Brannock & Humphries Achieves Landmark Decision For Florida’s Medicaid Recipients

In a 6-1 decision, the Florida Supreme Court held today that Florida’s Agency for Health Care Administration can satisfy its Medicaid lien from only the portion of a tort victim’s recovery designated as compensation for past medical expenses, providing a major win for Brannock & Humphries’ client and for Medicaid recipients around the state.

Medicaid law authorizes state Medicaid agencies, such as the Florida Agency for Health Care Administration (“AHCA”), to seek reimbursement when Medicaid pays for an injured party’s care and that party then sues and recovers from the tortfeasor.  In Florida, our Medicaid statute provides that AHCA can seek reimbursement from the portion of a settlement or a judgment on a verdict that compensates the injured person not only for his or her past medical expenses, but also for future medical expenses.  In this particular case, the injured person, Juan Villa, was paralyzed from the chest down in a horrific ATV accident, which was caused by a manufacturing defect.  The cost of his future care was going to be enormous – and was, therefore, the bulk of his settlement. 

AHCA argued that, under the Florida statute, it could recover all of its lien from the settlement, including from the large portion designated for Juan’s future medical care.  On behalf of Juan’s family, Brannock & Humphries countered that allowing AHCA to recover from the future medical expenses portion of the settlement violated Medicaid law and that AHCA should only be allowed to touch the money that was earmarked for the medical expenses AHCA had actually paid.  An administrative law judge sided with AHCA, as did the First District Court of Appeal.

Undeterred, Brannock & Humphries pursued the case all the way to the Florida Supreme Court where, today, the Court unanimously agreed that AHCA can only recover from the past medical expenses portion of a Medicaid recipient’s settlement or judgment.  While six Justices reached that conclusion based on a plain reading of the Medicaid statute and one Justice reached that conclusion based on United States Supreme Court precedent, the outcome was united.  For Juan Villa’s family, the difference amounted to hundreds of thousands of dollars.  It will, no doubt, mean the same for other injured Medicaid recipients. 

The decision can be found here.