Dillard v. Agency for Health Care Admin., Dep't of Juvenile Justice, Prison Health Servs., Inc.

• Court: Florida District Court of Appeals
• Writing for the Court: KHOUZAM
• Citation: Dillard v. Agency for Health Care Admin., 127 So.3d 820 (Fla. App. 2013)
• Decision Date: 27 November 2013
• Docket Number: No. 2D12–2654.,2D12–2654.
• Parties: Candy DILLARD, Individually and as Mother and Next Friend of Reuben Fife, Jr., Appellant, v. AGENCY FOR HEALTH CARE ADMINISTRATION, Department of Juvenile Justice, Prison Health Services, Inc., and Kevin Rambosk, in his official capacity as Sheriff of Collier County, Florida., Appellees.

127 So.3d 820

Candy DILLARD, Individually and as Mother and Next Friend of Reuben Fife, Jr., Appellant,

v.AGENCY FOR HEALTH CARE ADMINISTRATION, Department of Juvenile Justice, Prison Health Services, Inc., and Kevin Rambosk, in his official capacity as Sheriff of Collier County, Florida., Appellees.

No. 2D12–2654.

District Court of Appeal of Florida, Second District.

Nov. 27, 2013.

Richard K. Slinkman of Slinkman & Slinkman, P.A., Jupiter, for Appellant.

James H.K. Bruner, Sr., and Adam J. Stallard, Tallahassee, for Appellee Agency for Health Care Administration.

No appearance for remaining Appellees.

KHOUZAM, Judge.

Reuben Fife, Jr., was catastrophically injured when he overdosed on cocaine shortly after he was taken into custody at a juvenile detention center. Candy Dillard, Fife's mother, filed suit on Fife's behalf against the Sheriff of Collier County, the Department of Juvenile Justice, and Prison Health Services, claiming that he had been denied appropriate medical attention at the detention center. The suit settled, and because Fife had received and continues to receive Medicaid benefits to cover his medical costs, the Agency for Health Care Administration (AHCA), which administers Florida's Medicaid program, asserted its right to be reimbursed from the settlement. Dillard moved to reduce the Medicaid lien, and the circuit court denied her motion. Dillard appeals the denial. We reverse and remand because, although the trial court's order was well reasoned and appears to have been legally accurate when issued, it relied on case law that has since been overturned.

In the trial court, AHCA argued that it was entitled to be reimbursed in the amount produced by applying the formula set out in section 409.910(11)(f), Florida Statutes (2011), to the entire settlement. According to AHCA, this amount represented the past medical expenses portion of the settlement. ¹ Dillard, on the other hand, contended that the AHCA was only entitled to apply the statutory formula to the portion of the settlement already allocated to past medical expenses because 42 U.S.C. § 1396p(a)(1) (2012), the anti-lien provision of the Federal Medicaid law, prohibits the encumbrance or attachment of proceeds related to damages other than medical costs. Dillard relied on the United States Supreme Court's decision in Arkansas Department of Health & Human Services v. Ahlborn, 547 U.S. 268, 126 S.Ct. 1752, 164 L.Ed.2d 459 (2006).² The trial court found that section 409.910(11)(f) was not preempted by the Federal Medicaid law, citing Russell v. Agency for Health Care Administration, 23 So.3d 1266 (Fla. 2d DCA 2010), in which this court held that it was appropriate to apply the statutory formula to an entire settlement in the absence of evidence that the Medicaid lien extended beyond the portion of the settlement meant to cover medical damages.

But during the pendency of this appeal, the United States Supreme Court issued Wos v. E.M.A. ex rel. Johnson, ––– U.S. ––––, 133 S.Ct. 1391, 185 L.Ed.2d 471 (2013), and this court applied Wos to section 409.910(11)(f) in Agency for Health Care Administration v. Riley, 119 So.3d 514 (Fla. 2d DCA 2013), holding that Russell is no longer good law. In Wos, the Court held that an “irrebuttable, one-size-fits-all statutory presumption is incompatible with the Medicaid Act's clear mandate that a State may not demand any portion of a beneficiary's tort recovery except the share that is attributable to medical expenses.” 133 S.Ct. at 1399. The Court suggested that a State could remedy this problem by providing a process for determining which portion of the recovery is attributable to medical expenses. Id. at 1401–02.

In Riley, this court held that the statutory allocation in section 409.910(11)(f) should be treated as a default allocation and that the plaintiff must be given an opportunity to rebut it. The court clarified that “ ‘a plaintiff should be afforded an opportunity to seek the reduction of a Medicaid lien amount established by the statutory default allocation by demonstrating, with evidence, that the lien amount exceeds the amount recovered for medical expenses.’ ” Riley, 119 So.3d at 516 (quoting Roberts v. Albertson's Inc., 119 So.3d 457, 466 (Fla. 4th DCA 2012)). Accordingly, though we recognize that the trial court may ultimately deny Dillard's motion to reduce lien again on remand, we must reverse and remand for this issue to be newly decided at a supplemental hearing at which the...