In 2003, Joshua Micone applied for Medicaid benefits for himself and his family. In his applications, Joshua did not report his wife Jennifer's interest in a family limited partnership. The Department of Public Health and Human Services approved Joshua's application, and the Micone family received Medicaid benefits from 2003 to 2006. Subsequently, the Department notified Joshua that his household was ineligible for benefits paid over the past three years because of Jennifer's interest in the partnership and demanded repayment. Joshua contested the demand of benefits paid. The State Board of Public Assistance upheld a hearing officer's findings that Jennifer's interest in the partnership was a countable and available resource. The district court affirmed. On appeal, the Supreme Court affirmed, holding (1) the district court correctly concluded that that the hearing officer did not violate Mont. Code Ann. 2-4-623 when he did not issue a decision within ninety days after the case was deemed submitted; and (2) the district court correctly determined that substantial credible evidence supported the Department's finding that Jennifer's interest in the partnership was an available resource.
Donovan Donald (Don) was incapacitated in an accident and received several treatment in Kalispell Regional Medical Center (KRMC). Later, a dispute arose between Don's estate and KRMC over KRMC's acceptance or rejection of Medicaid's payments for Don's care. KRMC filed liens against the Estate. The Estate, in turn, sued KRMC and MASH, a company that had provided Medicaid application forms to the Estate, under several theories of liability. The district court granted Defendants' motions for summary judgment. The Supreme Court affirmed, holding the district court (1) did not err in granting summary judgment to KRMC and MASH; (2) correctly interpreted and applied the Montana Medicaid Act; (3) correctly awarded KRMC prejudgment interest but incorrectly included interest KRMC received from its interest-bearing account; and (4) did not abuse its discretion by awarding KRMC attorney fees and costs. Remanded with instructions to offset the prejudgment interest award by the amount of interest KRMC received from the interest-bearing account.
Plaintiff, on behalf of a class of similarly situated plaintiffs who received Medicaid assistance and were subject to a Medicaid lien pursuant to 53-2-612, MCA, sued defendant alleging that defendant had collected a greater amount than it was entitled from plaintiffs' recoveries from other sources. The parties raised several issues on appeal. The court held that Ark. Dept. of Health & Human Servs. v. Ahlborn applied retroactively to all class members' claims and that defendant must raise affirmative defenses with respect to individual class members to avoid Ahlborn's effect. The court held that the applicable statute of limitations to be 27-2-231, MCA, which provided for a five-year limitations period. The court declined to disturb the district court's order requiring defendant to compile data on individual class members' claims. The court reversed the district court's determination as to interest assessed against defendant, and concluded that no interest could be assessed until two years after any judgment had been entered, under 2-9-317, MCA. The court concluded that the term "third party" in the Medicaid reimbursement statutes included all other sources of medical assistance available to Medicaid recipients, including private health or automobile insurance obtained by the Medicaid recipient. The court reversed the district court's grant of summary judgment to the class on its proffered distinction between "first party" and "third party" sources. The court affirmed the district court's conclusion that plaintiffs' "made whole" claim was immaterial in light of Ahlborn.
Posted in: Class Action, Constitutional Law, Government & Administrative Law, Montana Supreme Court, Public Benefits