Wos v. E. M. A

In Wos v. E. M. A. (2013) 568 U.S. the California Supreme Court reviewed a North Carolina statute that established a conclusive presumption that when the state's Medicaid expenditures exceed one-third of a beneficiary's tort recovery, that one-third of the recovery represented compensation for medical expenses, even if the settlement or verdict expressly allocated a lower percentage of the judgment to medical expenses. The court concluded that "an irrebuttable, one-size-fits-all statutory presumption was incompatible with the Medicaid Act's clear mandate that a State may not demand any portion of a beneficiary's tort recovery except the share that is attributable to medical expenses." The Supreme Court recognized that in some cases the parties may stipulate to an allocation, but where a stipulation does not exist, fair allocations must be decided by the court at a hearing. The Supreme Court cited section 14124.76 as an example of a statute providing for such a hearing procedure.