Florida Medicaid Recipient Has Right to Refute Full Lien Recovery

A Florida appeals court rules that a Medicaid recipient may attempt to reduce the state's lien on her personal injury settlement by introducing evidence proving that the lien exceeds the amount of the settlement that is attributed to medical expenses.  Harrell v. State of Florida Agency for Health Care Administration (Fla. Dist. Ct. App., 1st, No. 1D12-5597, July 28, 2014).

Kaitlyn Harrell received a confidential settlement from the hospital where she was born after sustaining significant injuries during birth.  Florida's Agency for Health Care Administration (AHCA) asserted a $360,741.48 lien against the settlement for medical services that it had provided to Kaitlyn through the Medicaid program. 

Kaitlyn argued that the state's Medicaid recovery formula, which makes most of the settlement available for recovery, was overruled by the U.S. Supreme Court's 2006 ruling in Arkansas Department of Health and Human Services v. Ahlborn that a state may assert a Medicaid lien only against the portion of a settlement attributable to past medical expenses.  Despite this argument, the trial court allowed AHCA to recover the full amount of the lien.  Shortly after the trial court's ruling, the Supreme Court issued its decision in Wos v. E.M.A. upholding Ahlborn and clarifying that one-size-fits-all Medicaid recovery formulas are inappropriate if they fail to afford beneficiaries the opportunity to prove that the size of the lien exceeds the portion of the settlement allocated to medical expenses.  Kaitlyn appealed.

The District Court of Appeal of Florida, First District, reverses the trial court and remands the case for further proceedings.  The court states that "we now hold that a plaintiff must be given the opportunity to seek reduction of the amount of a Medicaid lien established by the statutory formula outlined in section 409.910(11)(f), by demonstrating, with evidence, that the lien amount exceeds the amount recovered for medical expenses.  When such evidence is introduced, a trial court must consider it in making a determination on whether AHCA's lien amount should be adjusted to be consistent with federal law."

To read the full text of this decision, go to:  https://caselaw.findlaw.com/fl-district-court-of-appeal/1674038.html

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