J.J. Richards, Marcus McCarty, and others similarly situated, are recipients of benefits under Medicaid, a cooperative federal and state program for medical assistance to persons of lower incomes. The injuries that caused the need for their benefits arose from the tortious conduct of others. In a class action suit, Richards and McCarty mount a statutory and constitutional challenge to the application of OCGA § 49-4-149, which provides a mechanism for the State to recoup money spent on Medicaid benefits. The trial court granted partial summary judgment to the defendant, Georgia Department of Community Health “GDCH”, the state agency which administers Medicaid. The class action plaintiffs appeal, and for the reasons that follow, we affirm. Under Medicaid, financial assistance is provided by GDCH to those persons who need medical care and who meet certain financial eligibility requirements. See 42 USCA § 1396 et seq.; OCGA § 49-4-140 et seq. When the injuries necessitating the medical care are caused by a third-party tortfeasor, GDCH takes certain steps to recover the value of the medical assistance it funds. In Richards’s case, GDCH paid $24,947.13 for medical services on his behalf, and Richards sought recovery from the tortfeasor. GDCH filed a lien against the recovery for $24,947.13, notifying Richards’s attorney. GDCH and Richards’s attorney entered into a negotiated settlement.1 Out of the total award Richards received, the attorney lien for Richards’s attorney was satisfied first, and GDCH used a “negotiation matrix” to determine how much of the remaining money GDCH would receive. GDCH accepted $21,205.06 to satisfy its lien for $24,947.13, and to ensure that Richards received at least 20 percent of the award, consistent with GDCH policy. In McCarty’s case, GDCH made payments of $14,070.98 to medical providers and filed a lien; McCarty has yet to receive a settlement award or judgment and there has not yet been any reimbursement to GDCH for the medical assistance. In this case, Class A represents those whose tort recoveries have been used to reimburse GDCH, and Class B consists of those where no reimbursement has yet occurred collectively, “Richards”.
1. Under 42 USCA § 1396k a 1 A, a state’s Medicaid plan must require a recipient to assign “any rights . . . to payment for medical care from any third party.” The federal Code also requires: 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 USCA § 1396a a 25 H.
