Any recent interesting Supreme Court decisions?
July 1, 2022 | View PDF
Yes, one in particular concerned a then 13-year-old school girl who stepped off a school bus in Florida and was struck by a truck in 2008. The young girl now 14 years older is in a permanent vegetative state. The case is SUPREME COURT OF THE UNITED STATES No. 20–1263, GIANINNA GALLARDO, AN INCAPACITATED PERSON, BYAND THROUGH HER PARENTS AND CO- GUARDIANS PILAR VASSALLO AND WALTER GALLARDO, PETITIONER v. SIMONE MARSTILLER, IN HER OFFICIAL CAPACITY AS SECRETARY OF THE FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION. The majority opinion was written by Justice Clarence Thomas.
After WellCare of Florida paid almost $21,500.00 towards her care, Florida Medicaid paid almost $863,000.00. Gallardo had assigned her right to recover from third parties as a condition of receiving Florida Medicaid. The parents sued the truck owner and the Lee County School Board for $20 million. It was settled on for $800,000.00. Florida Medicaid was entitled to a 4% recovery of that amount for past medical expenses. The settlement also included language that some of the settlement would be assigned to future medical expenses.
Florida’s statutory formula meant that Florida was entitled to $300,000.00 of the settlement. The settlement however explicitly allocated just over $35,000.00 to Florida. $300,000.00 was placed into escrow and the presumed allocation was challenged. Florida defended the presumed allocation stating that the statutory allocation would be for past and future medical expenses. In the meantime Gallardo sought a declaration that Florida was violating the Medicaid Act by trying to recover from the settlement for future medical expenses.
The Eleventh Circuit had previously ruled that a state is not prohibited from recovering future medical expenses.
The Writ of Certiorari was granted by the United States Supreme Court because the Supreme Court of Florida and the Eleventh Circuit had reached opposite conclusions. Gallardo argued that the Eleventh Circuit had erred because the Medicaid anti-lien provision “forecloses recovery from settlement amounts other than those allocated for past medical care paid for by Medicaid.”
The Supreme Court of the United States agreed to hear the case. Justice Thomas wrote, “The plain text of §1396k(a)(1)(A) decides this case. This provision requires the State to acquire from each Medicaid beneficiary an assignment of “any rights . . . of the individual ... to support ... for the purpose of medical care ... and to payment for medical care from any third party.” §1396k(a)(1)(A). Nothing in this provision purports to limit a beneficiary’s assignment to “payment for” past “medical care” already paid for by Medicaid. To the contrary, the grant of “any rights . . . to payment for medical care” most naturally covers not only rights to payment for past medical expenses, but also rights to payment for future medical expenses”. Furthermore, Justice Thomas said, “The plain text of §1396k(a)(1)(A) decides this case. This provision requires the State to acquire from each Medicaid beneficiary an assignment of “any rights . . . of the individual ... to support ... for the purpose of medical care ... and to payment for medical care from any third party.” §1396k(a)(1)(A). Nothing in this provision purports to limit a beneficiary’s assignment to “payment for” past “medical care” already paid for by Medicaid. To the contrary, the grant of “any rights . . . to payment for medical care” most naturally covers not only rights to payment for past medical expenses, but also rights to payment for future medical expenses.”
Medicaid, aside from being a program for the poor is also a financially poor program because of all that it does. In Alabama, Medicaid pays for more than seventy percent (70%) of all residents in the nursing homes. Alabama residents using Medicaid that acquire too many assets, can lose their Medicaid benefits until they can spend down and/ or pay penalties and again be eligible. A few years ago Alabama began to try and recover from the estates of decedents having their estates probated. Obviously in the case of a deceased person all medical expenses are past but any recovery that may be possible may help the program since Alabama can be entitled up to the amount previously expended by Medicaid on a decedent during their life.
Considering the above, I understand why Florida would seek the repayment of third parties to a beneficiary regardless of whether it has been paid or is expected to be paid.
This article is informative only and not meant to be all inclusive. Additionally this article does not serve as legal advice to the reader and does not constitute an attorney-client relationship. The reader should seek counsel from their attorney should any questions exist. ”No representation is made that the quality of legal services performed is greater than the quality of legal services performed by other lawyers.” As always if you do not have an attorney, ask a trusted friend or family member or contact the Alabama State Bar, Lawyer Referral service.