Lien on Me (Part 2): How A Florida Medicaid Lien Can Impact Your Nursing Home, Assisted Living Facility, or Group Home Abuse, Neglect, or Wrongful Death Case

In Part 1 of the Lien on Me blog series, we discussed the impact of Medicare Liens on your abuse and neglect case. You can read that blog here. In this installment, we turn to Florida Medicaid liens and how they can impact recovery in a nursing home, assisted living facility, and group home abuse and neglect case.

Florida Medicaid Liens

Florida's Medicaid Third-Party Liability Act, Fla. Stat. § 409.910, et. seq., states that the Florida Agency for Health Care Administration (“the Agency”) has an “automatic lien for the full amount of medical assistance provided by Medicaid to or on behalf of the recipient for medical care furnished as a result of any covered injury or illness for which a third party is or may be liable…” See Fla. Stat. § 409.910(6)(c). The Agency carries out its lien enforcement functions through a contract with Health Management Systems, Inc. and its subcontractor, Conduent Payment Integrity Solutions. Because Medicaid is generally considered the payer of last resort, a Medicaid lien is usually considered a first lien, superior to all other liens. See Fla. Stat. § 409.910(1) and (6)(c)9.

Medicaid Estate Recovery Exceptions (In the Event of Death)

Florida law places limits on Medicaid estate recovery in cases involving a deceased recipient. Under Florida’s Medicaid Estate Recovery Act, Fla. Stat. § 409.9101, Medicaid generally seeks reimbursement from the estate of a deceased beneficiary. However, the statute provides that “[p]ayment of benefits to a person under the age of 55 years does not create a debt.” In practical terms, if a Medicaid recipient dies before age 55, Medicaid cannot assert an estate recovery claim based solely on benefits paid. This protection often arises in the group home context as group homes generally include a younger population of residents, compared to nursing homes or assisted living facilities.

Even when the recipient is over 55, estate recovery is not enforceable if the recipient is survived by a spouse, a child under the age of 21, or a child who is blind or permanently and totally disabled under federal Medicaid eligibility standards.

Importantly, these limitations apply only in the estate recovery context following death. If a Medicaid recipient suffers abuse or neglect but survives, Medicaid may still assert a third-party liability lien under Fla. Stat. § 409.910 against any recovery obtained in the case.

What Does this Mean for Your Case?

In practical terms, if Medicaid pays for hospitalization, surgery, therapy, or other treatment arising from abuse or neglect at a nursing home, assisted living facility, or group home, Medicaid has a statutory right to reimbursement from any recovery obtained in the case, absent a valid exception. Failing to properly address a Medicaid lien can delay settlement and create unnecessary complications.

When Do We Notify Medicaid?

From a litigation strategy perspective, it is often critical to determine the Medicaid lien amount as early as possible. In nursing home, assisted living facility, and group home cases, we often request lien information during the pre-suit period so that any settlement discussions can be grounded in economic reality.

In addition, a Plaintiff must provide notice of the filing of an abuse and/or neglect lawsuit to the Agency within thirty (30) days of filing the lawsuit. A Plaintiff must also provide notice to the Agency at least twenty-one (21) days prior to a voluntary dismissal, an event that might suggest a settlement. See Fla. Stat. § 409.910(11)(a). And, of course, a Plaintiff must notify the Agency in the event of a settlement.

How Much Does Medicaid Take? (The Recovery Formula)

In the event of a settlement or judgment in favor of a Plaintiff subject to a Medicaid lien, the recovery must be distributed according to statute. Florida Statute § 409.910(11)(f) states that the amount recovered shall be distributed as follows:

1. After attorney’s fees and taxable costs are satisfied, one-half of the remaining recovery shall be paid to the Agency up to the total amount of the lien.

2. The balance of the recovery shall be paid to the recipient.

For purposes of this calculation, attorneys’ fees are calculated as 25% of the total recovery. Further, “taxable costs” is a term of art that refers to those costs that are defined by guidelines contained in the Florida Rules of Civil Procedure, rather than all costs incurred in the case.

The Bottom Line

If you or your loved one suffered abuse or neglect in a nursing home, assisted living facility, or group home, and Medicaid paid for any portion of the resulting care, you may need to consider the impact a Medicaid lien may have on your case.

FIDJ Fights for Victims of Abuse and Neglect

FIDJ represents victims and families in cases involving Florida nursing home, assisted living facility, and group home abuse, neglect, and wrongful death. If you or your loved one suffered at the hands of a facility, contact the experienced attorneys at FIDJ for a free, confidential case review or submit the details of your case through our online form.