Justia Summary

Gallardo suffered catastrophic injuries resulting in permanent disability when a truck struck her as she stepped off her Florida school bus. Florida’s Medicaid agency paid $862,688.77 to cover Gallardo’s initial medical expenses and continues to pay her medical expenses. Gallardo’s suit against the truck’s owner and the School Board resulted in an $800,000 settlement, with $35,367.52 designated as compensation for past medical expenses. The settlement did not specifically allocate any amount for future medical expenses.

The Medicaid Act requires participating states to pay for certain individuals’ medical costs and to make reasonable efforts to recoup those costs from liable third parties, 42 U.S.C. 1396k(a)(1)(A). Under Florida’s Medicaid Third-Party Liability Act, a beneficiary who accepts medical assistance from Medicaid automatically assigns to the state any right to third-party payments for medical care; Florida was entitled to $300,000–presumptively representing the portion of the recovery that is for past and future medical expenses.

The Supreme Court affirmed the Eleventh Circuit. The Medicaid Act permits a state to seek reimbursement from settlement payments allocated for future medical care. The Act’s anti-lien provision, prohibiting states from recovering medical payments from a beneficiary’s “property,” does not foreclose recovery from settlement amounts other than those allocated for past medical care paid for by Medicaid. Florida’s statute is expressly authorized by section 1396k(a) and is within the recognized exception to the anti-lien provision. The relevant distinction is between medical and nonmedical expenses, not between past and future medical expenses. Section 1396k(a)(1)(A) does not authorize a “lifetime assignment” covering any rights acquired in the future but covers only rights the individual possesses while on Medicaid.