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Florida First DCA rules that Medicare lien on personal injury recovery was subject to pro rata reduction

On November 18, 2020, in Soto v. Agency for Health Care Administration, No. 1D17-5387, the Florida First DCA reversed a determination by an administrative law judge (ALJ) that the recipient of a personal injury settlement was not entitled to a reduction of the Medicaid lien imposed against the settlement. The ALJ concluded that the plaintiff was not entitled to a reduction because she failed to prove that her pro rata methodology was sanctioned by the Legislative mandate for the Medicaid lien to be paid in full. However, the First DCA noted that since this case was decided by the ALJ, the Florida Supreme Court and the First DCA have accepted the use of the pro rata method to reduce the Medicaid lien when the Medicaid recipient has  presented competent, substantial, and uncontradicted evidence to support her position that only a portion of the settlement should be allocated for past medical expenses. See Giraldo v. Agency for Health Care Admin., 248 So. 3d 53, 56 (Fla. 2018); Bryan v. State, 291 So. 3d 1033, 1036 (Fla. 1st DCA 2020); Mojica v. Agency for Health Care Admin., 285 So. 3d 393, 398 (Fla. 1st DCA 2019); Eady v. State, 279 So. 3d 1249, 1259 (Fla. 1st DCA 2019).

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