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The Supreme Court ruled Monday that Florida’s Medicaid program can seek reimbursement from lawsuit settlement payments that are allocated for the future care of accident victims.
Justice Clarence Thomas authored a 7-2 opinion, which sided with the Florida Agency for Health Care Administration. The opinion was joined by Democratic-appointed Justice Elena Kagan, while Justice Sonia Sotomayor wrote a dissent joined by Justice Stephen Breyer.
Gianinna Gallardo was a 13-year-old living in Florida in 2008 when she was struck by a truck that catastrophically injured her and rendered her in a vegetative state. Florida’s Medicaid program paid over $862,000 for her care. Her parents later filed suit against the truck owner and were awarded $800,000 in damages.
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<mediadc-iframe data-state="{"cms.site.owner":{"_ref":"00000161-3486-d333-a9e9-76c6fbf30000","_type":"00000161-3461-dd66-ab67-fd6b93390000"},"cms.content.publishDate":1654539019089,"cms.content.publishUser":{"_ref":"00000177-1b39-d2c7-af7f-5fbf13ff0004","_type":"00000161-3461-dd66-ab67-fd6b933a0007"},"cms.content.updateDate":1654539019089,"cms.content.updateUser":{"_ref":"00000177-1b39-d2c7-af7f-5fbf13ff0004","_type":"00000161-3461-dd66-ab67-fd6b933a0007"},"iFrameEmbedCode":"","_id":"00000181-3a35-df81-a381-7a35c2820000","_type":"00000161-b425-d761-a563-f7e77e270000"}”>iFrame ObjectThe state of Florida filed a lien against Gallardo’s parents, claiming it was entitled to $300,000 of the settlement.
Federal Medicaid law imposes a requirement on states to pay the medical costs for individuals in need and have the ability to make reasonable efforts to recoup said costs, according to the majority opinion by Thomas.
“That assignment permits a state to seek reimbursement from the portion of a beneficiary’s private tort settlement that represents ‘payment for medical care,’” Thomas wrote, “despite the Medicaid Act’s general prohibition against seeking reimbursement from a beneficiary’s ‘property.’”
In Sotomayor’s dissent, she argued the majority opinion suffered inconsistencies from the “structure of the Medicaid program and will cause needless unfairness and disruption.”
Medicaid “is not a loan,” she contended, adding that if a beneficiary’s circumstances are changed and they gain the ability to pay for their own expenses, “the beneficiary is not obligated to repay the state for past expenses, no matter the magnitude of the change in circumstances.”
Sotomayor argued the solution is that “the individual simply becomes ineligible for benefits moving forward.”
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Since Gallardo’s accident nearly 14 years ago, she has continued to receive Medicaid benefits that went toward a ““special needs trust,” which can pay expenses not covered by Medicaid.
The Justice Department argued Gallardo’s family lawsuit was viable, while 14 states and groups including the National Conference of State Legislatures sided with Florida’s healthcare administration.
