Supreme Court Rules in Favor of Florida Medicaid in Settlement Dispute

June 6, 2022 by Dan McCue
Supreme Court Rules in Favor of Florida Medicaid in Settlement Dispute
The U.S. Supreme Court. (Photo by Dan McCue)

WASHINGTON — The U.S. Supreme Court ruled 7-2 on Monday in favor of Florida’s Medicaid program in a dispute over how much money the state can take from an accident victim’s private settlement to recover the costs of their care.

Gianinna Gallardo was just 13 when she was struck by a truck shortly after she stepped off her Florida school bus.

Florida’s Medicaid agency paid $862,688.77 to cover Gallardo’s initial medical expenses, and the agency continues to pay her medical expenses. 

While this was going on, Gallardo, through her parents, sued the truck’s owner and driver, as well as the Lee County School Board.

According to the Supreme Court’s summary of the case, Gallardo sought compensation for past medical expenses, future medical expenses, lost earnings, and other damages. That litigation resulted in a settlement for $800,000, with $35,367.52 expressly designated as compensation for past medical expenses

The settlement did not specifically allocate any amount for future medical expenses.

The Medicaid Act requires participating states to pay for certain needy individuals’ medical costs and then to make reasonable efforts to recoup those costs from liable third parties. 

Under Florida’s Medicaid Third-Party Liability Act, the court said, “a beneficiary like Gallardo who ‘’accept[s] medical assistance’ from Medicaid ‘automatically assigns to the [state] agency any right’ to third-party payments for medical care.” 

Applied to Gallardo’s settlement, Florida’s statutory framework entitled the state to $300,000— 37.5% of $800,000, the percentage the statute sets as presumptively representing the portion of the settlement compensating for future medical expenses. 

On review, the 11th U.S. Circuit Court of Appeals held the relevant Medicaid Act provisions do not prevent a state from seeking reimbursement from settlement monies allocated for future medical care. 

Gallardo argued that the Medicaid Act’s anti-lien provision — which prohibits states from recovering medical payments from a beneficiary’s ‘property,’ forecloses recovery from settlement amounts other than those allocated for past medical care paid for by Medicaid. 

But in a ruling written by Justice Clarence Thomas, the court majority held that the provision does not apply to state laws “expressly authorized by the terms of… the Medicaid Act.” 

In a dissent, Justice Sonia Sotomayor said “the court’s atomizing interpretation has little to commend it, particularly when contrasted with the consistent, administrable scheme Congress crafted. 

“The court’s reading also undercuts Congress’ choice to allow Medicaid beneficiaries to place their excess recovery funds in Special Needs Trusts, protecting their ability to pay for important expenses Medicaid will not cover.”

In short, she said, the majority’s holding “is inconsistent with the structure of the Medicaid program and will cause needless unfairness and disruption.”

Dan can be reached at [email protected] and at https://twitter.com/DanMcCue.

A+
a-
  • Medicaid
  • Supreme Court
  • In The News

    Health

    Voting

    Supreme Court

    Five Takeaways From the Abortion Pill Case Before US Supreme Court

    WASHINGTON (AP) — U.S. Supreme Court justices on Tuesday did not appear ready to limit access to the abortion pill mifepristone,... Read More

    WASHINGTON (AP) — U.S. Supreme Court justices on Tuesday did not appear ready to limit access to the abortion pill mifepristone, in a case that could have far-reaching implications for millions of American women and for scores of drugs regulated by the Food and Drug Administration. It's... Read More

    March 26, 2024
    by Tom Ramstack
    Supreme Court Skeptical of Ban on Abortion Pill Mifepristone

    WASHINGTON — A hearing Tuesday before the Supreme Court indicated a majority of the justices want to maintain women’s access... Read More

    WASHINGTON — A hearing Tuesday before the Supreme Court indicated a majority of the justices want to maintain women’s access to the abortion pill mifepristone despite objections from anti-abortion activists. The doctors and organizations who sued argued the Food and Drug Administration was wrong in granting... Read More

    March 19, 2024
    by Dan McCue
    Supreme Court Gives Texas Green Light to Deport Illegal Immigrants

    WASHINGTON — A divided Supreme Court on Tuesday allowed Texas to begin enforcing a state law that effectively allows officials... Read More

    WASHINGTON — A divided Supreme Court on Tuesday allowed Texas to begin enforcing a state law that effectively allows officials to deport undocumented immigrants, despite objections from the Biden administration, which argued only the federal government has authority over immigration issues. In an unsigned order, the... Read More

    A Supreme Court Ruling in a Social Media Case Could Set Standards for Free Speech in the Digital Age

    WASHINGTON (AP) — In a busy term that could set standards for free speech in the digital age, the Supreme... Read More

    WASHINGTON (AP) — In a busy term that could set standards for free speech in the digital age, the Supreme Court on Monday is taking up a dispute between Republican-led states and the Biden administration over how far the federal government can go to combat controversial social... Read More

    March 4, 2024
    by Dan McCue
    Justices Rule Trump Can Stay on Colorado Ballot

    WASHINGTON — In a unanimous decision, the Supreme Court ruled Monday that former President Donald Trump may remain on Colorado’s... Read More

    WASHINGTON — In a unanimous decision, the Supreme Court ruled Monday that former President Donald Trump may remain on Colorado’s primary ballot, rejecting a challenge to his eligibility based on a section of the 14th Amendment that bars those who have “engaged in insurrection” from holding... Read More

    About as Many Abortions Happening in US Monthly as Before Roe Was Overturned, Report Finds

    The number of abortions performed each month is about the same as before the U.S. Supreme Court overturned Roe v. Wade and... Read More

    The number of abortions performed each month is about the same as before the U.S. Supreme Court overturned Roe v. Wade and the nationwide right to abortion more than a year and a half ago, a new report finds. The latest edition of the #WeCount report conducted for... Read More

    News From The Well
    scroll top