GUIDRY, J.
This is an appeal of a judgment granting the Louisiana Department of Health and Hospitals (DHH) reimbursement from the proceeds of a personal injury settlement that the injured tort victim received pursuant to a compromise of the victim's claims against the Louisiana Department of Transportation and Development (DOTD). For the following reasons, we affirm.
A consent judgment was signed by the district court on April 6, 2009, which adopted an agreement between the DOTD and Juanita Christine Paulsell to settle a personal injury suit that Ms. Paulsell filed against the DOTD on behalf of her daughter, Patricia Jolynn Paulsell-Lathrop, for the severe injuries her daughter sustained in a motorcycle accident that occurred on June 13, 2005.
On September 7, 2011, the DHH filed a petition for intervention in the district court, asserting the following:
Named as defendants in the intervention were Ms. Paulsell, as curatrix of Patricia, Ms. Paulsell's attorneys, Nelson W. Wagar, III and Ronnie G. Penton, the DOTD, and the State of Louisiana through the Office of Risk Management (ORM). Ms. Paulsell generally denied the allegations of the petition for intervention and further answered the petition to assert: that the DHH failed to state a claim; that its claims, if any, were barred by prescription; that it was not entitled to the provisions of La. R.S. 46:446, because the party from which DHH seeks reimbursement was not a "third-party tortfeasor," but was also the State of Louisiana; that if its claim for reimbursement were valid, it is subject to reduction for apportionment of the fees incurred by Ms. Paulsell in effecting the settlement with the DOTD and to reduction for apportionment pursuant to the make-whole doctrine; and that the DHH failed to mitigate its damages. Thereafter, the DHH filed an "unopposed" motion for leave to file the petition for intervention, which was granted by the trial court.
Following the trial court's granting of the DHH's motion to file a petition for intervention, Ms. Paulsell, Mr. Wagar, and
On September 3, 2013, the trial court held a hearing to consider the exceptions and alternative motion for summary judgment filed by Ms. Paulsell, as well as the motion for summary judgment filed by the DOTD and the ORM. Following that hearing, the trial court denied the exceptions and alternative motion for summary judgment filed by Ms. Paulsell, but granted the motion for summary judgment filed by the DOTD and the ORM, signing judgments to that effect on September 10, 2013, and September 12, 2013, respectively. Ms. Paulsell was granted a devolutive appeal from the September 12, 2013 summary judgment in favor of the DOTD and the ORM, which judgment was designated as a final judgment pursuant to La. C.C.P. art. 1915(B) by the trial court.
At issue is this appeal and the associated writ application is the application of La. R.S. 46:446, which statute provides, in pertinent part:
It is Ms. Paulsell's contention that the DOTD and/or ORM is not a third party from which the DHH can seek reimbursement, because all three agencies essentially
The DHH is established as a body corporate with the power to sue and be sued. Further, DHH is "responsible for the development and providing of health and medical services for the prevention of disease for the citizens of Louisiana" and for providing "health and medical services for the uninsured and medically indigent citizens of Louisiana." La. R.S. 36:251. Likewise, the DOTD is also established as a body corporate with the power to sue and be sued; however, it is "responsible for developing and implementing programs to assure adequate, safe, and efficient transportation and other public works facilities and services in the state." La. R.S. 36:501. Finally, the ORM is within the division of administration that is headed by the commissioner of administration. La. R.S. 39:1528. The commissioner of administration, through the ORM, is responsible for managing "all tort claims made against the state or any state agency whether or not covered by the Self-Insurance Fund" and managing "all state insurance covering property and liability exposure, through commercial underwriters or by self-insuring." La. R.S.39:1535(A).
The particular purpose at issue in this matter is a determination of the DHH's right to seek reimbursement from the medical proceeds of Patricia's settlement with the DOTD. Congress has directed States, in administering their Medicaid programs, to seek reimbursement for medical expenses incurred on behalf of beneficiaries who later recover from third-party tortfeasors. States must require beneficiaries "to assign the State any rights ... to support (specified as support for the purpose of medical care by a court or administrative order) and to payment for medical care from any third party." Wos v. E.M.A. ex rel. Johnson, ___ U.S. ___, ___, 133 S.Ct. 1391, 1396, 185 L.Ed.2d 471 (2013)(quoting 42 U.S.C. § 1396k(a)(1)(A)).
The U.S. Supreme Court, in Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268, 275-276, 126 S.Ct. 1752, 1758, 164 L.Ed.2d 459
Therefore, as outlined above, the reimbursement sought by DHH is not only pursuant to La. R.S. 46:446, but is required under federal law as a condition for the partial federal funding of our state Medicaid program. While federal money does not fully fund our state Medicaid program, at least half, if not more, of the state's Medicaid funding comes from federal funds. The exact percentage of the federal contribution is calculated using a formula keyed to the state's per capita income. See 42 U.S.C. § 1396d(b) and Ahlborn, 547 U.S. at 275, 126 S.Ct. at 1758 n. 4. Hence, as La. R.S. 46:446 was adopted as a requirement of federal law, it is proper to consider the federal authority by which La. R.S. 46:446 was enacted to properly determine who is a "third party" for the purpose of determining whether the DHH is entitled to seek reimbursement of state Medicaid expenditures from Patricia's settlement with the DOTD.
According to federal law, for purposes of the Medicaid program and the reimbursement requirement in particular, a third party is defined to mean "any individual, entity or program that is or may be liable to pay all or part of the expenditures for medical assistance furnished under a State plan." 42 C.F.R. § 433.136. In this case, the party liable, pursuant to the April 6, 2009 consent judgment, is the DOTD. Thus, the DOTD would qualify as a "third party" under the federal definition provided in the applicable Medicaid regulations, because it is an entity liable to "pay all or part of the expenditures formedical assistance furnished under a State plan." Moreover, the ORM also qualifies as a "third party," because, as administrator of the Future Medical Care Fund through the state treasurer, it is responsible for issuing payments for Patricia's future medical expenses, "as incurred," from the Future Medical Care Fund in compliance with La. R.S. 13:5106(B)(3)(c) and
Accordingly, we find no error in the trial court's conclusion that the DHH is entitled to seek reimbursement from the Future Medical Care Fund administered by the ORM. Likewise, we deny the associated writ application filed by Ms. Paulsell seeking a declaration that the DHH has no right or cause of action to seek such a reimbursement.
As for a second, related assignment of error raised by Ms. Paulsell regarding the trial court's statements in its reasons for judgment that the ORM, as administrator of the Future Medical Care Fund, is a primary payer, we observe that the issue of "primary payer" is not properly before us in review of the September 12, 2013 summary judgment. The sole issues raised by the ORM and the DOTD in their motion for summary judgment was whether the DHH was entitled to seek reimbursement from the ORM for Medicaid payments made on behalf of Patricia relative to the injuries she sustained in the June 13, 2005 motorcycle accident and whether the plaintiff is entitled to recover attorney's fees in her action seeking to enforce the settlement with the DOTD. Furthermore, while the trial court did make reference to Medicaid being a payor of last resort, no such ruling is found in the summary judgment rendered. Rather, the summary judgment only holds that the DHH is entitled to reimbursement for Medicaid expenditures made on behalf of Patricia and that the plaintiff may not recover attorney fees for litigating "the propriety of ORM" not paying certain claims submitted for payment from the Future Medical Care Fund. Thus, we decline to consider whether the ORM is the "primary payer" in review of the summary judgment before us. See Wise v. Bossier Parish School Board, 02-1525, p. 8 n. 6 (La.6/27/03), 851 So.2d 1090, 1095 n. 6.
For the foregoing reasons, we affirm the summary judgment rendered by the trial court holding that the DHH can seek reimbursement for Medicaid expenditures made by DHH relative to the injuries Patricia sustained in the June 13, 2005 motorcycle accident from the settlement proceeds designated for Patricia's future medical expenses. Moreover, we deny the associated writ application filed by Ms. Paulsell. All costs of this appeal are cast to Juanita Christine Paulsell, as curator of Patricia Jolynn Paulsell-Lathrop.