August 20, 2020

Federal Circuit Affirms Government Must Pay Cost Sharing Reduction Amounts Under ACA

The United States Circuit Court of Appeals for the Federal Circuit affirmed a decision by the United States Court of Federal Claims in the Sanford Health Plan and Montana Co-op case that the Government owed the plans the cost sharing reduction payments referenced in the ACA despite Congress not making specific appropriations for these payments. The trial court had granted summary judgment for the plaintiffs, concluding that the provision on reimbursement of cost-sharing reductions in the ACA is “money-mandating” and that the government is liable for money damages for its failure to make reimbursements for the 2017 reductions. The appeals court did not reach the contract claim in either case. Based on stipulations as to damages, the court ultimately entered final judgments of $360,254 for Sanford and $1,234.058 for Montana.