Repayment of Medicaid Lien

Published March 2014 by Ted Babbitt

Dillard v Agency for Health Care Administration, 38 Fla. L. Weekly D2486 (2nd DCA Fla., Nov. 27, 2013) involved an action by a catastrophically injured minor taken into custody at a juvenile detention center as a result of cocaine overdose.  His mother filed suit against the Sheriff of Collier County and others claiming that her son had been denied appropriate medical care at the detention center and, as a result, suffered the injuries sued upon.  The case was settled and the Agency for Healthcare Administration, which administers Florida’s Medicaid Program, claimed a Medicaid lien for the amount it had provided to the injured plaintiff.  The trial court enforced the lien under Fla. Stat. 409.910(11)(f) utilizing the formula set out in that statute against the entire amount of the settlement.  The formula provides that after deduction of 25% of any award, judgment or settlement and taxable costs, up to one-half of the remaining recovery must be paid to reimburse Medicaid for the services provided.  Section 4 of that statute provides the following:

Notwithstanding any provision of this section to the

contrary, the Agency shall be entitled to all medical

coverage benefits up to the total amount of medical

assistance provided by Medicaid.  For the purposes

of this paragraph, “medical coverage” means any

benefits under health insurance, a health maintenance

organization, a preferred provider arrangement, or

prepaid health clinic and the portion of the benefits

designated for medical payments under coverage

for workers’ compensation, personal injury protection,

and casualty.”

The trial court relied upon Russell v. Agency for Health Care Administration, 23 So. 3d 1266 (Fla. 2nd DCA 2010) where the Second District approved the application of the statutory formula to the entire settlement unless there was evidence that the Medicaid lien was in excess of the portion of the settlement designed to cover medical damages.  After the trial court’s decision, the United States Supreme Court issued Wos v E.M.A. ex rel. Johnson, 133 Sup. Ct. 1391 (2013) and based on that the Second District issued its opinion in Health Care Administration v Riley, 119 So. 3d 514 (Fla. 2nd DCA 2013).  In Riley, the Second District, in keeping with the holding in Wos, supra, ruled that a plaintiff must be given the opportunity to reduce the Medicaid lien as set forth in the statutory formula with evidence that the lien amount exceeded the amount recovered in the settlement for medical expenses.  Dillard provides that Medicaid is precluded from recovering its lien from the entire settlement and that the statutory formula can only be applied to the portion of the settlement already allocated to past medical expenses.  The issue of future medical expenses was not decided by the Dillard Court because of failure to timely raise that issue.

Florida Statute 409.910 has now been substantially amended.

In accordance with the above-cited cases that statute now provides that after a settlement the plaintiffs may file a petition within 21 days of paying the Medicaid lien or after setting up an account placing the benefits in a trust account for the benefit of the agency.  That petition can request that a hearing be held at which time evidence can be presented asking that a court limit the Medicaid lien in accordance with the statute.

NOTE:  BECAUSE A NUMBER OF PEOPLE HAVE REQUESTED COPIES OF PAST ARTICLES, A COMPILATION OF THESE ARTICLES IS NOW AVAILABLE TO MEMBERS OF THE PALM BEACH COUNTY BAR ASSOCIATION, FREE OF CHARGE, BY CALLING (561) 684-2500.