STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, APPELLANT,
v.
MAJOR WILLIAMS, APPELLEE

Fla. 4th DCA | 2013-12-04
No. 4D12-1046
WARNER, STEVENSON and GERBER, JJ., concur.
127 So. 3d 854 Florida District Court of Appeal, Fourth District (2013) Positive Treatment
Cited by 4 cases
Topics
Federal Preemption Evidentiary Hearing

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Opinion of the Court
PER CURIAM.

*855PER CURIAM.

The Agency for Health Care Administration appeals an order limiting its Medicaid payments lien on appellee’s personal injury settlement to amounts allocated to medical expenses based upon an allocation formula asserted by appellee, rather than on the default allocation provision of section 409.910(ll)(f), Florida Statutes (2012). In Roberts v. Albertson’s Inc., 119 So.3d 457 (Fla. 4th DCA 2012), we recently addressed the precise issue of how the statutory provision should be applied. There we held that “a plaintiff should be afforded an opportunity to seek the reduction of a Medicaid lien amount established by the statutory default allocation by demonstrating, with evidence, that the lien amount exceeds the amount recovered for medical expenses.” Id. at 466. After our original opinion was issued, the U.S. Supreme Court held that state statutes containing default allocation formulas for Medicaid reimbursement are pre-empted by federal law to the extent that they can be categorized as conclusive presumptions. See Wos v. E.M.A. ex rel. Johnson, — U.S. —, 133 S.Ct. 1391, 1398, 185 L.Ed.2d 471 (2013). Roberts is consistent with Wos.

We reverse the trial court’s order, concluding that it did not hold an evidentiary hearing prior to adopting the allocation formula it used. Both Roberts and Wos emphasize the fact that the allocation must be based upon evidence.

Reversed and remanded for further proceedings.

WARNER, STEVENSON and GERBER, JJ., concur.

Cases With Similar Vibessemantic neighbors from the corpus

Citator

Cited By

  • Iala Suarez v. Port Charlotte HMA, LLC, 171 So. 3d 740 (Fla. 2d DCA 2015)
    …see also Garcon v. Fla. Agency for Health Care Admin., 150 So. 3d 1101, 1102 (Fla.2014); Harrell v. State, 143 So. 3d 478, 480 (Fla. 1st DCA 2014); Davis v. Roberts, 130 So. 3d 264, 269 (Fla. 5th DCA 2013); Agency for Health Care Admin, v. Williams, 127 So. 3d 854, 855 (Fla. 4th DCA 2013). Suarez should be given an opportunity to challenge the amount of the settlement allocated for recovered medical expense damages in the newly-adopted agency proceedings under section 490.910(17)(b). “[T]o render the mandamu…
  • Kaitlyn Harrell v. State, 143 So. 3d 478 (Fla. 1st DCA 2014)
    …ry formula in section 409.910(ll)(f) is not mandatory; parents of Medicaid recipient child were entitled to opportunity to demonstrate AHCA’s lien exceeded portion of settlement allocated to medical expenses); Ag. for Health Care Admin, v. Williams, 127 So. 3d 854 (Fla. 4th DCA 2013) (holding similarly). As the Fifth District recently noted, “Ahlbom and Wos make clear that section 409.910(ll)(f) is preempted by the federal Medicaid statute’s anti-lien provision to the extent it creates an irrebuttable presump…

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