Kaitlyn Harrell, a minor, individually etc. v. State of Florida, Agency for Health Care Admin.
143 So. 3d 478
Fla. Dist. Ct. App.2014Background
- Kaitlyn Harrell suffered birth-related injuries; AHCA Medicaid paid $360,741.48 for Kaitlyn's care and asserted a lien for that amount from the settlement.
- Harrells petitioned to determine the Medicaid lien amount under §409.910(11)(f), contending the Ahlborn decision preempts the statutory formula and allows recovery only of medical expenses proportionate to the settlement.
- AHCA urged the statutory formula was mandatory, entitling full lien recovery; relied on Russell v. AHCA.
- Trial court ruled for AHCA, indicating it was bound to apply the statutory formula and could not consider evidence challenging the lien.
- On appeal, Florida First District receded from prior Hickcox-based reasoning, adopting Riley’s approach that a plaintiff may present evidence to rebut the lien amount; remanded to consider the evidence and determine the proper lien amount consistent with federal law.
- The Wos v. E.M.A. decision held that a state may not recover beyond medical expenses from a tort recovery, preempting irrebuttable, one-size-fits-all statutory presumptions and supporting the need to reassess the lien on remand.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Preemption of §409.910(11)(f) by the federal Medicaid Act. | Harrells argue Ahlborn/Wos require reducing the lien to match medical expenses proportion. | AHCA argues the formula is mandatory and permits full lien recovery. | Lien preemption recognized; require consideration of evidence to adjust lien on remand. |
| Right to challenge the lien amount with evidence. | Harrells entitled to present evidence that lien exceeds medical expenses. | AHCA argues no qualifying exception to the statutory amount. | Remand permitted; court must assess evidence and adjust lien accordingly. |
Key Cases Cited
- Wos v. E.M.A., 133 S. Ct. 1391 (2013) (federal preemption of irrebuttable lien presumptions; no recovery beyond medical expenses allowed)
- Riley v. Agency for Health Care Admin., 119 So. 3d 514 (Fla. 2d DCA 2013) (adopts Albertson’s approach; allows rebuttal to lien amount)
- Davis v. Roberts, 130 So. 3d 264 (Fla. 5th DCA 2013) (statutory formula not mandatory; opportunity to rebut lien)
- Williams v. Agency for Health Care Admin., 127 So. 3d 854 (Fla. 4th DCA 2013) (similar holding on rebuttal to lien amount)
- Russell v. Agency for Health Care Administration, 23 So. 3d 1266 (Fla. 2d DCA 2010) (earlier view supporting full statutory lien)
- Storey ex rel. Storey v. Hickcox, 44 So. 3d 600 (Fla. 1st DCA 2010) (prior framework relying on Russell; receded in light of Wos)