U.S. Supreme Court sides with Florida government agency against family in Medicaid dispute

Pillars at the United States Supreme Court. (Zach Camp on Unsplash)

Nearly 14 years after a Lee County girl was catastrophically injured when she was hit by a truck, the U.S. Supreme Court on Monday ruled Florida’s Medicaid program could recover some of the money. money he had paid for his initial care.

The judges, in a 7-2 opinion, sided with the Florida Agency for Health Care Administration in a case that has caught the attention of officials across the country.

The dispute stems from a November 2008 crash in which Gianinna Gallardo was hit by a truck after getting off a Lee County school bus. Florida’s Medicaid program paid $862,688 to cover initial medical costs for Gallardo, who was 13 at the time of the crash and remains in a “persistent vegetative state,” according to the Supreme Court’s ruling.

Gallardo’s parents sued the owner of the truck, its driver and the Lee County School Board and reached an $800,000 settlement. The settlement designated $35,367 for “past” medical expenses, with an unspecified amount earmarked for “future” medical expenses, according to the opinion written by Judge Clarence Thomas.

Citing a formula in state law, the Agency for Health Care Administration, which administers most of Florida’s Medicaid program, said it was entitled to recoup $300,000 from the settlement. of $800,000. But attorneys for the Gallardo family have argued that the state should not be able to recoup the money for future medical expenses.

The Supreme Court, however, upheld a decision of the 11th U.S. Circuit Court of Appeals that upheld the state.

“Under (a section of federal law), Florida may seek reimbursement of settlement amounts representing ‘payment for medical care,’ past or future,” Thomas wrote in a 16-page opinion joined by the judge. Chief John Roberts and Justices Samuel Alito, Elena Kagan, Neil Gorsuch, Brett Kavanaugh and Amy Coney Barrett.

But Justice Sonia Sotomayor, in a dissent joined by Justice Stephen Breyer, wrote that the majority opinion “is inconsistent with the structure of the Medicaid program and will cause unnecessary injustice and disruption.” Sotomayor also wrote that Medicaid “is not a loan.”

“If a Medicaid beneficiary’s financial situation changes and a beneficiary gains the ability to pay their own medical expenses, the beneficiary is not obligated to reimburse the state for past expenses, regardless of the magnitude of the change in circumstances,” the dissent said. said. “Rather, the ordinary consequence is that the individual simply becomes ineligible for benefits in the future.”

Gallardo continued to receive Medicaid benefits. Sotomayor wrote that the money from the legal settlement was placed in what is called a “special needs trust,” which can pay for expenses not covered by Medicaid.

The US Department of Justice aligned with the Gallardo family on the Supreme Court, while 14 states and groups such as the National Conference of State Legislatures supported the Agency for Health Care Administration.

–Jim Saunders, Florida Press Service