Gallardo v. Marstiller, No. 20-1263 ___U.S.___ (June 6, 2022) (J. Thomas)
Plaintiff, a student, suffered catastrophic injuries when she was hit by a truck while getting off a Florida school bus. 42 U. S. C. §1396k(a)(1)(A) requires participating states to pay low income citizen's medical bills and to make reasonable efforts to recoup those costs from liable third parties. Florida Medicaid does this and paid $862,688.77 of plaintiffs' initial medical expenses and continues to pay her medical bills. Fla. Stat. §409.910 gives Florida Medicaid the right to recoup past and future medical payments from personal injury settlements under a presumption that 37.5% of any settlement is for past and future medical expenses. Plaintiff may overcome this presumption by clear and convincing evidence.
Through her parents, plaintiff sued the truck owner and driver as well as the school board. She settled for $800,000 expressly designating $35,367.52 of the settlement as payment for past medical expenses. The settlement agreement was silent as to future medical expenses.
Florida Medicaid asserted a lien on the $800,000 of 37.5% or $300,000. Plaintiff brought this lawsuit seeking a declaration that the Medicaid Act does not allow Florida Medicaid to lien future medical expenses.
The Eleventh Circuit of the United States Court of Appeals found the Medicaid Act allows states to seek reimbursement from settlements for future medical expenses and the United States Supreme Court affirmed.
The Medicaid Act's anti-lien provision prohibits States from recovering medical expenses from a beneficiary's property. 42 USC §1396p(a)(1) . However, 42 USC §§1396a(a)(25) and 1396k(a) require that beneficiaries assign their rights to third-party payments for medical care to the state. Third party recoveries are therefore exempt from the anti-lien provision. Further, the federal statutes' authorization to states to seek reimbursement for “any rights . . . to payment for medical care” is properly interpreted to include both past and future medical expenses. If Congress wanted to limit it to past expenses, it could have said so. Florida Medicaid's lien statute is valid.