Posted on Jul 08, 2022

Injury Settlements

Supreme Court Rules State Medicaid Programs Can Recoup a Larger Share of Injury Settlements

In the unfortunate case that you get injured due to someone else's negligence and receive Medicaid in order to pay for care, the state is legally able to recover those funds from a personal injury settlement or award.

Due to a legal case involving a Floridian teen who had a catastrophic accident more than a decade ago, the U.S. Supreme Court has ruled that state Medicaid programs may be repaid from settlement funds reserved for future medical expenses as well. This goes for anyone who receives medical care through Medicaid after having an injury that results in disability and requires a lawsuit.

The accident occured in 2008, when a truck struck Gianinna Gallardo as she stepped off her Florida school bus.

This incident caused her to suffer catastrophic injuries and resulted in permanent disability. According to this article by ElderLawAnswers, the state’s Medicaid agency paid $862,688.77 in medical payments on Gallardo’s behalf. Her parents filed a lawsuit against the truck's owner, driver, and the Lee County School board. The case eventually settled for $800,000 and around $35,000 of that went toward past medical expenses. 

The state Medicaid agency claimed it was entitled to more than $300,000 in medical payments from this settlement. This included money that had was supposed to be allocated for her future medical expenses. Gianinna’s parents then sued the agency in federal court. 

When a U.S. district court ruled in favor of Gianinna, the Medicaid agency appealed.

court of appeals reversed the lower court’s decision. Ultimately, the U.S. Supreme Court agreed to hear the case so they could resolve the conflict. In a 7-2 decision, the Supreme Court agreed that the state is allowed to recover benefits for Gianinna’s past and future medical care.

Justice Clarence Thomas wrote the majority opinion, and noted that Medicaid law “distinguishes only between medical and nonmedical care, not between past (paid) medical care payments and future (un-paid) medical care payments.” Justices Sonia Sotomayor and Stephen Breyer argued that accepting Medicaid shouldn’t leave a beneficiary indebted to the state for future care that may or may not be needed. 

You can read more on this case here.

If you need help qualifying for Medicaid, do not hesitate to reach out to our firm! We have a 100% success rate with Medicaid applications and know all the tricks to get even high-net-worth individuals qualified. You can learn more about the Medicaid application in our FREE report 5 Reasons Your MassHealth Long-Term Care Application will be Denied