Amendment to Florida’s Medicaid Third-Party Liability Act


Effective July 1, 2013, Florida’s amended Medicaid Third-Party Liability Act, Fla.Stat. §409.910(17), et. seq., now provides a procedural mechanism for Medicaid beneficiaries to challenge their responsibility for reimbursement to the Florida Agency for Healthcare Administration after receiving payments from liable third parties.  Beneficiaries must file a petition for administrative hearing with the Division of Administrative Hearings in Tallahassee, Fla., and prove by clear and convincing evidence that a lesser portion of the total recovery should be allocated as reimbursement for medical expenses than the amount asserted by the agency.  Fla.Stat. §409.910(17)(a)(1).  The new statutory procedure is the “[e]xclusive method for challenging the amount of third-party benefits payable to the agency,” Fla.Stat. §409.910(17)(a), and the beneficiary bears its own fees and costs for any such administrative proceeding.  Fla.Stat. §409.910(17)(a)(4). 


The amendment is in response to the U.S. Supreme Court’s decision in Wos v. E.M.A. ex rel. Johnson, 133 S.Ct. 1391 (2013), holding a North Carolina statute unconstitutional where it required up to one-third of any damages recovered by a Medicaid beneficiary for a tortious injury to be paid to the state as reimbursement for payments it made for medical treatment on account of the injury.  Citing its prior decision in Arkansas Dept. of Health and Human Servs. v. Ahlborn, 547 U. S. 268, 284, the Court in Wos held that the statute violated the federal Medicaid statute’s anti-lien provision, 42 U.S.C. §1396p(a)(1), which preempts a state’s effort to take any portion of a Medicaid beneficiary’s tort judgment or settlement not designated as payments for medical care. The North Carolina statute had the potential effect of requiring a beneficiary to pay the state settlement money intended for non-medical items, such as pain and suffering, in the event the recipient entered into an undifferentiated settlement with a liable party.  The former version of Florida’s Medicaid Third-Party Liability Act similarly required reimbursement without regard to whether compensation was intended for medical expenses and, consequently, was unlikely to withstand constitutional scrutiny.