Florida medicaid Liens. Florida residents that suffer from injuries caused by another person are lucky because they can often pay costly medical bills through Medicaid if they qualify for coverage. Medicaid is a government assistance program that provides long-term health coverage to those with low income and few assets. It is sometimes necessary for the person injured to seek further relief by suing the person that caused the injury.
However, what many people do not realize is Medicaid can place a lien on any judgment or monetary settlement a plaintiff receives for wrongful injury or death. The issue then becomes should Medicaid receive a reimbursement for all services given to the recipient or just the medical expenses.
This issue came up in the case of Ark. HHS v. Ahlborn, 547 U.S. 268 (4th DCA July 20, 2016). In this case, the recipient Heidi Ahlborn was severely and permanently injured by in an auto accident with another driver. The other driver was at fault for the accident. Ahlborn owned little assets, which made her able to qualify for Medicaid coverage in her state.
In 1997, Ahlborn filed a lawsuit against her two alleged tortfeasors in state court and sought compensation for the injuries she received in the car accident. She asked for compensation for past medical costs, permanent injuries, and future medical expenses. She also claimed future pain and suffering, loss of earnings, and the permanent impairment of the ability to earn in the future.
This case was eventually settled out of court in 2002 for a total of $550,000. The parties did not allocate the settlement between categories of damages. The Medicaid agency for the state asserted a medicaid lien against the settlement proceeds of $215,645.30, which was the total cost of payments made by Medicaid for Ahlborn’s care.
Ahlborn’s attorneys contested the medicaid lien and argued the lien violated the federal Medicaid lien laws because the payment would require depletion of compensation for injuries other than past medical expenses. The issue came down to whether Medicaid was owed the full amount of payments made or just the payments made for medical expenses.
The U.S. Supreme Court ruled that Medicaid (through a Medicaid lien) could only recover the amount the agency paid for Ahlborn’s medical expenses, which is this case was $35,581.47. The justices looked to the language of the anti-lien statutes and the legislative history of the law. The Court found neither the language nor the history of the law calls for a total reimbursement to Medicaid for the Medicaid Lien. Rather, the only reimbursement the recipient should pay is for medical expenses he or she received.
The upshot of this case is that Medicaid recipients will have to pay Medicaid funds back for the medical expenses he or she receives (under a Medicaid lien) if the recipient wins a civil case or receives a settlement. So if a person is injured in a car accident, and sues the other driver for her damages, then she must pay Medicaid back for the medical expenses Medicaid paid for.
This is good news, however, because it allows the injured person to receive additional remedies besides medical costs. For instance, if the injury gives the recipient a permanent disability then this person can sue for loss of potential earnings. The money the recipient receives for loss of potential earnings damages does not need to be paid to Medicaid.
For more information on Medicaid liens against civil judgments contact The Law Office of David M. Goldman PLLC today at 904-685-1200.