A Florida district court refuses to re-litigate its decision prohibiting the state of Florida from seeking reimbursements for Medicaid payments it made on a recipient’s behalf from portions of the recipient’s personal injury settlement that are allocated to future medical expenses, but the court clarifies that the recipient must overcome the state’s formula-based allocation with clear and convincing evidence. Gallardo v. Senior (U.S. Dist. Ct., N.D. Fla., No. 4:16cv116-MW/CAS, July 18, 2017).

Thirteen-year-old Gianinna Gallardo was struck by a vehicle and seriously injured. Her parents sued the parties responsible, and the case eventually settled for $800,000, or about 4 percent of the case’s $20 million value. Because Medicaid had provided $862,688.77 in medical payments on Gianinna’s behalf, her attorney advised Florida’s Agency for Health Care Administration (AHCA) of the settlement. The attorney also advised the agency that $35,367.52 of the settlement represented past medical expenses that were recoverable by AHCA. Under Florida’s formula for determining the agency’s reimbursement, the agency would recover $323,508.29 in medical payments from Gianinna’s settlement.

Gianinna’s parents sued AHCA in federal court seeking an injunction and a declaration that Florida’s reimbursement statute violates federal law inasmuch as it allows the state to recover from the portion of her settlement beyond that allocable to past medical expenses. AHCA argued that it was entitled to satisfy its lien from the portion of the settlement representing compensation for both past and future medical expenses. The parties filed cross motions for summary judgment, and the district court granted the Gallardos’ motion for summary judgment. The court found that, consistent with the U.S. Supreme Court’s decision in Arkansas Department of Health and Human Services, et al. v. Ahlborn (547 U.S. 268 (2006)), AHCA is entitled to recover for past medical payments it made on Gianinna’s behalf only from that portion of the settlement allocated to past medical expenses. The agency hired a new lawyer and filed a motion to alter or amend the judgment.

The U.S. District Court, Northern District of Florida, denies AHCA’s motion, holding that the state is not entitled to a “re-do.” According to the court, the law does not “allow an unhappy litigant to repackage and relitigate previously decided issues or make new arguments that it wished it made in the first place.” The court amends its prior judgment to clarify that the prior judgment was not intended “to enjoin [the agency] from requiring a recipient to overcome the formula-based allocation with clear and evidence for that recipient to be successful.”

For the full text of this decision, go to: https://cases.justia.com/federal/district-courts/florida/flndce/4:2016cv00116/85090/59/0.pdf?ts=1500540195

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