Gallardo v. Mayhew, No. 17-13693 (11th Cir. 2020)Annotate this Case
Plaintiff sought declaratory and injunctive relief to prevent the Florida Agency for Health Care Administration (FAHCA) from recovering beyond that portion of her settlement specifically designated by the settling parties as compensation for her past medical expenses.
The Eleventh Circuit reversed the district court's grant of summary judgment in favor of plaintiff. As a preliminary matter, the court held that the parties' unilateral allocation does not bind FAHCA. On the merits, the court held that federal medicaid law does not preempt FAHCA's practice of seeking reimbursement from portions of a settlement that represent all medical expenses. The court also held that federal law does not preempt Florida's method of allocating the share of a personal injury settlement from which it is entitled to seek reimbursement: its formula of half the settlement after 25 percent attorney's fees, combined with the procedure in which a recipient may challenge that allocation in an administrative hearing by clear and convincing evidence.