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Florida First DCA rules that since Medicaid recipient died before settlement of personal injury case,amount of Medicaid lien cannot be challenged based on dispute about what part of an undifferentiated settlement is allocable to past medical expenses

On March 26, 2021, in Cabrera v. State of Florida, Agency for Health Care Administration, No. 1D18-755, the Florida First DCAaffirmed an Administrative Law Judge ‘s dismissal of a plaintiff’s petition challenging a Medicaid lien which had been applied against his personal injury settlement for the death of his daughter in a motor vehicle accident. Florida’s Agency for Health Care Administration (AHCA) had claimed it was owed $51,838.61 in a lien repayment amount after applying the statutory formula under § 409.910(11)(f), Florida Statutes, from the $140,000 that the plaintiff received in total third-party benefits. The plaintiff’s petition to the ALJ challenged this lien amount, asserting that the method in Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 268 (2006), should be applied. Under this analysis, applying § 409.910(17)(b), only $4,039.17 in past medical expenses would be payable to the Agency as the amount of past medical expenses deemed to be recovered under the settlement. The Agency disagreed and contended that the opportunity to rebut the medical expense allocation under § 409.910(17)(b) was not available where the Medicaid recipient died before third-party benefits were recovered through settlement or other means. Because the settlement here was not reached until July 14, 2017, the ALJ determined that the AHCA had no right to recovery until that time and the 2017 version of § 409.910(17(b) therefore applied. This was crucial to the ruling in the case, because in 2017 the Florida legislature amended the statute to specifically provide that that the right to contest the amount of the lien applied only if “[i]f federal law limits the agency to reimbursement from the recovered medical expense damages.” The First DCA pointed out that the federal anti-lien provision, 42 U.S.C. § 1396(p)(a)(1) (2017), states that “[n]o lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State Plan,“and concluded that by its express terms the Medicaid Act’s anti-lien provision only applies to living Medicaid recipients.