ANA ROSS, ETC., APPELLANT,
v.
AGENCY FOR HEALTH CARE ADMINISTRATION, APPELLEE
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Ana Ross, as personal representative of her deceased husband's estate, appealed a trial court decision requiring full reimbursement of Medicaid expenses from settlement proceeds. The Florida appellate court affirmed that the Agency for Health Care Administration is entitled to receive the full amount of medical expenses it paid, regardless of the personal representative's attempt to allocate only 25% of the lien.
The personal representative does not have the right to allocate settlement funds such that the Agency receives less than the full amount of its Medicaid expenditures. The trial court properly ordered payment of the full amount of the Medicaid lien ($168,691.58) to the Agency.
[1] A state agency that pays medical expenses under Medicaid has an automatic lien for the full amount of those expenses against any settlement proceeds recovered from a liab…
[2] A personal representative of an estate cannot allocate settlement funds in a manner that results in the state agency receiving less than the full amount of its Medicaid e…
Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.
Join FLexlaw to unlock all legal intelligence“Contrary to the personal representative's contention, she does not have the right to allocate the settlement funds in such a manner that the Agency receives less than the full amount of its expenditures for medical assistance.”
Establishes the core holding that the personal representative cannot reduce the Agency's recovery through unilateral allocation of settlement proceeds.
Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.
Join FLexlaw to unlock all legal intelligenceAlexander Ross died from injuries sustained in a two-car collision caused by Richard Rebollida, an employee of Equity Financial Corporation. Medicaid …
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FLETCHER, Judge.
Ana Ross is the personal representative of the estate of her husband Alexander Ross who sustained fatal injuries in a two-car collision with a car driven by Richard Rebollida, an employee of Equity Financial Corporation. Alexander Ross remained in a coma for several weeks before he died from his injuries.
Pursuant to Florida’s participation in the Medicaid program, the Agency for Health Care Administration [Agency] paid $168,691.58 of Alexander Ross’ medical expenses. In return, the Agency received an automatic lien for the full amount of the medical expenses paid on behalf of Alexander Ross, as provided by Section 409.910(6)(c), Florida Statutes (2002). The Agency filed its lien with the court, putting the personal representative, Ana Ross, on notice of the state’s right to full compensation for the medical expenses it paid on behalf of the decedent, Alexander Ross.
During this time the personal representative brought a wrongful death action against Richard Rebollida and Equity Financial Corporation, which action she settled with the employer for $900,000. The decedent’s uninsured/underinsured policy provided an additional $25,000.
Having received $925,000 in settlement proceeds the personal representative attempted to allocate the sum among the survivors, the attorneys and the Agency, allocating for the Agency an amount that satisfied just 25% of the total Medicaid lien. The trial court granted the allocation with the exception that the court ordered payment to the Agency of the full amount of the Medicaid lien of $168,691.58. This appeal followed.
Contrary to the personal representative’s contention, she does not have the right to allocate the settlement funds in such a manner that the Agency receives less than the full amount of its expenditures for medical assistance. Strafford v. Agency for Health Care Admin., 915 So. 2d 643 (Fla. 2d DCA 2005) (“Following a settlement, the court is required to segregate an amount sufficient to repay the Agency’s expenditures for medical assistance and shall order this amount to be paid directly to the Agency.”). The Wrongful Death Act does not alter this requirement. Englich v. Agency for Healthcare Admin., 916 So. 2d 994 (Fla. 4th DCA 2005).1
Accordingly the trial court’s allocation order is affirmed.
. We note that pursuant to Section 409.910(1 l)(f)(l), Florida Statutes (2002), Medicaid is to be fully reimbursed unless full reimbursement would take away more than half of a third party benefit. Such is not the case here.
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The Est. OF Betsy Gladis Hernandez v. Agency for Health Care Admin., 190 So. 3d 139 (Fla. 3d DCA 2016)…s interpreting its provisions, the trial court correctly denied the plaintiffs request to reduce the Medicaid lien proportionately to the amount the survivors’ recovery bore to their total claim.”). In Ross v. Agency for Health Care Administration, 947 So. 2d 457 (Fla. 3d DCA 2006), this court expressly adopted the reasoning of Strafford and Englich. Like Englich and Strafford, Ross involved an estate’s personal representative seeking to allocate wrongful death settlement proceeds among the survivors and the…
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Authorities Cited
- Englich v. Agency for Healthcare Admin., 916 So. 2d 994 (Fla. 4th DCA 2005)
- Strafford v. Agency for Health Care Admin., 915 So. 2d 643 (Fla. 2d DCA 2005)