Court revives lawsuit vs. state Medicaid expansion
National News
The Arizona Court of Appeals on Tuesday revived a lawsuit challenging Gov. Jan Brewer's expansion of the state's Medicaid insurance plan for the poor, ruling that Republican lawmakers have the right to sue over their contention that a hospital assessment that funds the expansion is a tax requiring a two-thirds vote of the Legislature.
Republicans in the House and Senate sued last year, saying only a simple majority last June passed the expansion bill that included the assessment. A Maricopa County judge in February dismissed the case, saying lawmakers were suing over a lost political battle because the Legislature itself decides whether a supermajority vote is needed.
But the appeals court rejected that decision and sent the case back to Judge Katherine Cooper for more action. In an 11-page ruling, the unanimous three-judge panel said the 36 Republican lawmakers who sued could have defeated House Bill 2010 if the supermajority vote was required, so it was proper for Cooper to decide if the Arizona Constitution required that vote.
The ruling was a major loss for Brewer, who pushed the Medicaid bill through the Legislature by cobbling together a coalition of minority Democrats and 14 Republicans.
She is one of only a handful of Republican governors who embraced Medicaid expansion, a key part of President Barack Obama's health care law. In all, 25 states plus Washington, D.C., are moving ahead with the expansion, while 19 states have turned it down. An additional six states are weighing options.
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Workers’ Compensation Subrogation of Administrative Fees and Costs
When a worker covered by workers’ compensation makes a claim against a third party, the workers’ compensation insurance retains the right to subrogate against any recovery from that third party for all benefits paid to or on behalf of a claimant injured at work. When subrogating for more than basic medical and indemnity benefits, the Texas workers’ compensation subrogation statute provides that “the net amount recovered by a claimant in a third‑party action shall be used to reimburse the carrier for benefits, including medical benefits that have been paid for the compensable injury.” TX Labor Code § 417.002.
In fact, all 50 states provide for similar subrogation. However, none of them precisely outlines which payments or costs paid by a compensation carrier constitute “compensation” and can be recovered. The result is industry-wide confusion and an ongoing debate and argument with claimants’ attorneys over what can and can’t be included in a carrier’s lien for recovery purposes.
In addition to medical expenses, death benefits, funeral costs and/or indemnity benefits for lost wages and loss of earning capacity resulting from a compensable injury, workers’ compensation insurance carriers also expend considerable dollars for case management costs, medical bill audit fees, rehabilitation benefits, nurse case worker fees, and other similar fees. They also incur other expenses in conjunction with the handling and adjusting of workers’ compensation claims. Workers’ compensation carriers typically assert, of course, that, they are entitled to reimbursement for such expenditures when it recovers its workers’ compensation lien. Injured workers and their attorneys disagree.