A Florida appeals court rules that the guardian of a Medicaid recipient may not deduct a guardianship fee from the recipient's income because the fee is not medically necessary. Lutheran Services Florida, Inc. v. Department of Children and Families (Fl. Ct. App., 2nd Dist., No. 2D13-5840, Nov. 25, 2015).
Lutheran Services Florida (LSF) is the court-appointed guardian of nursing home resident Larry Peron. LSF's duties include reviewing Mr. Peron's medical treatment and giving consent for medical procedures. When Mr. Peron qualified for Medicaid, he paid the majority of his income to the nursing home as the patient responsibility amount.
LSF obtained a court order authorizing that a monthly $200 guardianship fee be deducted from Mr. Peron's income and petitioned the Department of Children and Families to deduct the guardianship fee from Mr. Peron's patient responsibility amount. The Department denied the petition, determining that the fee cannot be deducted from a Medicaid recipient's income because it is not "medically necessary" under state law. A hearing officer upheld the determination, noting that state law defines medically necessary as services provided in accordance with generally accepted standards of medical practice and reviewed by a physician. LSF appealed.
The Florida Court of Appeals affirms, holding that the guardianship fee is not medically necessary. According to the court, state law allows only deductions from a Medicaid recipient's income for "medical or remedial care services rendered by a medical professional directly to the Medicaid recipient." The court acknowledges that this result leaves a gap "wherein a guardian of an incapacitated ward who provides the necessary consent for medically necessary treatment cannot be compensated for its services under the state's Medicaid program," and suggests that the legislature look into changing the law.
For the full text of this decision, go to: http://www.2dca.org/opinions/Opinion_Pages/Opinion_Pages_2015/November/November%2025,%202015/2D13-5840.pdf
Did you know that the ElderLawAnswers database now contains summaries of more than 2,000 fully searchable elder law decisions dating back to 1993? To search the database, click here.