the phrase
" 'any rights . . . of the individual' " is "most naturally read"
to impose a temporal limitation to rights possessed while on
Medicaid, ante, at 11–12. Neither party even suggests this
reading of the statute.4 That is because it is anything but
natural, especially under the interpretive approach the
Court uses today. An "individual" continues to be an "indi-
vidual" for the duration of his or her life, whether on or off
Medicaid. Were there any ambiguity, the word " 'any,' " we
are told, " 'has an expansive meaning' " that would counsel
against the Court's implicit limitation. Ante, at 6. Perhaps
sensing that its claim to natural meaning lacks force, the
Court, at last, acknowledges "background legal principles"
that militate against allowing a lifetime assignment. Ante,
at 12. While background principles indisputably are rele-
vant, the Court errs by discarding the more relevant back-
ground rule of insurance law that Congress embraced in the
Act, see supra, at 9, which could have avoided the Court's
dilemma altogether.5
Over the long term, the Court's alteration of the balance
Congress struck between preserving Medicaid's status as
payer of last resort and protecting Medicaid beneficiaries'
property might frustrate both aims. As a State's right of
recovery from any damages payout expands, a Medicaid
beneficiary's share shrinks, reducing the beneficiary's in-
centive to pursue a tort action in the first place. See Brief
——————
4 In its briefing, Florida responded to the lifetime-assignment concern
by stating only that its own law did not go so far. Brief for Respondent
45. Confronted anew with the concern at argument, Florida proposed an
implicit "germaneness requirement," see Tr. of Oral Arg. 68–70, which
the Court does not embrace, see ante, at 12, n. 5.
5 The Court does not dispute the background principle that an insurer's
third-party recovery is limited to the elements for which the insurer has
made payment. See supra, at 9. The Court responds, however, that Con-
gress clearly displaced this principle in the assignment provision. See
ante, at 8, n. 2. That, of course, is the entire question. For the reasons
explained, the Court's reading of the assignment provision is erroneous.
15Cite as: 596 U. S. ____ (2022)
SOTOMAYOR, J., dissenting
for American Justice Association et al. as Amici Curiae 16–
20. Under the provisions of the Act at issue here, States
may sue tortfeasors directly, but as Florida itself explains,
it is "more cost-effective" for beneficiaries to sue. Tr. of Oral
Arg. 65. By diminishing beneficiaries' interests in doing so,
the Court's expansion of States' assignment rights could
perversely cause States to recover fewer overall expenses,
all while unsettling expectations in the States that have re-
lied on a contrary reading of federal law.6
In the end, the Court's atomizing interpretation has little
to commend it, particularly when contrasted with the con-
sistent, administrable scheme Congress crafted. The
Court's reading also undercuts Congress' choice to allow
Medicaid beneficiaries to place their excess recovery funds
in Special Needs Trusts, protecting their ability to pay for
important expenses Medicaid will not cover. See n. 1, su-
pra. Congress may wish to intercede to address any disrup-
tion that ensues from today's decision, but under a proper
reading of the Act, such intervention would have been un-
necessary.
* * *
"[T]he meaning of a statute is to be looked for, not in any
single section, but in all the parts together and in their re-
lation to the end in view." Panama Refining Co. v. Ryan,
293 U. S. 388, 439 (1935) (Cardozo, J., dissenting). Because
the Court disserves this cardinal rule today, I respectfully
dissent.
——————
6 The vast majority of lower courts (including Florida's Supreme Court)
read these provisions much as I do. See, e.g., Latham v. Office of Recovery
Servs., 2019 UT 51, 448 P. 3d 1241; Giraldo v. Agency for Health Care
Admin., 248 So. 3d 53 (Fla. 2018); In re E. B., 229 W. Va. 435, 729
S. E. 2d 270 (2012); Doe v. Vermont Office of Health Access, 2012 VT 15A,
191 Vt. 517, 54 A. 3d 474; Pet. for Cert. 18–19 (collecting additional
cases).