High Court Wrestles With Florida Medicaid Clawback Dispute
A case before the U.S. Supreme Court questioned whether a state can be reimbursed for prior medical treatment by clawing back funds received by a Medicaid recipient in a personal injury lawsuit for future medical costs. In the case of Gallardo v. Marstiller, the justices debated how broad or limiting some provisions of the Medicaid Act are. Gianinna Gallardo has been in a vegetative state since she was hit by a truck while getting off a school bus in 2008. A lawsuit against the owner of the truck, the driver, and the school board for past medical expenses, plus future medical expenses, lost earnings, and other damages, was settled for $800,000. However, a lien from the Florida Agency for Healthcare Administration said the agency was entitled to $300,000 from the settlement because it paid more than $862,000 for Gallardo's previous medical treatment. A key issue being debated is whether the state's recoveries are limited to the funds allocated in the settlement for prior medical care. While Florida argued that the Medicaid Act requires states to seek reimbursement from third parties that are liable for a Medicaid beneficiary's care, it and some other states have legislation that permit them to recover past payments for a beneficiary from parts of a settlement for both past and future medical costs. Gallardo's parents asserted the Act supersedes state law, so Florida can only ask for reimbursement for settlement amounts attributable to previous, not future, care. As such, they said, the state is only entitled to the $35,000 allocated in the settlement for previous medical costs.
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