GIRALDO V. AHCA: HOW WILL IT AFFECT YOUR CASE?

Serving nearby areas by Palm Beach and West Palm Beach, Florida

GIRALDO V. AHCA: HOW WILL IT AFFECT YOUR CASE?

The Supreme Court of Florida set forth their decision in Giraldo v. Agency for Health Care Administration on July 5, 2018 which answered the question of whether the Agency for Healthcare Administration (AHCA) can place a lien on the future medical expenses portion of a Florida Medicaid recipient’s tort recovery. The Court held that ACHA may only satisfy their Medicaid lien by reaching only the past medical expenses of a Medicaid recipient’s tort recovery – a big win for Florida Medicaid recipient plaintiffs.

So, what does that mean for you and your case?

If you are Medicaid recipient and receive a tort recovery, Medicaid is entitled to essentially be repaid for any benefits paid out on your behalf for medical care and treatment as is related to the subject tort. This new decision from our Florida Supreme Court makes it so that this lien only attaches to that portion of your recovery which is deemed for past medical expenses, and does not attach to settlement funds that are allocated to future medical expenses.

For example, in the case of Giraldo, the plaintiff suffered severe injuries as a result of an ATV accident and Florida Medicaid (which is administered by AHCA) paid $322,222.27 for his medical care and the lien was calculated to be $321,720.16. The plaintiff’s claim was settled as against one defendant for $1 million. In appealing the amount of the lien, the plaintiff established that only $13,881.79 of the $1 million settlement represented compensation for past medical expenses. Since the Florida Supreme Court held that AHCA cannot place a lien on future medical expenses, the total lien amount originally calculated as $321,720.16, was reduced to a lien amount of $13,881.79, the amount of the past medical bills. This essentially allowed the plaintiff in that case to enjoy the benefit of an additional $307,838.37 of his recovery.  

This new ruling, fresh off the press from the Florida Supreme Court, means you (if you are a Medicaid recipient) could potentially have to pay back much less to satisfy your Medicaid lien, therefore allowing you to benefit from more of your tort recovery to compensate you for your loss, pain and suffering, and future medical care. Of course there is a process by which you have to undertake in order to appeal the lien amount through Florida Medicaid/AHCA, but we as experienced Florida tort attorneys will represent you in that process.

Overall, this decision by the Florida Supreme Court is very beneficial to the Medicaid recipient who has a Florida tort claim.  

 

Source: Maria Isabel Giraldo, et al., v. Agency for Health Care Administration, SC17-97 (Fla. July 5, 2018).

By Hali Marsocci