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In State of Florida, Agency for Health Care Administration v. Williams, 38 Fla. L. Weekly D2545a (Fla. 4th DCA December 4, 2013), the Agency for Health Care Administration (AHCA) appealed the trial court's order limiting AHCA's Medicaid lien for medical expenses using the plaintiff's allocation formula rather than the default allocation provision of § 409.910(11)(f), Fla. Stat.

The 4th DCA held that the trial court had erred in determining the amount of Medicaid's lien in the underlying personal injury settlement by using the allocation formula put forth by plaintiff in lieu of the default statutory allocation without first holding an evidentiary hearing.

In reversing, the 4th DCA relied on Roberts v. Albertson's, Inc., 119 So. 3d 457 (Fla. 4th DCA 2012), which held that if a plaintiff seeks a reduction of Medicaid's lien for medical expenses as established by the default allocation, he or she must produce evidence that the lien amount exceeds the amount recovered for medical expenses.

 

 

This summary was prepared by Susan Fuller of our firm.


Susan Fuller

 

 


38 Fla. L. Weekly D2545a

 

Torts -- Settlement -- Medicaid lien -- Error to limit Agency for Health Care Administration's Medicaid payment lien on personal injury settlement to amounts allocated to medical expenses based upon allocation formula asserted by Medicaid recipient, rather than on default statutory allocation provision, without conducting evidentiary hearing

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Appellant, v. MAJOR WILLIAMS, Appellee. 4th District. Case No. 4D12-1046. December 4, 2013. Appeal from the Circuit Court for the Seventeenth Judicial Circuit, Broward County; Michael L. Gates, Judge; L.T. Case No. 07-14107 CACE 12. Counsel: Adam J. Stallard, Tallahassee, for appellant. Floyd Faglie of Staunton & Faglie, PL, Monticello, for appellee. Steven E. Quinnell of Quinnell Elder Law Firm, Pensacola, for Amicus Curiae Academy of Florida Elder Law Attorneys. Pamela Jo Bondi, Attorney General, Louis F. Hubener and Rachel E. Nordby, Tallahassee, for Amicus Curiae State of Florida.

(Per Curiam.) The Agency for Health Care Administration appeals an order limiting its Medicaid payments lien on appellee's personal injury settlement to amounts allocated to medical expenses based upon an allocation formula asserted by appellee, rather than on the default allocation provision of section 409.910(11)(f), Florida Statutes (2012). In Roberts v. Albertson's Inc., 119 So. 3d 457 (Fla. 4th DCA 2012), we recently addressed the precise issue of how the statutory provision should be applied. There we held that "a plaintiff should be afforded an opportunity to seek the reduction of a Medicaid lien amount established by the statutory default allocation by demonstrating, with evidence, that the lien amount exceeds the amount recovered for medical expenses." Id. at 466. After our original opinion was issued, the U.S. Supreme Court held that state statutes containing default allocation formulas for Medicaid reimbursement are pre-empted by federal law to the extent that they can be categorized as conclusive presumptions. See Wos v. E.M.A. ex rel. Johnson, __ U.S. __, 133 S. Ct. 1391, 1398, 185 L. Ed. 2d 471 (2013). Roberts is consistent with Wos.

We reverse the trial court's order, concluding that it did not hold an evidentiary hearing prior to adopting the allocation formula it used. Both Roberts and Wos emphasize the fact that the allocation must be based upon evidence.

Reversed and remanded for further proceedings. (Warner, Stevenson and Gerber, JJ., concur.)












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