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AHCA’S Attempt to Reach a Medicaid Recipient’s Tort Recovery is Thwarted.

On July 5, 2018 (how appropo one day after Independence Day) the Florida Supreme Court ruled that under federal law AHCA may only reach the past medical expenses portion of a Medicaid recipient’s tort recovery to satisfy its Medicaid third party liability lien.

See Giraldo v. ACHA (No. SC17-297). This ruling now resolves the conflict between the Second District Court of Appeal’s decision in Willoughby v. AHCA, 212 So.3d 516 (Fla. 2d DCA 2017) and the First District Court of Appeal’s decision in Giraldo v. AHCA, 208 So.3d 244 (Fla. 1st DCA 2016).

The Plaintiff settled with multiple tortfeasors for $1 million. Medicaid had paid $322,222.27 for the Plaintiff’s medical care. Applying the formula found in Florida Statute 409.910(11)(f) AHCA calculated the presumptive lien amount at $321,720.16.

At the DOAH hearing, the Plaintiff’s counsel presented expert testimony to establish that only $13, 881.79 of the $1 million recovery represented compensation for past medical expenses. However, Plaintiff’s counsel did not present evidence to rebut the statutory lien amount.

The Florida Supreme Court interpreted the federal anti-lien law to refer to health care services already furnished (past medical expenses) and not giving the states a right to assignment of the portion of a tort recovery from which the plaintiff is expected to pay for future medical expenses. Moreover, the Court directed the administrative law judge to reduce the amount awarded to $13,881.79 in satisfaction of ACHA’s lien.

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