SCOTUS Gallardo Decision May Reshape Medicaid Law
In a decision on 06/06/2022, the Supreme Court of the Unites States (SCOTUS) decided that Florida’s Medicaid agency may “seek reimbursement from settlement payments allocated for future medical care”.
This decision may allow States to amend their Medicaid statutes to recover future medical expenses from personal injury cases similar to Medicare. We are prepared to assist our clients with any Medicaid Set Aside allocation requests to reimburse them for past or future accident-related medical care.
As described in the opinion, petitioner Gianinna Gallardo suffered catastrophic injuries resulting in permanent disability when a truck struck her as she stepped off her Florida school bus. Florida’s Medicaid agency paid $862,688.77 to cover Gallardo’s initial medical expenses, and the agency continues to pay her medical expenses. Gallardo, through her parents, sued the truck’s owner and driver, as well as the Lee County School Board. She sought compensation for past medical expenses, future medical expenses, lost earnings, and other damages. That litigation resulted in a settlement for $800,000, with $35,367.52 expressly designated as compensation for past medical expenses. The settlement did not specifically allocate any amount for future medical expenses.
The Medicaid Act requires participating States to pay for certain needy individuals’ medical costs and then to make reasonable efforts to recoup those costs from liable third parties. 42 U. S. C. §1396k(a)(1)(A).
Under Florida’s Medicaid Third-Party Liability Act, a beneficiary like Gallardo who “accept[s] medical assistance” from Medicaid “automatically assigns to the [state] agency any right” to third-party payments for medical care. Fla. Stat. §409.910(6)(b).
Applied to Gallardo’s settlement, Florida’s statutory framework entitled the State to $300,000—i.e., 37.5% of $800,000, the percentage the statute sets as presumptively representing the portion of the tort recovery that is for “past and future medical expenses,” absent clear and convincing rebuttal evidence. §§409.910(11)(f )(1), (17)(b). Gallardo challenged the presumptive allocation in an administrative proceeding.
For a full reading of this important decision, click here >>