Davis v. Roberts
130 So. 3d 264
Fla. Dist. Ct. App.2013Background
- Nine-year-old Hunter Davis was severely injured in a crash; Medicaid (AHCA) paid $282,928.87 and the Florida DOH paid $6,340; total past-medical liens = $289,268.87.
- The parties settled Hunter’s individual claim for $1,000,000; the settlement allocated 10% of total damages to past medical expenses, i.e., $23,926.88 to medical expenses and $976,073.12 to other damages.
- AHCA agreed to the settlement amount but objected to the allocation and demanded full repayment of its Medicaid lien under Fla. Stat. § 409.910(11)(f), which provides a statutory formula for recovery.
- The trial court held it was bound by § 409.910(11)(f) and awarded AHCA the full lien, concluding it lacked discretion to reduce recovery despite findings that the settlement and allocation were fair.
- On appeal, the court considered whether § 409.910(11)(f)’s statutory allocation is mandatory or a rebuttable default and whether a recipient may present evidence to limit AHCA’s recovery to the portion of the settlement attributable to medical expenses.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether § 409.910(11)(f) requires full repayment to AHCA regardless of a settlement's allocation | Appellants: statute should not override federal anti-lien limits; trial court may limit AHCA to amount actually allocated to medical expenses | AHCA: statute is mandatory and precludes courts from considering evidence that less of the settlement represents medical expenses | The statutory formula is a default allocation; it cannot be applied in an irrebuttable way to recover more than the portion of a settlement allocable to medical expenses under federal law |
| Whether a Medicaid recipient may present evidence to reduce the AHCA lien below the statutory allocation | Appellants: recipient must be allowed to prove by evidence that the lien exceeds the medical-expense portion of recovery | AHCA: recipient has no right to prove a smaller medical allocation; only statutory formula applies | Recipient is entitled to an evidentiary hearing to rebut the statutory default and show the lien exceeds medical-expense recovery |
| Whether the trial court had discretion to reduce the lien after finding the settlement/allocation fair | Appellants: trial court has authority to bind AHCA and reduce lien when supported by evidence | AHCA: trial court was bound by § 409.910 and lacked discretion | Trial court erred in believing it was without discretion; remand for supplemental evidentiary hearing to allow proof and judicial allocation |
Key Cases Cited
- Arkansas Dep’t of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (Establishes that Medicaid may recover only the portion of a tort recovery allocable to medical expenses)
- Wos v. E.M.A. ex rel. Johnson, 133 S. Ct. 1391 (Clarifies that statutory presumptions that recover more than medical-allocable portions violate Medicaid anti-lien rules and that judicial allocations/bindings preclude recovery beyond medical portion)
- Smith v. Agency for Health Care Admin., 24 So.3d 590 (Fla. 5th DCA 2009) (Held § 409.910 formula applies when no allocation or evidence is offered; recipient must be allowed to present evidence to reduce lien)
- Roberts v. Albertson’s, Inc., 119 So.3d 457 (Fla. 4th DCA 2012) (Statutory allocation is a rebuttable default; recipient may seek judicial determination of portion allocable to medical expenses)
- E.M.A. v. Cansler, 674 F.3d 290 (4th Cir. 2012) (Federal appellate discussion leading to Wos, describing conflicts between state statutory caps and Medicaid anti-lien requirements)