Gallardo v. Marstiller

P R E L I M I N A R Y P R I N T
Volume 596 U. S. Part 1
Pages 420–449
OFFICIAL REPORTS
OF
T H E S U P R E M E C O U R T
June 6, 2022
REBECCA A. WOMELDORF
reporter of decisions
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420 OCTOBER
TERM, 2021
Syllabus
GALLARDO, an incapacitated person, by and through
her
parents and co-guardians VASSALLO et al. v.
MARSTILLER, SECRETARY OF THE FLORIDA
AGENCY FOR HEALTH CARE
ADMINISTRATION
certiorari to the united states court of appeals for
the eleventh circuit
No. 20–1263. Argued January 10, 2022—Decided June 6, 2022
Petitioner Gianinna Gallardo suffered catastrophic injuries resulting in
permanent disability when a truck struck her as she stepped off her
Florida school bus. Florida's Medicaid agency paid $862,688.77 to cover
Gallardo's initial medical expenses, and the agency continues to pay her
medical expenses. Gallardo, through her parents, sued the truck's
owner and driver, as well as the Lee County School Board. She sought
compensation for past medical expenses, future medical expenses, lost
earnings, and other damages. That litigation resulted in a settlement
for $800,000, with $35,367.52 expressly designated as compensation for
past medical expenses. The settlement did not specifcally allocate any
amount for future medical expenses.
The Medicaid Act requires participating States to pay for certain
needy individuals' medical costs and then to make reasonable efforts to
recoup those costs from liable third parties. 42 U. S. C. § 1396k(a)(1)(A).
Under Florida's Medicaid Third-Party Liability Act, a benefciary like
Gallardo who “accept[s] medical assistance” from Medicaid “automati-
cally assigns to the [state] agency any right” to third-party payments
for medical care. Fla. Stat. § 409.910(6)(b). Applied to Gallardo's set-
tlement, Florida's statutory framework entitled the State to $300,000—
i. e., 37.5% of $800,000, the percentage the statute sets as presumptively
representing the portion of the tort recovery that is for “past and future
medical expenses, ” absent clear and convincing rebuttal evidence.
§§ 409.910(11)(f )(1), (17)(b). Gallardo challenged the presumptive allo-
cation in an administrative proceeding. She also brought this lawsuit
seeking a declaration that Florida was violating the Medicaid Act by
trying to recover from portions of the settlement compensating for fu-
ture medical expenses. The Eleventh Circuit concluded that the rele-
vant Medicaid Act provisions do not prevent a State from seeking reim-
bursement from settlement monies allocated for future medical care.
963 F. 3d 1167, 1178.

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421
Syllabus
Held: The Medicaid Act permits a State to seek reimbursement from set-
tlement
payments allocated for future medical care. Pp. 428–435.
(a) Gallardo argues that the Medicaid Act's anti-lien provision—which
prohibits States from recovering medical payments from a benefciary's
“property,” § 1396p(a)(1)—forecloses recovery from settlement amounts
other than those allocated for past medical care paid for by Medicaid.
But this Court has held that the provision does not apply to state laws
“expressly authorized by the terms of §§ 1396a(a)(25) and 1396k(a)” of
the Medicaid Act. Arkansas Dept. of Health and Human Servs. v. Ahl-
born, 547 U. S. 268, 284. Here, Florida's Medicaid Third-Party Liability
Act—under which Florida may seek reimbursement from settlement
amounts representing “payment for medical care,” past or future—“is
expressly authorized by the terms of . . . [§ ]1396k(a)” and thus falls
squarely within the “exception to the anti-lien provision” that this Court
has recognized. Ibid.
The plain text of § 1396k(a)(1)(A) decides this case. Nothing in
§ 1396k(a)(1)(A) limits a benefciary's assignment to payments for past
“medical care” already paid for by Medicaid. To the contrary, the grant
of “any rights . . . to payment for medical care” most naturally covers
not only rights to payment for past medical expenses, but also rights to
payment for future medical expenses. § 1396k(a)(1)(A); see Un i ted
States v. Gonzales, 520 U. S. 1, 5. The relevant distinction is thus “be-
tween medical and nonmedical expenses,” Wos v. E. M. A., 568 U. S. 627,
641, not between past and future medical expenses.
Statutory context reinforces that § 1396k(a)(1)(A)'s reference to “pay-
ment for medical care” is not limited as Gallardo suggests. For exam-
ple, when the Medicaid Act separately requires state plans to comply
with § 1396k, it describes that provision as imposing a “mandatory as-
signment of rights of payment for medical support and other medical
care owed to recipients.” § 1396a(a)(45) (emphasis added). Section
1396a(a)(45) thus distinguishes only between medical and nonmedical
care, not between past (paid) medical care payments and future (unpaid)
medical care payments. If Congress had intended to draw such a dis-
tinction, “it easily could have drafted language to that effect.” Missis-
sippi ex rel. Hood v. AU Optronics Corp., 571 U. S. 161, 169. In fact,
Congress did include more limiting language elsewhere in the Medicaid
Act. Section 1396a(a)(25)(H), which requires States to enact laws
granting themselves automatic rights to certain third-party payments,
contains precisely the limitation that Gallardo would read into the as-
signment provision. Thus, if § 1396k(a)(1)(A)'s broad language alone
were not dispositive, its contrast with the limiting language in
§ 1396a(a)(25)(H) would be. Pp. 428–430.
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LARDO v. MARSTILLER
Syllabus
(b) Gallardo's arguments that § 1396k(a)(1)(A) has a different mean-
i
ng are unconvincing. Gal lardo constr ues the prefatory clause to
§ 1396k(a)(1)(A)— which provides that the “purpose” of the assignment
provision is to “assis[t] in the collection of medical support payments
and other payments for medical care owed to recipients of medical as-
sistance under the State plan”—to limit the assignment provision to
payments that are already “owed” for “past medical care provided under
the [state] plan.” Brief for Petitioner 30. But the prefatory clause de-
fnes to whom the third-party payments are “owed”—“recipients of med-
ical assistance under the State plan.” It does not specify the purpose
for which those payments must be made, referring to “medical support”
and “medical care” payments, consistent with the adjacent language in
§ 1396k(a)(1)(A).
Gallardo also proposes that the Court read the assignment provision
to incorporate the more limited language in § 1396a(a)(25)(H). But the
Court must give effect to, not nullify, Congress' choice to include limit-
ing language in some provisions but not others, see Russello v. United
States, 464 U. S. 16, 23. Ahlborn, which Gallardo contends eliminated
any daylight between § 1396a(a)(25)(H) and § 1396k(a)(1)(A), was clear
that these two provisions “ech[o]” or “reinforc[e]” each other insofar as
they both involve “recovery of payments for medical care,” 547 U. S., at
282, and not “payment for, for example, lost wages,” id., at 280. Ahl-
born did not suggest that these provisions must be interpreted in lock-
step. Gallardo's idea that one of these two complementary provisions
must “prevail” over the other is therefore mistaken. The complemen-
tary provisions concern different requirements; they do not confict just
because one is broader than the other.
Gallardo and the United States also argue that § 1396k(a)(1)(A) should
be interpreted consistently with §§ 1396a(a)(25)(A) and (B), which re-
quire a State to seek reimbursement “to the extent of ” a third party's
liability “for care and services available under the plan.” But the rele-
vant language—“pay[ment] for care and services available under the
plan”—could just as readily refer to payment for medical care “avail-
able” in the future. Regardless, Congress did not use this language to
defne the scope of an assignment under § 1396k(a)(1)(A), implying again
that the provisions should not be interpreted the same way. This impli-
cation is strengthened by the fact that § 1396k(a)(1)(A) was enacted
after §§ 1396a(a)(25)(A) and (B), and Congress did not use the existing
language in §§ 1396a(a)(25)(A) and (B) to defne the scope of the manda-
tory assignment.
Finally, Gallardo's two policy arguments for her preferred interpreta-
tion both fail. First, citing a footnote from Ahlborn, she contends that
it would be “ `absurd and fundamentally unjust' ” for a State to “ `share

Cite
as: 596 U. S. 420 (2022)
423
Syllabus
in damages for which it has provided no compensation.' ” 547 U. S., at
288,
n. 19. But the Court's holding there was dictated by the Medicaid
Act's “text,” not by the Court's sense of fairness. Id., at 280. Second,
Gallardo speculates that the Court's reading of § 1396k(a)(1)(A) would
authorize a “lifetime assignment” covering not only the rights an indi-
vidual has while a Medicaid benefciary but also any rights acquired in
the future when the individual is no longer a Medicaid benefciary. Not
so. The provision is most naturally read as covering those rights “the
individual” possesses while on Medicaid. And given background legal
principles about the scope of assignments, § 1396k(a)(1)(A) cannot be
read to cover the sort of “lifetime assignment” Gallardo invokes.
Pp. 430–434.
963 F. 3d 1167, affrmed.
Thomas, J., delivered the opinion of the Court, in which Roberts, C. J.,
and Alito, Kagan, Gorsuch, Kavanaugh, and Barrett, JJ., joined.
Sotomayor, J., fled a dissenting opinion, in which Breyer, J., joined,
post, p. 435.
Bryan S. Gowdy argued the cause for petitioner. With
him on the briefs were Meredith A. Ross, Scott L. Nelson,
and Floyd Faglie.
Vivek Suri argued the cause for the United States as ami-
cus curiae in support of petitioner. With him on the brief
were Deputy Solicitor General Kneedler, Acting Assistant
Attorney General Boynton, and Deputy Solicitor General
Gannon.
Henry C. Whitaker, Solicitor General of Florida, argued
the cause for respondent. With him on the brief were Ash-
ley Moody, Attorney General, Daniel W. Bell, Chief Deputy
Solicitor General, and Christopher J. Baum, Senior Deputy
Solicitor General.*
*Celene H. Humphries and Jeffrey R. White fled a brief for the Ameri-
can Association for Justice et al. as amici curiae urging reversal.
Briefs of amici curiae urging affrmance were fled for the State of Utah
et al. by Sean D. Reyes, Attorney General of Utah, Melissa A. Holyoak,
Solicitor General, and Stan ford E. Purser, Deputy Solicitor General, by
Dave Yost, Attorney General of Ohio, Benjamin M. Flowers, Solicitor Gen-
eral, Michael J. Hendershot, Chief Deputy Solicitor General, and John
Rockenbach, Deputy Solicitor General, and by the Attorneys General for
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424 GAL
LARDO v. MARSTILLER
Opinion of the Court
Justice Thomas delivered the opinion of the Court.
Medicaid
requires participating States to pay for certain
needy individuals' medical costs and then to make reasonable
efforts to recoup those costs from liable third parties. Con-
sequently, a State must require Medicaid benefciaries to as-
sign the State “any rights . . . to payment for medical care
from any third party.” 42 U. S. C. § 1396k(a)(1)(A). That
assignment permits a State to seek reimbursement from the
portion of a benefciary's private tort settlement that repre-
sents “payment for medical care,” ibid., despite the Medicaid
Act's general prohibition against seeking reimbursement
from a benefciary's “property,” § 1396p(a)(1). The question
presented is whether § 1396k(a)(1)(A) permits a State to seek
reimbursement from settlement payments allocated for fu-
ture medical care. We conclude that it does.
I
A
States participating in Medicaid “must comply with [the
Medicaid Act's] requirements” or risk losing Medicaid fund-
ing. Harris v. McRae, 448 U. S. 297, 301 (1980); see 42
U. S. C. § 1396c. Most relevant here, the Medicaid Act re-
quires a State to condition Medicaid eligibility on a benef-
ciary's assignment to the State of “any rights . . . to support
. . . for the purpose of medical care” and to “payment for
medical care from any third party.” § 1396k(a)(1)(A); see
a lso § 1396a(a)(45) (mandating States' compliance w ith
their respective States as follows: Steve Marshall of Alabama, Leslie Rut-
ledge of Arkansas, Christopher M. Carr of Georgia, Derek Schmidt of
Kansas, Jeff Landry of Louisiana, Austin Knudsen of Montana, Douglas
J. Peterson of Nebraska, Wayne Steneh jem of North Dakota, John M.
O'Connor of Oklahoma, Alan Wilson of South Carolina, Jason R. Ravnsb-
org of South Dakota, and Ken Paxton of Texas; and for the National Con-
ference of State Legislatures et al. by Christopher M. Egleson and Lisa
E. Soronen.
Courtney Brewer and John S. Mills fled a brief for the American Acad-
emy of Physician Life Care Planners as amicus curiae.
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Opinion of the Court
§ 1396k). The State must also enact laws by which it auto-
matica
lly acquires a right to certain third-party payments
“for health care items or services furnished” to a benefciary.
§ 1396a(a)(25)(H). And the State must use these (and other)
tools to “seek reimbursement” from third parties “to the ex-
tent of [their] legal liability” for a benefciary's “care and
services available under the plan.” §§ 1396a(a)(25)(A)–(B).
The Medicaid Act also sets a limit on States' efforts to
recover their expenses. The Act's “anti-lien provision” pro-
hibits States from recovering medical payments from a bene-
ficiary's “property. ” § 1396p(a)(1); see also § 1396a(a)(18)
(requiring state Medicaid plans to comply with § 1396p).
Because a “benefciary has a property right in the proceeds
of [any] settlement,” the anti-lien provision protects settle-
ments from States' reimbursement efforts absent some stat-
utory exception. Wos v. E. M. A., 568 U. S. 627, 633 (2013).
State laws “requir[ing] an assignment of the right . . . to
receive payments [from third parties] for medical care,” as
“expressly authorized by the terms of §§ 1396a(a)(25) and
1396k(a), ” are one such excepti on. Arkan sas Dep t. o f
Health and Human Servs. v. Ahlborn, 547 U. S. 268, 284
(2006). Accordingly, a State may seek reimbursement from
the portion of a settlement designated for the “medical care”
described in those provisions; otherwise, the anti-lien provi-
sion prohibits reimbursement. Id., at 285.
B
To satisfy its Medicaid obligations, Florida has enacted its
Medicaid Third-Party Liability Act, which directs the State's
Medicaid agency to “seek reimbursement from third-party
benefts to the limit of legal liability and for the full amount
of third-party benefts, but not in excess of the amount of
medical assistance paid by Medicaid.” Fla. Stat. § 409.910(4)
(2017).
1
To this end, the statute provides that when a bene-
1
For the sake of simplicity, we refer to the State, its Medicaid agency,
or simply Medicaid interchangeably.
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426 GAL
LARDO v. MARSTILLER
Opinion of the Court
fciary “accept[s] medical assistance” from Medicaid, the
b
eneficiary “automatically assig ns to the [state] agency
any r ight” to th ird-par ty payments for medica l care.
§ 409.910(6)(b). A lien “for the full amount of medical assist-
ance provided” then “attaches automatically” to any settle-
ments related to an injury “that necessitated that Medicaid
provide medica l assistance. ” §§ 409.910(6)(c), (6)(c)(1),
409.901(7)(a).
Rather than permit the State to recover from a benefci-
ary's entire settlement, the statute entitles Florida to half
a benefciary's total recovery, after deducting 25% for at-
torney's fees and costs (i. e., 37.5% of the tot a l ). See
§ 409.910(11)(f )(1). This amount presumptively represents
the portion of the tort recovery that is for “past and future
medical expenses. ” § 409.910(17)(b). Beneficiaries can
rebut that presumption by proving with clear and convincing
evidence “that the portion of the total recovery which should
be allocated as past and future medical expenses is less than
the amount calculated by [Florida's] formula.” Ibid.
C
In 2008, a truck struck then-13-year-old petitioner Gia-
ninna Gallardo after she stepped off her school bus. Gal-
lardo suffered catastrophic injuries and remains in a per-
sistent vegetative state. Florida's Medicaid agency paid
$862,688.77 to cover her initial medical expenses, after
WellCare of Florida, a private insurer, paid $21,499.30. As
a condition of receiving Medicaid assistance, Gallardo had as-
signed Florida her right to recover from third parties. Be-
cause Gallardo is permanently disabled, Medicaid continues
to pay her medical expenses.
Gallardo, through her parents, sued the truck's owner and
driver, as well as the Lee County School Board, seeking com-
pensation for past medical expenses, future medical ex-
penses, lost earnings, and other damages. Although Gal-
lardo sought over $20 million in damages, the litigation
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427
Opinion of the Court
ultimately settled for $800,000—a 4% recovery. The settle-
ment
expressly designated $35,367.52 of that amount as com-
pensation for past medical expenses—4% of the $884,188.07
paid by Medicaid and WellCare. The settlement also recog-
nized that “some portion of th[e] settlement may represent
compensation for future medical expenses,” App. 29, but
did not specifcally allocate any amount for future medical
expenses.
Under Florida's statutory formula, the State was pre-
sumptively entitled to $300,000 of Gallardo's settlement
(37.5% of $800,000). Gallardo, citing the settlement's ex-
plicit allocation of only $35,367.52 as compensation for past
medical expenses, asked Florida what amount it would ac-
cept to satisfy its Medicaid lien. When Florida did not re-
spond, Gallardo put $300,000 in escrow and challenged the
presumptive allocation in an administrative proceeding.
There, Florida defended the presumptive allocation because,
in its view, it could seek reimbursement from settlement pay-
ments for past and future medical expenses, and so was not
limited to recovering the portion Gallardo had allocated for
past expenses.
While the administrative proceeding was ongoing, Gal-
lardo brought this lawsuit seeking a declaration that Florida
was violating the Medicaid Act by trying to recover from
portions of the settlement compensating for future medical
expenses. The U. S. District Court for the Northern Dis-
trict of Florida granted Gallardo summary judgment. See
Gallardo v. Dudeck, 263 F. Supp. 3d 1247, 1260 (2017). The
Eleventh Circuit reversed, concluding that “the text and
structure of the federal Medicaid statutes do not confict
with Florida law” because they “only prohibit a State from
asserting a lien against any part of a settlement not `desig-
nated as payments for medical care.' ” Gallardo v. Dudeck,
963 F. 3d 1167, 1176 (2020) (quoting Ahlborn, 547 U. S., at
284). The Eleventh Circuit explained that the relevant
Medicaid Act provisions “d[o] not in any way prohibit [a

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428 GAL
LARDO v. MARSTILLER
Opinion of the Court
State] from seeking reimbursement from settlement monies
for
medical care allocated to future care.” 963 F. 3d, at
1178 (emphasis deleted). Judge Wilson dissented, contending
that the Medicaid Act “limit[s] the state to the part of the
recovery that represents payment for past medical care.”
Id., at 1184.
Because the Supreme Court of Florida came to the oppo-
site conclusion of the Eleventh Circuit, see Giraldo v. Agency
for Health Care Admin., 248 So. 3d 53, 56 (2018), we granted
certiorari, 594 U. S. ––– (2021).
II
Gallardo argues that the Eleventh Circuit erred by per-
mitting Florida to seek reimbursement for medical expenses
from settlement amounts representing payment for future
medical care. According to Gallardo, the Medicaid Act's
anti-lien provision in § 1396p forecloses recovery from settle-
ment amounts other than those allocated for past medical
care paid for by Medicaid. Thus, Gallardo concludes, the
anti-lien provision preempts any state law that permits addi-
tional recovery.
We disagree. Under § 1396k(a)(1)(A), Florida may seek
reimbursement from settlement amounts representing “pay-
ment for medical care,” past or future. Thus, because Flori-
da's assignment statute “is expressly authorized by the
terms of . . . [§ ]1396k(a),” it falls squarely within the “excep-
tion to the anti-lien provision” that this Court has recog-
nized. Ahlborn, 547 U. S., at 284.
A
The plain text of § 1396k(a)(1)(A) decides this case. This
provision requires the State to acquire from each Medicaid
benefciary an assignment of “any rights . . . of the individual
. . . to support . . . for the purpose of medical care . . . and
to payment for medica l care from any th ird par ty. ”
§ 1396k(a)(1)(A). Nothing in this provision purports to limit

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as: 596 U. S. 420 (2022)
429
Opinion of the Court
a benefciary's assignment to “payment for” past “medical
care”
already paid for by Medicaid. To the contrary, the
grant of “any rights . . . to payment for medical care” most
naturally covers not only rights to payment for past medical
expenses, but also rights to payment for future medical ex-
penses. Ibid. (emphasis added); see United States v. Gonza-
les, 520 U. S. 1, 5 (1997) (“[T]he word `any' has an expansive
meaning ”). The relevant distinction is thus “between medi-
cal and nonmedical expenses,” Wos, 568 U. S., at 641, not be-
tween past expenses Medicaid has paid and future expenses
it has not.
Statutory context reinforces that § 1396k(a)(1)(A)'s refer-
ence to “payment for medical care” is not limited as Gallardo
suggests. First, when § 1396k(a)(1)(A) limits the kind of
“support” (e. g., child support) covered by a benefciary's as-
signment, the statute does not single out support allocated
for past expenses that a State has already paid. Instead, it
requires only that support payments be “specifed as support
for the purpose of medical care” generally. § 1396k(a)(1)(A)
(emphasis added). Second, when the Medicaid Act sepa-
rately requires state plans to comply with § 1396k, it de-
scribes that provision as imposing a “mandatory assignment
of rights of payment for medical support and other medical
care owed to recipients.” § 1396a(a)(45) (emphasis added).
In short, § 1396k(a)(1)(A) and § 1396a(a)(45) distinguish only
between medical and nonmedical care, not between past
(paid) medical care payments and future (unpaid) medical
care payments. If Congress had intended to draw such a
distinction, “it easily could have drafted language to that ef-
fect.” Mississippi ex rel. Hood v. AU Optronics Corp., 571
U. S. 161, 169 (2014).
In fact, Congress did include such limiting language else-
where in the Medicaid Act. Section 1396a(a)(25)(H), which
requires States to enact laws granting themselves automatic
rights to certain third-party payments, contains precisely
the limitation that Gallardo would read into the assignment
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LARDO v. MARSTILLER
Opinion of the Court
provision. That provision applies only when “payment has
been
made under the State plan for medical assistance for
health care items or services furnished to an individual,” and
covers only third-party payments “for such health care items
or services.” § 1396a(a)(25)(H) (emphasis added). Thus, if
§ 1396k(a)(1)(A)'s broad language alone were not dispositive,
its contrast with the limiting language in § 1396a(a)(25)(H)
would be. “Had Congress intended to restrict” § 1396k(a)
(1)(A) to past expenses Medicaid has paid, it “would have
done so expressly as it did in” § 1396a(a)(25)(H). Russello
v. United States, 464 U. S. 16, 23 (1983).
In sum, because the plain meaning of § 1396k(a)(1)(A), in-
formed by statutory context, allows Florida to seek reim-
bursement from settlement amounts representing past or
future “payments for medical care,” Florida's assignment
provision falls within the “exception to the anti-lien provi-
sion.” Ahlborn, 547 U. S., at 284.
2
B
Gallardo nevertheless argues that § 1396k(a)(1)(A) has a
di fferent meani ng, largely by discounti ng the text of
§ 1396k(a)(1)(A) and then relying on other differently worded
provisions or on policy arguments, none of which we fnd
convincing.
Insofar as she confronts § 1396k(a)(1)(A) itself, Gallardo
largely focuses on its prefatory clause, which provides that
the “purpose” of the assignment provision is to “assis[t] in
2
According to the dissent, our conclusion conficts with the “background
principl[e] of insurance law” that an insurer's third-party recovery is lim-
ited “ `to the same elements as those for which [the insurer] has made
payment.' ” Post, at 442 (opinion of Sotomayor, J.) (quoting 16 S. Plitt,
D. Maldonado, J. Rogers, & J. Plitt, Couch on Insurance § 226:36 (3d ed.
2021)). But even assuming this principle is relevant as the dissent sup-
poses, the dissent concedes that it gives way if a “contractual ter[m]”—an
assignment provision, for example—permits a broader recovery. Post, at
442; see also, e. g., 16 Couch on Insurance § 222:63 (citing examples). Here,
§ 1396k(a)(1)(A) mandates an assignment provision that does just that.
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431
Opinion of the Court
the collection of medical support payments and other pay-
ments
for medical care owed to recipients of medical assist-
ance under the State plan.” § 1396k(a). Gallardo construes
this language to limit the assignment provision to payments
that are already “ `owed' ” for “past medical care provided
under the [state] plan.” Brief for Petitioner 30.
Gallardo's argument misreads the statutory text. The
prefatory clause does not refer to payments “owed” “under
the State plan,” but rather to “payments . . . owed to recipi-
ents of medical assistance under the State plan.” § 1396k(a)
(emphasis added). In other words, the prefatory language
Gallardo invokes defnes to whom the third-party payments
are “owed”—“recipients of medical assistance under the
State plan.” It does not specify the purpose for which those
payments must be made. On that score, the prefatory clause
refers to “medical support” and “medical care” payments,
consistent with the adjacent language in § 1396k(a)(1)(A).
With little support in the text of § 1396k(a)(1)(A), Gallardo
proposes that we read the assignment provision to incorpo-
rate § 1396a(a)(25)(H)'s more limited language. But as ex-
plained above, see supra, at 429–430, we must give effect to,
not nullify, Congress' choice to include limiting language in
some provisions but not others, see Russello, 464 U. S., at
23. Gallardo responds that our decision in Ahlborn elimi-
nated any daylight between § 1396a(a)(25)(H) and § 1396k(a)
(1)(A), because we said there that these provisions “reiter-
at[e],” “reinforc[e],” and “ech[o]” each other. 547 U. S., at
276, 280, 281. But Ahlborn was clear that these two provi-
sions “ech[o]” or “reinforc[e]” each other insofar as they both
involve “recovery of payments for medical care,” id., at 282,
and not “payment for, for example, lost wages,” id., at 280.
Ahlborn did not suggest that we must otherwise interpret
these provisions in lockstep.
Conceding the provisions' scope could differ, Gallardo ar-
gues that the later enacted § 1396a(a)(25)(H) should “pre-
vai[l]” over the earlier enacted § 1396k(a)(1)(A). Brief for
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Opinion of the Court
Petitioner 34. But Gallardo does not identify any confict
requir
ing one of the provisions to prevail. Both provisions
require the State to obtain rights—either by assignment or
by statute—to certain third-party payments. Because they
concern different requirements, they do not confict just be-
cause one is broader in scope than the other. In fact, the
provisions complement each other. Section 1396k(a)(1)(A)
provides a broad, but not foolproof, contractual right to
third-party payments for medical care. See Brief for Re-
spondent 33 – 34 (explai ni ng circumst ances when an as-
signment under § 1396k(a)(1)(A) might be ineffective). By
contrast, § 1396a(a)(25)(H) provides a more targeted statu-
tory right for when the assignment might fail. See Brief
for United St ates as Amicus Cur i ae 28 – 29 (explai ni ng
that, prior to § 1396a(a)(25)(H)'s enactment, insurers were
“thwarting [§ 1396k(a)(1)(A)] by refusing to recognize assign-
ments and arguing that their insurance contracts forbade as-
signments” (internal quotation marks and alteration omit-
ted)).
3
Thus, the idea that one of these two complementary
provisions must “prevail” over the other is mistaken.
Gallardo and the United States also invoke §§ 1396a(a)
(25)(A) and (B), which require States to “take all reasonable
measures to ascertain the legal liability of third parties . . .
3
The United St ates makes a si mi lar arg ument when it relies on
§ 1396a(a)(25)(I)(ii), under which States must enact laws requiring health
insurers to “accept the State's right of recovery and the assignment to the
State of any right of an individual or other entity to payment from the
party for an item or service for which payment has been made under
the State plan.” We disagree that this provision “suggests that Congress
understood the assignment of rights under Section 1396k to be limited
to third-party payments for services covered by Medicaid.” Brief for
United States as Amicus Curiae 19. Like § 1396a(a)(25)(H), this provi-
sion targets specifc attempts by health insurers to avoid making pay-
ments to state Medicaid programs. Its narrower focus on health insurers,
who typically pay only once medical services are rendered, explains its
application to a narrower category of third-party payments, and says little
to nothing about the meaning of § 1396k(a)(1)(A)'s broader scope.
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Opinion of the Court
to pay for care and services available under the [Medicaid]
plan”
and to “seek reimbursement . . . to the extent of such
legal liability.” They argue that these provisions are the
Medicaid Act's “main” or “anchor” third-party liability provi-
sions and limit the State's recovery under any other provi-
sion “to the extent of ” a third party's payments “for care
and services available under the plan,” §§ 1396a(a)(25)(A)–
(B), which they interpret to include only payments for medi-
cal care that Medicaid has already covered. Reply Brief 6
(internal quotation marks omitted); see Brief for United
States as Amicus Curiae 18.
This argument suffers from several problems. To begin,
it is far from clear that §§ 1396a(a)(25)(A) and (B) refer only
to past expenses the State has already paid. The relevant
language—“pay[ment] for care and services available under
the plan”—could just as readily refer to payment for medical
care “available” in the future. Regardless, even if this lan-
guage means what Gallardo says it does, Congress did not
use this language to defne the scope of an assignment under
§ 1396k(a)(1)(A), implying again that the provisions should
not be interpreted the same way. See supra, at 429–430.
This implication is strengthened by the fact that § 1396k(a)
(1)(A) was enacted after §§ 1396a(a)(25)(A) and (B). It would
have been easy for Congress to use the existing language in
§§ 1396a(a)(25)(A) and (B) to defne the scope of the manda-
tory assignment. But it did not.
4
Finally, Gallardo relies on two policy arguments for her
preferred interpretation. First, citing a footnote from Ahl-
born, she contends that it would be “ `absurd and fundamen-
tally unjust' ” for a State to “ `share in damages for which
it has provided no compensation.' ” 547 U. S., at 288, n. 19
(quoting Flanigan v. Department of Labor and Industries,
4
That Congress required States' compliance with § 1396k(a)(1)(A) via
a separate paragraph—§ 1396a(a)(45)—rather than subordinating it under
§ 1396a(a)(25), supports our conclusion that they need not be interpreted
in lockstep.

434 GAL
LARDO v. MARSTILLER
Opinion of the Court
123 Wash. 2d 418, 426, 869 P. 2d 14, 17 (1994)). Although Ahl-
bo
rn noted possible unfairness if States were given “absolute
priority” to collect from the entirety of a tort settlement, 547
U. S., at 288, our holding there was dictated by the Medicaid
Act's “text,” not by our sense of fairness, id., at 280. Had
the text of the Medicaid Act authorized “absolute priority,”
Ahlborn would have been decided differently.
Second, Ga l lardo specu lates that our readi ng of
§ 1396k(a)(1)(A) would authorize a “lifetime assignment” cov-
ering not only the rights an individual has while he is a Med-
icaid benefciary but also any rights he acquires in the fu-
ture when he is no longer a Medicaid benefciary. Brief for
Petitioner 32. Not so. Section 1396k(a)(1)(A) only assigns
“any rights . . . of the individual” (emphasis added), which
is most naturally read as covering those rights “the individ-
ual” possesses wh i le on Medicaid. We must a lso read
§ 1396k(a)(1)(A)'s text in light of background legal principles,
and it is blackletter law that assignments typically cover
“only [those] rights possessed by the assignors at the time of
the assignments,” United States v. Central Gulf Lines, Inc.,
974 F. 2d 621, 629 (CA5 1992); see also 6A C. J. S., Assign-
ments § 88 (2022), or those rights “expected to arise out of
an existing . . . relationship,” see Restatement (Second) of
Contracts § 321(1) (1981); see also 9 A. Corbin, Contracts
§ 50.1 (2022). Given that legal backdrop, § 1396k(a)(1)(A)
cannot cover the sort of “lifetime assignment” Gallardo
invokes.
5
5
Florida also suggested at argument that § 1396k(a)(1)(A) includes a ger-
maneness requirement such that the assignment extends only to payments
for medical care germane—i.e., related—to an injury or illness for which
Medicaid covered treatment. See Tr. of Oral Arg. 69. However, we have
no adversary briefng on this issue and no cause to resolve it. It is undis-
puted that the settlement from which Florida seeks recovery is germane
to the injury for which Florida paid out Medicaid funds, and Florida law
requires as much. See Fla. Stat. § 409.910(6)(c).
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Sotomayor, J., dissenting
***
F
or these reasons, we affrm the judgment of the Court
of Appeals.
It is so ordered.
Justice Sotomayor, with whom Justice Breyer joins,
dissenting.
Where a Medicaid benefciary recovers an award or settle-
ment from a tortfeasor for medical expenses, specifc provi-
sions of the Medicaid Act direct a State to reimburse itself
from that recovery for care for which it has paid. These
provisions constitute a limited exception to the Act's default
rule prohibiting a State from imposing a lien against the ben-
efciary's property or seeking to use any of that property to
reimburse itself. Accordingly, a State may claim portions of
the benefciary's tort award or settlement representing pay-
ments for the benefciary's medical care, but not those repre-
senting other compensation to the benefciary (e. g., damages
for lost wages or pain and suffering). Arkansas Dept. of
Health and Human Servs. v. Ahlborn, 547 U. S. 268, 282–286
(2006). This statutory structure recognizes that it would be
“ `fundamentally unjust' ” for a state agency to “ `share in
damages for which it has provided no compensation.' ” Id.,
at 288, n. 19.
Today, however, the Court permits exactly that. It holds
that States may reimburse themselves for medical care fur-
nished on behalf of a benefciary not only from the portions
of the benefciary's settlement representing compensation for
Medicaid-furnished care, but also from settlement funds that
compensate the Medicaid benefciary for future medical care
for which Medicaid has not paid and might never pay. The
Court does so by reading one statutory provision in isolation
while giving short shrift to the statutory context, the rela-
tionships between the provisions at issue, and the framework
set forth in precedent. The Court's holding is inconsistent
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LARDO v. MARSTILLER
Sotomayor, J., dissenting
with the structure of the Medicaid program and will cause
needless
unfairness and disruption. I respectfully dissent.
I
Congress conditions a State's receipt of federal Medicaid
funding, see 42 U. S. C. § 1396d(b), on compliance with federal
requirements for the program. The Court today details at
length one of these requirements: that a state Medicaid plan
pursue reimbursement for the State's payments where reim-
bursement is available from a third party. See ante, at 424–
425. It devotes comparatively little attention to another
central requirement: that a State not assert claims against
the property of Medicaid benefciaries or recipients.
Under the Medicaid Act's anti-lien provision, enacted in
1965 as part of the original Act, “[n]o lien may be imposed
against the property of any individual prior to his death on
account of medical assistance” provided under the state Med-
icaid plan, whether “paid or to be paid.” § 1396p(a)(1); see
Ahlborn, 547 U. S., at 283–284. In addition, the Act's anti-
recovery provision, also enacted in 1965, provides that “[n]o
adjustment or recovery of any medical assistance correctly
paid on behalf of an individual under the State plan may
be made.” § 1396p(b)(1). Together, the anti-lien and anti-
recovery provisions establish that acceptance of Medicaid
does not render a benefciary indebted to the State or give
the State any claim to the benefciary's property. In other
words, Medicaid is not a loan. If a Medicaid benefciary's
fnancial circumstances change and a benefciary gains the
ability to pay for his or her own medical expenses, the bene-
fciary is not obligated to repay the State for past expenses,
no matter the magnitude of the change in circumstances.
Rather, the ordinary consequence is that the individual sim-
ply becomes ineligible for benefts moving forward.
1
1
Petitioner Gianinna Gallardo has continued to receive Medicaid bene-
fts, despite the proceeds from her tort settlement, because those proceeds
were transferred into a congressionally authorized Special Needs Trust, a
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437
Sotomayor, J., dissenting
In Ahlborn, this Court held that the Medicaid provisions
enabl
ing the State to seek reimbursement from third parties
liable for a benefciary's medical care (discussed in detail
below) establish a narrow exception to the anti-lien provi-
sion. The exception applies where the benefciary directly
sues a tortfeasor for payment of medical costs.
2
As a
threshold matter, the Court held that a benefciary's settle-
ment proceeds qualifed as benefciary “property” protected
by the anti-lien provision unless an exception to that provi-
sion applied. Id., at 285–286. The Court further held that
Medicaid's assignment to the State of rights to reimburse-
ment from third parties “carved out” an “exception to the
anti-lien provision” permitting the State “to recover that
portion of a settlement that represents payments for medical
care.” Id., at 282, 284–285.
Importantly, the Ahlborn Court rejected the State's claim
that it could seek reimbursement more broadly from the re-
mainder of the settlement funds. It held that “the anti-lien
provision applies” to bar a State's assertion of a lien beyond
the portion of a settlement representing payments for medi-
cal care. Id., at 285; accord, Wos v. E. M. A., 568 U. S. 627,
636 (2013). As relevant to the case before it, the Ahlborn
Court concluded that the State could not recover from por-
narrow exception to Medicaid's asset limits. See Reply Brief 22, n. 6.
Such a trust exists to pay expenses not covered by Medicaid, which may
include, for example, certain home nursing care or a home ramp for a
wheelchair. Upon a benefciary's death, all trust assets are transferred to
the State until the State is fully reimbursed for all medical assistance it
has furnished. See § 1396p(d)(4)(A); Brief for American Justice Associa-
tion et al. as Amici Curiae 4–7.
2
The Ahlborn Court “assume[d]” without deciding “that a State can
fulfll its obligations under the federal third-party liability provisions by
. . . placing a lien on . . . the settlement that a Medicaid recipient procures
on her own.” Arkansas Dept. of Health and Human Servs. v. Ahlborn,
547 U. S. 268, 280, n. 9 (2006); see also id., at 281 (“assuming ” that one of
these provisions, § 1396k(b), “applies in cases where the State does not
actively participate in the litigation”).
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tions of a settlement representing compensation “for dam-
ages
distinct from medical costs—like pain and suffering, lost
wages, and loss of future earnings.” 547 U. S., at 272. The
Court noted that it would be “unfair to the recipient” and
“ `absurd' ” for the State to “ `share in damages for which it
has provided no compensation.' ” Id., at 288, and n. 19.
II
The Court summarizes Florida's Medicaid Third-Party Li-
ability Act and the facts of petitioner Gianinna Gallardo's
case. See ante, at 425–428. The question presented is
whether the exception to the anti-lien provision recognized
in Ahlborn extends to permit Florida to claim the share of
Gallardo's settlement allocated for her future medical ex-
penses as compensation for the State's expenditures for her
past medical expenses.
Before answering that question, a note is in order about
what is not in dispute. Consider a hypothetical example in
which Florida has spent $1,000 on a benefciary's medical
care, after which the benefciary secures a $1,500 tort settle-
ment, $200 of which is allocated for those already-incurred
medical expenses, $500 of which is allocated for future medi-
cal care, and the remainder of which ($800) compensates for
nonmedical expenses. The parties agree, as they must, that
Florida cannot recover anticipated expenses for services it
has not furnished, but may pursue reimbursement only for
expenses it has paid (i. e., Florida can recover no more than
$1,000). The parties further agree that Florida can recover
these expenses from the portion of the benefciary's settle-
ment allocated for these expenses (i. e., the $200), and that
Florida can challenge the allocation of the settlement if it
contends that too low a portion was designated for past med-
ical expenses. The parties also do not dispute that Florida
cannot recover from the $800 representing nonmedical ex-
penses. The only dispute is whether Florida also may
recover its past medical costs from the distinct portion of
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Sotomayor, J., dissenting
the benefciary's settlement representing future medical ex-
penses
(i. e., the $500)—expenses it has not paid and might
never pay. Under a proper reading of the applicable statu-
tory provisions in context, Florida may not do so.
As Ahlborn explains, Florida's ability to seek reimburse-
ment from Gallardo's settlement hinges on establishing that
an exception to the anti-lien and anti-recovery provisions ap-
plies. Several provisions, enacted over a span of decades,
set forth the exception relevant here. The frst, §§ 1396a(a)
(25)(A) and (B) (collectively, the third-party liability provi-
sion), was enacted three years after the Medicaid Act and
the anti-lien and anti-recovery provisions. The third-party
liability provision authorizes a State only to recover for
“medical assistance” that “has been made available on behalf
of the individual,” and only “after medical assistance has
been made available.” § 1396a(a)(25)(B) (emphasis added).
And it authorizes recovery only “to the extent of,” ibid., “the
legal liability of third parties . . . to pay for care and services
available under the plan,” § 1396a(a)(25)(A). In this context,
the provision's reference to care “available under the plan”
can only be understood to refer to care that is available by
virtue of having been paid under the plan, not care that theo-
retically may or may not be made available in the future.
Put differently, as a textual matter, this provision extends
only to a third party's liability to pay for services actually
furnished by a state plan.
Congress subsequently enacted two legal tools for a State
to use when seeking reimbursement, consistent with the
third-party liability provision, for services paid.
The frst of these tools is the assignment provision,
§ 1396k(a)(1)(A), enacted in 1977 and made mandatory in
1984. In that provision, to “assis[t] in the collection of . . .
payments for medical care,” § 1396k(a), Congress required
each state Medicaid plan to condition eligibility on assign-
ment of “any rights” of the benefciary “to payment for medi-
cal care from any third party,” § 1396k(a)(1)(A). Florida
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Sotomayor, J., dissenting
rests its argument on the understanding that this language
confers
upon it a right to recover payments designated for
medical care regardless of whether those payments compen-
sate for medical care for which Florida actually has paid.
Several textual signals foreclose Florida's interpretation
of the assignment provision. For one, the provision, by its
terms, does not stand alone. Instead, Congress enacted it
“[f]or the purpose of assisting in [a State's] collection of ” pay-
ments for medical care owed to benefciaries. § 1396k(a).
It would be anomalous, then, to read the provision to reach
beyond the third-party liability provision it “assist[s]” in im-
plementing. Ibid.; see Guam v. United States, 593 U. S.
–––, ––– (2021) (similarly interpreting a statutory provision
in light of an earlier “anchor provision”). Supporting that
understanding, Congress later amended the statute contain-
ing the assignment provision to require benefciaries “to co-
operate with the State in identifying . . . any third party who
may be liable to pay for care and services available under
the plan. ” § 1396k(a)(1)(C) (the cooperation provision).
The cooperation provision echoes the third-party liability
provision's focus on care “available under the plan.” Ibid.
It would be bizarre for Congress to mandate a more far-
reaching assignment of a benefciary's right to payment for
all medical support, paid or unpaid, but limit the benefciary's
duty to cooperate only to services paid. Finally, another
provision of the Act directs each State to pass laws requiring
insurers to “accept . . . the assignment to the State of any
right of an individual or other entity to payment . . . for an
item or service for which payment has been made under the
State plan.” § 1396a(a)(25)(I)(ii). In this insurer accept-
ance provision, Congress described the assignment provi-
sion's mandate as specifc to third-party payments for serv-
ices the state plan has funded. Taken together, these
textual indicators establish that the assignment provision
reaches only a third party's liability for services made avail-
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Sotomayor, J., dissenting
able by Medicaid, not liability for services for which Medicaid
has
not paid and may never pay.
The second tool Congress enacted to implement the third-
par ty l iabi l ity prov isi on is the acquisiti on prov isi on,
§ 1396a(a)(25)(H). A 1990 General Accounting Offce report
found that some health insurers were “thwart[ing]” the as-
signment provision by “refusing to pay [States] for any of
several reasons,” including by declining to recognize Medi-
caid assignments or by insisting that such assignments con-
ficted with their insurance contracts. Medicaid: Legislation
Needed to Improve Collections From Private Insurers 5
(GAO/HRD–91–25, Nov.). Congress addressed this in 1993
by directing each State to enact laws under which the State
automatically acquires a benefciary's rights to third-party
payments specifcally “for health care items or services fur-
nished” to the benefciary, without the need for separate as-
signments. § 1396a(a)(25)(H). The text of this acquisition
provision, too, clearly restricts a State's acquisition to the
portion of a third-party payment pertaining to “health care
items or services” for which “payment has been made under
the State plan” and does not extend to third-party payments
for services the plan has not furnished. Ibid.; see ante, at 430.
This Court's task is to interpret these provisions “ `as a
symmetrical and coherent regulatory scheme' ” while “ `ft-
[ting] . . . all parts into an harmonious whole.' ” FDA v.
Brown & Williamson Tobacco Corp., 529 U. S. 120, 133
(2000). Doing so here leads to only one “symmetrical and
coherent” conclusion: that the assignment and acquisition
provisions work in tandem to effectuate the third-party lia-
bility provision. As explained by the United States as ami-
cus curiae in support of Gallardo, Congress “added the belt”
(the acquisition provision) “because it feared that the sus-
penders” (the assignment provision) “were not doing their
job.” Brief for United States as Amicus Curiae 29. The
two provisions take different paths toward the same goal,
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and each reinforces the other. All of the provisions enable
a
State to reimburse itself for expenses it has paid, not for
expenses it may or may not incur in the future. None of the
provisions authorize a State to seek such reimbursement
from the portions of a benefciary's tort settlement repre-
senting payments for care for which the State has not paid.
This interpretation is also consistent with the structure of
the Medicaid program as a whole, under which a State's re-
covery from a benefciary's compensation in tort is permissi-
ble under a narrow exception to the general, asset-protective
rule established by the anti-lien and anti-recovery provi-
sions. Ahlborn further explained that the third-party lia-
bility provision and acquisition provision both “reinforce[d]
the limitation implicit in the assignment provision.” 547
U. S., at 280. In particular, the Court described the acquisi-
tion provision's requirement (that a State enact laws under
which it acquires a benefciary's rights to third-party pay-
ments for “health care items or services furnished to an
individual” “under the State plan,” § 1396a(a)(25)(H)) as “re-
iterat[ing] ” and “echo[ing] ” the assig nment provisi on's
requirement (that a state plan condition eligibility on a bene-
fciary's assignment of rights to payment). Id., at 276, 281.
Ahlborn's repeated recognition of the relationships between
these three provisions cannot be squared with Florida's pri-
mary argument, which would sever the provisions and read
the assignment provision to eclipse the limitations of the
other two.
Moreover, Medicaid is an insurance statute, and Ahlborn's
discussion of the unfairness that would ensue from a State's
“ `shar[ing] in damages for which it has provided no compen-
sation,' ” id., at 288, n. 19, tracks background principles of
insurance law. Under those principles, recovery by an in-
surer against a third party “is generally limited to the same
elements as those for which [the insurer] has made pay-
ment,” absent contractual terms to the contrary. 16 S. Plitt,
D. Maldonado, J. Rogers, & J. Plitt, Couch on Insurance
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Sotomayor, J., dissenting
§ 226:36 (3d ed. 2021); see Brief for United States as Amicus
Cur
iae 21–22. This, too, supports a cohesive reading of
these provisions as allowing States to recover their past ex-
penses only from sources that compensate for the care and
services state plans actually have furnished.
3
An additional absurdity would fow from an overbroad
reading of the assignment provision decoupled from its com-
panions. Florida maintains that the assignment provision's
reference to “any rights . . . to payment for medical carefrom
any third party,” § 1396k(a)(1)(A), permits recovery from set-
tlement funds compensating for all medical expenses, past or
future. If this provision were interpreted in isolation to
sweep so broadly, however, its text would place no temporal
limitation on the rights assigned to the State. For example,
if Medicaid were to fund an individual's medical care as a
teenager, the State would be entitled to recover the costs of
that care from any unrelated future tort settlement for medi-
cal expenses, regardless of whether the individual remained
on Medicaid or the state plan furnished any services related
to those future injuries. Such a nonsensical “lifetime as-
signment,” Brief for Petitioner 32, would constitute an “un-
fair” erosion of the anti-lien provision, Ahlborn, 547 U. S., at
288, contravening Congress' careful design. In contrast, a
harmonious reading of the statute, consistent with Ahlborn,
limits the funds from which a State may recover to those
awarded for expenses paid and therefore presents no such
concern.
3
Much as an insurer might modify this default rule under contract, Con-
gress could do so by statute. The parties agree that Congress did so as
to Medicare, which, in the parties' view, permits a broader scope of recov-
ery for services (both furnished and to be furnished) from a third party's
liability in tort. See Brief for Respondent 41; Reply Brief 8–9. The dif-
ference, if any, between the two programs refects Medicaid's focus on the
needy, as well as the fact that individuals may lose and regain Medicaid
eligibility over time based on changes in their circumstances, whereas
most Medicare enrollees are seniors entitled to coverage for the rest of
their lives.
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III
D
espite the foregoing, the Court reads the assignment pro-
vision standing alone to establish, unlike all the other provi-
sions of the Act at issue, a substantially broader right to
recover from payments for all medical care, whether paid by
the State or not. The Court commits several errors on the
path to its holding, which departs from the statutory scheme
as understood in Ahlborn and forces the Court to adopt an
implausible workaround in order to mitigate the absurd con-
sequence, discussed above, of its acontextual reading.
A
The Court's analysis starts off backward. The Court
states frst that the Act requires a State to condition Medi-
caid eligibility on assignment of rights, and only then notes
that the anti-lien provision “also” limits States' recovery ef-
forts. Ante, at 425. In fact, the anti-lien and anti-recovery
provisions establish a general rule, and the subsequently
enacted third-party liability provision and its companions
create a limited exception. That exception, in turn, should
not be construed “to the farthest reach of [its] linguistic pos-
sibilit[y] if that result would contravene the statutory de-
sign.” Maracich v. Spears, 570 U. S. 48, 60 (2013). The
Court's misframing, however, causes it to displace the back-
ground principle of the anti-lien and anti-recovery provisions
by relying on language in the assignment provision that is
vague at best.
The Court places great weight on the assignment provi-
sion's use of the word “any” in its reference to “rights . . . to
payment for medical care.” § 1396k(a)(1)(A); see ante, at 429.
The Court presumes that “ `[t]he word “any” has an expan-
sive meaning.' ” Ibid. But whether the word “any” indi-
cates an intent to sweep broadly “necessarily depends on the
statutory context.” National Assn. of Mfrs. v. Department
of Defense, 583 U. S. 109, 123 (2018). Here, as explained,
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Sotomayor, J., dissenting
statutory context establishes that the word “does not bear
the
heavy weight the [Court] puts upon it.” Ibid. To the
extent the Court suggests the word “any” supersedes all
other contrary contextual indications, it ignores precedent.
See, e. g., United States v. Alvarez-Sanchez, 511 U. S. 350,
356–358 (1994) (relying on context to interpret “ `any law-
enforcement offcer or law-enforcement agency' ” as limited
to those making arrests under federal law).
The Court also repeatedly relies on the fact that the ac-
quisition provision and third-party liability provision use
specifc language to limit the pool from which a State may
recover to funds that compensate for expenses Medicaid has
paid, whereas the assignment provision uses different lan-
guage. See ante, at 429–430, 431, 433. The Court invokes
the presumption that “ `[w]here Congress includes particular
language in one section of a statute but omits it in another
section of the same Act, it is generally presumed that Con-
gress acts intentionally and purposely in the disparate inclu-
sion or exclusion.' ” Russello v. United States, 464 U. S. 16,
23 (1983). This is unpersuasive. Putting aside the many
contextual clues that support Gallardo's reading of the as-
signment provision, see supra, at 440–441, the presumption
the Court cites is “ `strongest' in those instances in which the
relevant statutory provisions were `considered simultane-
ously when the language raising the implication was in-
serted.' ” Gómez-Pérez v. Potter, 553 U. S. 474, 486 (2008).
It has less force where, as here, different Congresses enacted
the provisions at issue over the course of multiple decades.
The presumption is especially unhelpful in this case because
it cuts both ways: Since 1965, the anti-lien provision has
specifed that a State may not impose a lien against a benef-
ciary's property “on account of medical assistance paid or
to be paid on his behalf.” § 1396p(a)(1) (emphasis added).
Accepting the Court's logic, Congress should have required
an assignment that unambiguously reached payments for
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both furnished and unfurnished care using this existing “paid
or
to be paid” language, but it failed to do so in the assign-
ment provision. See ante, at 433.
Meanwhile, the Court fails to give due regard to the clear
textual limitations imposed by the Act as a whole. For in-
stance, as to the assignment provision's mirror image in the
insurer acceptance provision, see supra, at 440, the Court
reasons that the latter's “narrower focus on health insurers,
who typically pay only once medical services are rendered,
explains its application to a narrower category of third-party
payments,” ante, at 432, n. 3. This is beside the point. In
the assignment provision, Congress required benefciaries to
assign certain rights to the State; in the insurer acceptance
provision, it required insurers to accept that assignment. It
makes no sense that Congress would require insurers to ac-
cept only a sliver of the mandatory assignment, regardless
of how insurers typically pay.
Ultimately, “[s]tatutory construction . . . is a holistic en-
deavor.” United Sav. Assn. of Tex. v. Timbers of Inwood
Forest Associates, Ltd., 484 U. S. 365, 371 (1988). Yet rather
than reading the assignment provision in a manner “compati-
ble with the rest of the law,” ibid., the Court disconnects it
from much of the Act. The Court does not hold that the
third-party liability provision extends as far as its reading
of the assignment provision. See ante, at 433; see also
supra, at 439. The Court also agrees that the acquisition
provision is “more limited,” meaning that the scope of that
provision, too, “differ[s]” from that of the assignment provi-
sion. Ante, at 431. To justify these anomalies, the Court
asserts that Congress, in enacting the acquisition provision,
saw ft to “provid[e] a more targeted statutory right for when
the assignment might fail.” Ibid. The Court offers little
explanation, however, for why Congress might have nar-
rowed such a necessary backstop in this way. The statutory
hodgepodge the Court perceives contrasts sharply with the
reasonable scheme Congress actually crafted.
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447
Sotomayor, J., dissenting
B
The
Court's reasoning also contradicts precedent. The
Court distinguishes Ahlborn because that case did not
squarely hold that the relevant provisions “must” be inter-
preted in “lockstep,” and it reduces Ahlborn's concern about
fairness to a disfavored “policy argumen[t]” that must yield
to text. Ante, at 431, 433. But Ahlborn's analysis refected
the Court's view of the text and context of the Act as a cohe-
sive whole. It is not only “our sense of fairness,” ante, at
434, but Congress' sense of fairness, as codifed in the Act's
anti-lien and anti-recovery provisions and recognized in Ahl-
born, that demonstrates the Court's error.
The Court itself appears to recognize that its textual anal-
ysis leads to unfair and absurd results, leading it to suggest
an unpersuasive workaround. The Court responds to the
lifetime-assignment quandary, see supra, at 443, by reason-
ing that the assignment provision's use of the phrase “ `any
rights . . . of the individual' ” is “most naturally read” to
impose a temporal limitation to rights possessed while on
Medicaid, ante, at 434. Neither party even suggests this
reading of the statute.
4
That is because it is anything but
natural, especia lly under the interpretive approach the
Court uses today. An “individual” continues to be an “indi-
vidual” for the duration of his or her life, whether on or off
Medicaid. Were there any ambiguity, the word “ `any,' ” we
are told, “ `has an expansive meaning ' ” that would counsel
against the Court's implicit limitation. Ante, at 429. Per-
haps sensing that its claim to natural meaning lacks force,
the Court, at last, acknowledges “background legal princi-
ples” that militate against allowing a lifetime assignment.
Ante, at 434. While background principles indisputably are
4
In its briefng, Florida responded to the lifetime-assignment concern
by stating only that its own law did not go so far. Brief for Respondent
45. Confronted anew with the concern at argument, Florida proposed an
implicit “germaneness requirement,” see Tr. of Oral Arg. 68–70, which the
Court does not embrace, see ante, at 434, n. 5.
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relevant, the Court errs by discarding the more relevant
background
rule of insurance law that Congress embraced in
the Act, see supra, at 442–443, which could have avoided the
Court's dilemma altogether.
5
Over the long term, the Court's alteration of the balance
Congress struck between preserving Medicaid's status as
payer of last resort and protecting Medicaid benefciaries'
property might frustrate both aims. As a State's right of
recovery from any damages payout expands, a Medicaid ben-
efciary's share shrinks, reducing the benefciary's incentive
to pursue a tort action in the frst place. See Brief for
American Justice Association et al. as Amici Curiae 16–20.
Under the provisions of the Act at issue here, States may
sue tortfeasors directly, but as Florida itself explains, it is
“more cost-effective” for benefciaries to sue. Tr. of Oral
Arg. 65. By diminishing benefciaries' interests in doing so,
the Court's expansion of States' assignment rights could per-
versely cause States to recover fewer overall expenses, all
while unsettling expectations in the States that have relied
on a contrary reading of federal law.
6
In the end, the Court's atomizing interpretation has little
to commend it, particularly when contrasted with the con-
sistent, admi nistrable scheme Congress craf ted. The
Court's reading also undercuts Congress' choice to allow
5
The Court does not dispute the background principle that an insurer's
third-party recovery is limited to the elements for which the insurer has
made payment. See supra, at 442–443. The Court responds, however,
that Congress clearly displaced this principle in the assignment provision.
See ante, at 430, n. 2. That, of course, is the entire question. For the
reasons explained, the Court's reading of the assignment provision is
erroneous.
6
The vast majority of lower courts (including Florida's Supreme Court)
read these provisions much as I do. See, e. g., Latham v. Offce of Recov-
ery Servs., 2019 UT 51, 448 P. 3d 1241; Giraldo v. Agency for Health Care
Admin., 248 So. 3d 53 (Fla. 2018); In re E. B., 229 W. Va. 435, 729 S. E. 2d
270 (2012); Doe v. Vermont Offce of Health Access, 2012 VT 15A, 191 Vt.
517, 54 A. 3d 474; Pet. for Cert. 18–19 (collecting additional cases).
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Sotomayor, J., dissenting
Medicaid benefciaries to place their excess recovery funds
i
n Special Needs Trusts, protecting their ability to pay for
important expenses Medicaid will not cover. See n. 1,
supra. Congress may wish to intercede to address any dis-
ruption that ensues from today's decision, but under a proper
reading of the Act, such intervention would have been
unnecessary.
***
“[T]he meaning of a statute is to be looked for, not in any
single section, but in all the parts together and in their rela-
tion to the end in view.” Panama Refning Co. v. Ryan, 293
U. S. 388, 439 (1935) (Cardozo, J., dissenting). Because the
Court disserves this cardinal rule today, I respectfully
dissent.
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Reporter’s Note
The attached opinion has been revised to refect the usual publication
and citation style of the United States Reports. The revised pagination
makes available the offcial United States Reports citation in advance of
publication. The syllabus has been prepared by the Reporter of Decisions
for the convenience of the reader and constitutes no part of the opinion of
the Court. A list of counsel who argued or fled briefs in this case, and
who were members of the bar of this Court at the time this case was
argued, has been inserted following the syllabus. Other revisions may
include adjustments to formatting, captions, citation form, and any errant
punctuation. The following additional edits were made:
p. 443, n. 3, line 3, “which appears to permit” is replaced with “which, in
the parties' view, permits”
p. 443, n. 3, line 5, “42 U. S. C. § 2651(a); see” is replaced with “See”
p. 443, n. 3, line 6, “But see § 2652(c) (providing that “[n]o action taken by
the United States . . . shall operate to deny to the injured person the
recovery for that portion of his damage not covered” under Medicare).
Any difference” is replaced with “The difference, if any,”