The U.S. Supreme Court unanimously affirmed the Eighth Circuit's ruling in a decision delivered by Justice John Paul Stevens. The Court held that federal Medicaid law did not authorize ADHS to assert a lien on Ahlborn's settlement in excess of the stipulated amount for past medical expenses, and that the federal anti-lien provision furthermore affirmatively prohibited it from doing so. The state has no claim against those portions of a settlement the parties agreed were attributable to pain and suffering or lost wages, the high court ruled. The Arkansas statutes were therefore unenforceable to the extent they provided for a contrary result.