199 So. 3d 286
Fla. Dist. Ct. App.2015Background
- LSF is court-appointed guardian for the person and property of ward Larry Perón, who lives in a nursing facility under Medicaid ICP.
- Perón’s income supports his care; ICP covers the balance after his patient responsibility payment.
- LSF sought deduction of a $200 monthly guardian fee from Perón’s income, as part of determining patient responsibility.
- Department denied the deduction, concluding guardian services were not medically necessary under Florida law.
- Hearing officer upheld the Department’s denial; this appeal challenges the decision as to medical necessity and eligibility for the deduction.
- Court affirms, holding guardian fees are not medically necessary under the statute and federal rules guiding Medicaid deductions, and notes a potential legislative gap.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether guardian fees are deductible as medical/remedial care under Medicaid. | LSF argues guardian services are medically necessary. | Department contends guardian fees are not medically necessary per statute and rule. | Guardian fees are not deductible; affirmed. |
Key Cases Cited
- GTC, Inc. v. Edgar, 967 So.2d 781 (Fla. 2007) (agency interpretation of medical necessity sustained)
- Wise v. Dep’t of Mgmt. Servs., Div. of Ret., 930 So.2d 867 (Fla. 2d DCA 2006) (reviews agency decisions de novo but defer to statutory interpretation)
- Level 3 Commc’ns, LLC v. Jacobs, 841 So.2d 447 (Fla. 2003) (deference to agency interpretation unless clearly unauthorized or erroneous)