Estate of Hernandez v. Agency for Health Care Administration
190 So. 3d 139
Fla. Dist. Ct. App.2016Background
- Decedent Betsy Hernandez died; Estate settled wrongful-death claims with Baptist Hospital for $700,000 (settlement did not allocate damages among survivors, estate, or medical expenses).
- Florida Medicaid (Agency for Health Care Administration) had paid $409,676.36 for Hernandez’s care and asserted an automatic lien on settlement “collateral” under Florida’s Medicaid Third-Party Liability Act, § 409.910, Fla. Stat.
- Estate petitioned probate court to allocate $500,000 to survivors’ wrongful-death damages and $200,000 to estate (to cover Medicaid lien and economic damages); Agency sought $262,500 under the Act’s statutory formula.
- Estate argued federal Medicaid anti-lien provision (42 U.S.C. § 1396p(a)(1)) and U.S. Supreme Court precedent (Ahlborn, Wos) preempt Florida law and require an evidentiary hearing to identify the portion of the settlement attributable to medical expenses.
- Trial court applied Florida’s statutory formula and ordered $262,500 paid to the Agency; on appeal the estate relied on Ahlborn/Wos/Garcon; the district court affirmed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether federal Medicaid anti-lien doctrine (Ahlborn/Wos) preempts Florida’s Medicaid Third-Party Liability Act for wrongful-death settlements of a deceased recipient | Estate: Ahlborn/Wos/Garcon require evidentiary hearing and bar liens on portions of recovery not allocated to medical expenses | Agency: Anti-lien provision applies only to living recipients; Wos/Ahlborn do not apply to wrongful-death liens | Court: Anti-lien provision applies only pre-death; no federal preemption—Florida Act governs wrongful-death liens |
| Whether Florida’s Wrongful Death Act prevents the Agency from attaching its Medicaid lien to amounts allocable to survivors | Estate: Wrongful Death Act treats survivors’ damages separately and bars Medicaid from taking survivors’ shares | Agency: Medicaid Third-Party Liability Act gives Agency priority/subrogation and requires repayment before apportionment | Court: Medicaid Act’s plain language and controlling Florida cases require satisfaction of Medicaid lien prior to apportionment; survivors’ allocations do not defeat Agency lien |
Key Cases Cited
- Arkansas Dep’t of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (holding federal Medicaid anti-lien bars state lien on portions of beneficiary's recovery not allocated to medical expenses)
- Garcon v. Florida Agency for Health Care Administration, 150 So. 3d 1101 (Fla. 2014) (Florida Supreme Court recognizing Wos’s applicability and remanding for Wos-consistent proceedings)
- Ross v. Agency for Health Care Administration, 947 So. 2d 457 (Fla. 3d DCA 2006) (holding Agency must be paid in accordance with Florida Medicaid Third-Party Liability Act before wrongful-death apportionment)
- Strafford v. Agency for Health Care Administration, 915 So. 2d 643 (Fla. 2d DCA 2005) (same)
- Englich v. Agency for Healthcare Administration, 916 So. 2d 994 (Fla. 4th DCA 2005) (same)