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Medicaid Injury Case Heads To Supreme Court


The U.S. Supreme Court has agreed to hear a case involving personal injury lawsuits and Medicaid reimbursements. Essentially, if you accept government health insurance, you are required to pay a certain amount back to Medicaid if the case goes your way.

One case involving a 13-year-old victim will head to the SCOTUS after Medicaid sent the family a large bill that was to be taken from the settlement money. The family claimed that the money was earmarked for future medical expenses, and on that basis, claimed Medicaid had no right to the money. A circuit court agreed, but Medicaid appealed the verdict and will now attempt to extract an extra $300,000 from the settlement money—money that the victim says Medicaid can’t touch because Medicaid can only sue against past medical expenses.

On appeal, Medicaid won as the judge agreed that Medicaid is not prohibited from sending a bill against the family’s future medical expenses.

Florida law is once again creating confusion for the government.

Understanding the arguments 

Federal law prohibits states from collecting monies from future medical expenses after a personal injury lawsuit. Florida law has no such prohibition. The Florida SCOTUS has already ruled that federal law trumps state law in such matters, so what is holding up the decision? The decision rendered by the lower appellate court directly contradicts a 2018 ruling that found that federal law trumps state law in Medicaid matters.

The issue is, that just like in Florida, federal and state courts have differed on the standard. Now, the plaintiffs will have to defend their position that Medicaid is not entitled to recoup future medical expenses, and Medicaid will have to prove they do.

Will Medicaid win? 

While the law is important, sometimes pragmatics are more important, and the law gives due deference to the pragmatics of a situation regardless of what the law says. In this case, you have a 13-year-old victim who was getting Medicaid prior to the incident. The child is injured, Medicaid covers his expenses, and then tries to recover as much money as they can. Since Medicaid reimbursements operate on a formula, the question of what is considered the “the settlement” for the purposes of reimbursement are important. If “the settlement” is all the money the victim is awarded, then Medicaid can take whatever it wants. If “the settlement” only applies to funds earmarked for past medical expenses, then Medicaid must work with a smaller sum.

Regardless of what happens there, Medicaid will likely be paying for the child’s future medical expenses. Since Medicaid is likely to cover those expenses, future medical expenses are likely to find their way back into Medicaid’s coffers anyway. The plaintiffs will be in a position of defending why they need access to that money if Medicaid will eventually end up picking up the bill. If not, the pragmatics could fall to Medicaid’s side and issues related to jurisdiction could fall by the wayside.

Talk to a Miami Personal Injury Attorney 

Those injured by the negligence of a careless or malicious party are entitled to sue to recover damages related to their injuries. Call the Miami personal injury lawyers at Payer Law today to schedule a free consultation and learn more about how we can help.


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