21-000052MTR Angela D. Sharpe, As Personal Representative Of The Estate Of Thomas Kenneth Sharpe, Deceased vs. Agency For Health Care Administration Status: Closed DOAH Final Order on Friday, April 30, 2021.

Summary: Under the prevailing law, the Petitioner, who died prior to the settlement of his underlying wrongful death case, was not entitled to a reduction of the Medicaid lien claimed by ACHA which applied and used the formula found in 409.910(11)(f).

S TATE OF F LORIDA

D IVISION OF A DMINISTRATIVE H EARINGS

A NGELA D. S HARPE , A S P ERSONAL

R EPRESENTATIVE OF T HE E STATE OF

T HOMAS K ENNETH S HARPE , D ECEASED ,

Petitioner ,

vs. Case No. 21 - 0052MTR

A GENCY F OR H EALTH C ARE

A DMINISTRATION ,

Respondent .

/

F INAL O RDER

A final hearing was conducted on March 9, 2021 , before Robert L.

Kilbride, Administrative Law Judge of the Division of Administrative

Hearings ("DOAH"), by video teleconfer ence, using Zoom technology.

A PPEARANCES

For Petitioner: Darryn L. Silverstein, Esquire

Silverstein, Silverstein and Silverstein, P.A.

20801 Biscayne Boulevard , Suite 504

Aventura, Florida 33180

For Respondent: Alexander R. Boler, Esq uire

2073 Summit Lake Drive , Suite 300

Tallahassee, Florida 32317

S TATEMENT O F T HE I SSUE

What amount of the wrongful death settlement recovered by Petitioner,

Angela D. Sharpe , as Personal Representative of the E state of Thomas

Kenneth Sharpe , deceased ("Sharpe"), must be paid to Respondent, Agency

for Health Care Administration ("AHCA" or "Agency"), pursuant to section

409.910, Florida Statutes (2020), to satisfy the Agency's claimed $119,687.65

Medicaid Lien.

P RELIMINARY S TATEMENT

On Januar y 6, 2021, Sharpe filed a Petition to Determine Medicaid's Lien

Amount to Satisfy Claim Against Personal Injury/Wrongful Death Recovery

by the Agency for Health Care Administration, pursuant to section

409.910(17)(b). The petition challenged the amount of AHCAÔs lien and

requested a hearing.

The matter was assigned to the undersigned to conduct an evidentiary

administrative hearing and render a final order establishing AHCA's lien

recovery amount.

The case was set for final hearing on March 9, 2021, and p roceeded to a

hearing on that date.

The parties filed a pre - hearing stipulation that included undisputed facts.

At the final hearing, Sharpe's Exhibits 1, 4 , and 6 were admitted into

evidence without objection. Sharpe presented testimony of personal

injur y/wrongful death lawyer, Darryn L. Silverstein, Esquire ; additional

testimony from Kenneth Bush, Esquire ; and testimony from the defense

attorney in the personal injury lawsuit , Benjamin Bedard , Esquire . The

Agency did not offer any exhibits nor did it cal l any witnesses.

Petitioner ordered the hearing Transcript. After the hearing, the

undersigned issued an Order on March 29, 2021 , requesting that the parties

address the applicability of the First District Court of AppealÔs recent

decision in Cabrera v. S tate of Florida, Agency for Health Care

Administration , issued on March 29, 2021, in Case No. 1D18 - 755 and any

related case. Both parties did so and timely filed proposed final orders, which

were reviewed and considered by the undersigned in the preparatio n of this

Final Order.

All references to the Florida Statutes are to the version in effect on the

date of the action or conduct involved.

F INDINGS O F F ACT

T he un d e rs ig ned m a k es the f o ll o w i ng F i n di n g s of Fa c t ba s ed on t he

s t i p u la t i ons of the par t i es a nd t he material e vi d en c e pr e s ented a t the

he a r i n g .

P AR T IES ' S T I P U L A T ED F AC T S

1. On June 23, 2016, Mr. Sharpe was operating a motor scooter and was

seriously injured after he had a collision with an automobile. Mr. Sharpe died

on July 17, 2019.

2. Mr. Sharpe was survived by his wife, Angela D. Sharpe.

3. Medicaid claims that Mr. SharpeÔs medical care , related to the injuries ,

was paid in the amount of $119,687.65 by AHCA. Mr. SharpeÔs entire claim

for past medical expenses based on liens was $133,423.67.

4. Th e death certificate related Mr. SharpeÔs death to the collision.

5. Angela D. Sharpe was appointed Personal Representative of the Estate

of Thomas Kenneth Sharpe.

6. Angela D. Sharpe , as the Personal Representative of the Estate of

Thomas Kenneth Sharpe, d eceased , brought a wrongful death action to

recover both the individual statutory damages of Mr. SharpeÔs surviving

spouse , as well as the individual statutory damages of the Estate of Thomas

Kenneth Sharpe, deceased and a survival claim against the operat or of the

automobile. (ÑDefendantÒ).

7. The case was settled through a settlement in the amount of

$100,000.00.

8. During the pendency of the action, AHCA was notified of the action and

AHCA asserted a $119,687.65 Medicaid lien against the Estate of Thoma s

Kenneth SharpeÔs cause of action and settlement of that action.

9. By letter, AHCA was notified of the settlement. This letter requested

AHCA to advise as to the amount AHCA would accept in satisfaction of the

$119,687.65 Medicaid lien

10. AHCA calculate d its payment pursuant to the section 409.910(11)(f)

formula based on the gross $100,000 .00 settlement, under which AHCA

demanded $29,353.30.

O THER S TIPULATIONS O F T HE P ARTIES

11. Based on AHCAÔs claimed lien of $119,687.65, Petitioner and AHCA

agree that application of the formula at section 409.910(11)(f) to the

$100,000.00 settlement amount requires payment to AHCA in the amount of

$29,353.30, if that amount is less than AHCAÔs lien.

12. Petitioner and AHCA agree that pursuant to section 409.910(17)(b),

Petitioner may contest the amount payable to AHCA per the formula in

section 409.910(11)(f) by filing a Petition with DOAH. 1

13. Petitioner and AHCA agree that DOAH has jurisdiction , pursuant to

section 409.910(17)(b) , to determine the Ñportion of a total recovery which

should be allocated as past medical expenses,Ò including when the total

recovery is an unallocated lump - sum settlement.

A D D I T I O N AL E V I D E N C E A T T HE H EAR I N G

14. A t the f i n a l he a ri n g , Sharpe pr e s ented e x p e r t te s t i mony fr om several

qualified a ttorneys who either represented Mr. Sharpe for his claims

1 As explained further herein, this stipulation is contrary to, or, at least, is severely

undermined by the law outlined by the Cabrer a case.

(Silverstein), defended the opposing party defendant (Bedard) , or reviewed

the file and case documents in preparation for the hearing (Bush).

15. The thrust of PetitionerÔs evidence was to establis h an evidentiary

basis to justify the application of the pro rata or proportionality test -- one

method frequently utilized by litigants to reduce A HC AÔs lien. See generally

Eady v. State , Ag. For Health C are Admin. , 279 So. 3d 1249 (Fla. 1 st DCA

2019).

1 6. However, application of the Medicaid lien principles articulated in

Cabrera fully dispos e of this case . T he recitation of additional facts and

opinions regarding the qualifications of the experts or the appropriate

methodology to use is unwarranted. It is unnecessary and improper to reach

any remaining issues as judicial restraint requires that the undersigned

resolve this case on the narrowest possible grounds. Digiport , Inc. v. Foram

Development BFC , LLC , 2020 WL 7379128, N. 5, ( Dec . 16, 2020 ) (Florida

Third District Court of Appeal) (Applying the principle of judicial restraint) ;

The Bank of New York Mellon Corp . v. Hernandez , 299 So. 3d 461, 466,

concurring opinion by Fernandez (Fla. 3rd DCA, 2020)

17. It was undisputed that the settlement of the under lying wrongful

death case occurred after Mr. Sharpe had passed away from his injuries

related to the automobile accident.

18. These are the relevant and material facts necessary to establish a

basis for the conclusions and ultimate action taken in this Fi nal Order. As

explored more fully below, because Mr. Sharpe died before the settlement

agreement was reached , the anti - lien provisions of the Medicaid Act do not

apply to limit the recovery by A HC A, which properly utilized the formula

found at section 409. 910(11)(f). Cabrera v. State of Fla . , Ag . for Health Care

Admin ., 2021 WL 1152328 ( Ma r. 26, 2021 ) .

C ONCLUSIONS O F L AW

19. A HC A i s the s t a te ag e n c y r e sp on s ibl e f o r a d m i n i s te r i ng F l o rid a ' s

M e d i c ai d pr o g r a m. § 409 . 910 ( 2 ) , F la . St a t.

20. DOAH has jurisdictio n over the parties and the subject matter of this

proceeding pursuant to sections 120.569 and 120.57(1), Florida Statutes.

F EDERAL M EDICAID L AW OF G ENERAL A PPLICABILITY

21. " M e d i c ai d i s a c o o p e r a t iv e f e d e r al - s t a te w e l f a r e pr o g r a m pr o vi d i ng

me d i c a l a s s i s t a n c e to nee d y p eo p l e . " Ro b er t s v. Al b er t s on ' s , I n c . , 11 9 So. 3d

457 , 4 5 8 ( F la . 4 th D C A 2 0 12 ) . A l thou g h s t a te p a r t i c i p a t i on i n th i s f e d e r a l

pr o g r a m i s v o l unt a r y , on c e a s t a te e l e c ts to p a r t i c i p a te, i t mu s t c o m p l y w i t h

th e f e d e r a l M e d i c ai d l a w. I d.

22. F e d e r a l la w r e q u ir es th a t p a r t i c i p a t i ng s t a tes s eek r e i m b u rs ement f or

me d i c a l e x p en s es i n c u rr ed on b eh al f of M e d i c ai d r e c i p i ents w ho la ter r e c o v er

fr om l e gally - l i abl e t h ir d p a r t i e s .

23. U n d er the U n i ted St a tes Su pr eme C ou r t ' s r e a s on i ng i n Ar k a n sas

D epar tm e nt of H e al th a nd H um a n S er v i c e s v. A h l b o r n , 54 7 U. S. 2 6 8 ( 2 0 06 ) ,

the f e d e r a l M e d i c ai d Ñ a nt i - li enÒ pr o vi s i ons a t 4 2 U. S . C . § 13 9 6 p( a ) ( 1 )

generally pr oh ibi t a M e d i c ai d li en on a ny pr o c e e d s fr om a M e d i c ai d r e c i p i ent ' s

to r t s e tt l ement.

24. H o w e v e r , the pr o vi s i ons r e q u i r i ng s t a t e s to s eek r e i m b u rs e m ent of

the i r M e d i c ai d e x p en d i tu r es fr om liabl e th i r d p a r t i e s , cr e a te a n e x pr e s s

e x c e p t i on to the Ñ a n t i - li en Ò la w a nd a utho r i z e s t a tes to s eek r e i m b u rs ement

fr om the me d i ca l e x p e n s e p o r t i on of the r e c i p i ent ' s to r t r e c o v e r y .

25. A s note d , the F e d e r a l M e d i c ai d A c t li m i ts a s t a te ' s r e c o v e r y t o c e r t ai n

p o r t i ons of the s ett l e ment f un d s r e c e iv ed b y the M e d i c ai d r e c i p i e nt. I n

Fl o r i d a , t h i s h a s b een r e c ent l y i nte rpr eted b y the F l o r i d a Su pr e me C ou r t to b e

the a mount i n a p e rs on a l i n j u r y s et t l em e nt w h i c h i s f ai rl y all o c abl e to p a s t

( not f utu r e) me d i c a l e x p en s e s . G iral do v. A g . f or Heal th C ar e A dm i n . , 24 8 S o.

3 d 53 , 5 6 ( F la . 2 0 18 ) .

26. I n th i s c a s e, Petitioner s ett l ed the p e rs on a l i n j u r y/wrongful death c lai m

a g a i n s t a t h i rd p a r t y w ho wa s lia bl e for Mr. SharpeÔs damages r e l at e d t o

AH C A' s M e d i c ai d l i e n, and for Mrs. SharpeÔs damage s . T he r e f o r e, AHCA' s li e n

m a y b e en f o rc ed a g ai n s t Sharpe' s to r t s e tt l ement. 2

27. Notably, and of paramount importance to the proper resolution of this

dispute, Mr. Sharpe succumbed to his injuries and passed away prior to the

settlement of the wrongful death case.

28. Se c t i on 409 . 910 ( 1 1 ) e s t abl is hes a f o r mu l a to d ete r m i ne the a m oun t

AHC A m a y r e c o v er f o r me d i c a l a ss i s t a n c e b ene f i ts p ai d fr om a j u d g ment,

a w a rd , or s ett l ement f r om a th i r d p a r t y . Se c t i on 40 9 . 9 1 0 ( 11 )(f ) s t a te s , i n

p e r t i nent p a r t:

N otw i th s t a n d i n g a n y pr o vi s i on i n th i s s e c t i on to

the c ont r a r y , i n the e v ent of a n a c t i o n i n to r t

agai n s t a t h i r d p a r ty i n w h i c h the r e c i p i ent or

h i s or her l e ga l r e pr e s en t a t iv e i s a p a r ty w h i c h

r e s u l ts i n a j u d g me n t, a w a r d , or s ett l em e nt f r o m

a th i r d p a r t y , the a mount r e c o v e r ed s h al l b e

d i s t r ib uted a s f o ll o w s:

1 . A f ter a tto r ne y Ôs fees and taxable costs as

d e f i ned b y the Fl o r i d a R u l es of C ivi l P r o c e d u r e,

o n e - h al f of the r em ai n i ng r e c o v e r y s h al l b e p ai d to

the ag en c y up to t he tot a l a mount of me d i ca l

a ss i s t a n c e pr o vi d ed b y M e d i c ai d.

2 . T he r em ai n i ng a m ount of the r e c o v e r y s h al l b e

p ai d to the r e c i p i e nt.

3 . F or p u rp o s e s of c al c u la t i ng the a g en c y ' s r e c o v e r y

of me d i c a l a ss i s t a n c e b ene f i ts pai d , the f ee f o r

s e r vi c es of a n a tto r n e y r et ai ned b y the r e c i p i ent or

h i s or her l e ga l r e pr e s ent a t i v e s h al l b e c al c u la ted

at 25 percent of the judgment , a w a rd , or

s ett l ement.

2 However, to the extent and degree that the $100,000.00 undifferentiated settlement

included intangible damages Mrs. Sharpe may have suffered, those damages would not be

recoverable by A HC A. Regardless, t here was no credible or persuasive testimon y at the

hearing to quantify what portion of the settlement was for her damages.

4 . N otw i th s t a n d i n g a ny pr o vi s i on of t h i s s e c t i on

to the c ont r a r y , the a g en c y s h al l b e ent i t l e d to al l

me d i c a l c o v e r ag e b e n e f i ts up to the to t a l a mount

of me d i c a l a ss i s t a n c e pr o vi d ed b y M e d i c a i d . F or

p u rp o s es of th i s p a r ag r a p h, "me d i c a l c o v e r ag e"

me a ns a ny b ene f i ts un d er he al th i n s u ra n c e, a

he al th m ai nten a n c e o r ga n i z a t i on, a p r e f e rr ed

pr o vi d er a rr a n g eme n t, or a pr e p ai d he al t h c li n i c ,

a nd the portion of benefits designated for me d i c a l

p ay ments u n d er c o v e r ag e f or w o rk e r s '

c om p en s a t i on, p e rs on a l i n j u r y pr o te c t i o n, a nd

c a s u al t y .

29. I n e ss en c e, s e c t i on 409 . 910 ( 11 )(f ) pr o vi d es th a t the A g en c y ' s r e c o v e r y

f or a M e d i c ai d li en i s the l e ss er o f : ( 1 ) i ts f u l l li e n ; or ( 2 ) one - h al f of the tot a l

a w a rd , a f ter d e d u c t i ng a tto r ne y ' s f ees of 25 % of the r e c o v e r y a nd t axabl e

c o s t s , not to e x c eed t h e tot a l a mount a c tu a ll y p ai d b y M e d i c ai d on the

r e c i p i ent ' s b eh al f . S e e A g . f or Heal th Car e A dm i n. v. R ile y , 11 9 S o . 3 d 51 4

( F la . 2 d D C A 20 1 3 ) .

30. H e r e, the p a r t i es ag r eed th a t a pp li c a t i o n of the s e c t i o n 4 0 9.9 1 0 ( 11 )(f)

f o r mu l a to P e t i t i one r Ôs s ett l ement w ou l d r e q u i r e p ay ment to A HC A of

$29,353.30.

31. A n other c o rr e sp on d i ng s e c t i on, section 40 9 .910 ( 17 ) ( b ) , out li ned b e l o w ,

pr o v id es a met h od b y w h i c h a M e d i c ai d r e c i p i ent , under certain

circumstances, m a y c h all en g e the a mount AHC A s ee k s un d er the f o r mu l a

f o u nd ab o v e a t s e c t i on 40 9 . 9 1 0 ( 11 )(f) .

32. M o r e sp e c i f i c all y , f o ll ow i n g the U n i ted St a tes Su pr eme C ou r t 's d e c i s i on

i n W os v. E . M . A . , 5 6 8 U. S. 62 7 , 6 3 3 ( 2013 ) , the Fl o r i d a L e gi s la tu r e cr e a ted a n

a d m i n i s t ra t iv e pr o c e s s to c h all e n g e a nd d ete r m i ne w h a t p o r t i on of a

j u d g ment, a w a rd , or se tt le m e nt i n a to r t a c t i on i s pr o p e r l y all o c a bl e to

me d i c a l e x p en s es a n d , thu s , w h a t p o r t i on o f a p et i t i one r' s s ett l ement m a y b e

r e c o v e r ed to r e i m b u r s e the M e d i c ai d li en h e l d b y A H C A . Se c t i on

40 9 . 9 1 0 ( 17 )( b ) s t a te s :

A r e c i p i ent m a y c on t e s t the a mount d e s ig n a ted a s

r e c o v e r ed m e d i c a l e x p en s e d a m ag es p a y abl e to the

ag en c y p u rs u a nt to the f o r mu l a sp e c i f i ed i n

p a r ag r a p h ( 11 )(f ) b y f ili n g a p et i t i on un d er c h a p ter

12 0 w i th i n 2 1 d ay s a f ter the d a te of p ay ment of

f un d s to the ag en c y o r a f ter the d a te of p la c i ng the

f u l l a mount of the th i rd - p a r ty b ene f i ts i n the t r u s t

a cc ount f o r the b ene f i t of the ag en c y p u r s u a nt to

p a r ag r a p h ( a ) . T he p et i t i on s h al l b e f il ed w i th the

D i v i s i on of A d m i n i s t r a t iv e H e a r i n g s . F or p u rp o s es

of c h a p ter 1 20 , the p ay ment of f un d s to t h e ag en c y

or the p l a c ement of the f u l l a mount o f t he

th i rd - p a r ty b ene f i ts i n the trust account f o r the

benefit of the agency c on s t i t u tes f i n a l ag e n c y

a c t i on a nd not i c e the r eo f . Fi n a l o rd er a utho r i ty f or

the pr o c e e d i n g s s p e c i f i ed i n t h i s s u b s e c t i on r e s ts

w i th the D ivi s i on of Ad m i n i s t r a t iv e H e a r i n g s . T h i s

pr o c e d u r e i s the e x c l u s iv e method f or c h a ll en g i ng

the a m ount of th i rd - p a r ty benefits payable to

the agency . I n o rd er to s u cc e s s f u ll y c h a ll e n g e the

a mount p ayabl e to t he ag en c y , the r e c i p i ent

mu s t pr o v e, b y c l e a r a nd c on vi n c i ng e v i d en c e, th a t

a l e ss er p o r t i on of t h e tot a l r e c o v e r y s hou l d b e

all o c a ted a s r e i m b u rs ement f or p a s t a n d f utu r e

me d i c a l e x p en s es th a n the a mount c al c u la ted b y

the ag en c y p u rs u a nt to the f o r mu l a s et f o r th i n

p a r ag r a p h ( 11 )(f ) or th a t M e d i c ai d pr o vi d e d a

l e ss er a mount of m e d i c a l a s s i s t a n c e t h a n th a t

a s s e r ted b y the ag en c y .

33. I n s i m p l e t e r m s , i f a qualified P et i t i one r c a n d em o n s t r a te th a t the

p o r t i on of a s e t t l ement f ai r l y all o c abl e a s pa y ment f or p a s t me d i c a l e x p e n s es

i s l e s s th a n t he a mount the A g en c y s ee ks , then the a moun t P e t i t i o n e r is

o b liga ted to p a y to AH CA f or i ts li en w ou l d b e r e d u c e d.

A PPLICATION OF THE F EDERAL A NTI - L IEN S TATUTE IN THIS C ASE

34. Federal law imposes some limits on a state's authority to recover

medical expenses paid by Medicaid. One limit is imposed by the federal

Medicaid "anti - lien" statute, 42 U.S.C. § 1396p(a)(1) . It provides, in

pertinent part, that: "[n]o lien may be imposed against the property of any

individual prior to his death on account of medical assistance paid or to be

paid on his beha lf under the State plan," except under specified

circumstances. 42 U.S.C. § 1396p(a)(1) (emphasis added).

35. Notably, however, Florida case law addressing the interplay between

this federal anti - lien statute and section 409.910 has consistently held that

in cases where the Medicaid recipient dies before the settlement of an action

for third - party benefits , the federal anti - lien statute does not operate to

preempt or negate the applicability of section 409.910(11)(f) . In th ose case s ,

the formula under secti on 409.910(11)(f) governs the distribution of benefits

recovered from a third - party . Goheagan v. Perkins , 197 So. 3d 112 (Fla. 4th

DCA 2016) and Estate of Hernandez v. Ag . for Health Care Admin . , 190 So.

3d 139 (Fla. 3d DCA 2016) .

36. This principle of Med icaid recovery law was recently reaffirmed by

the First District Court of Appeal in Cabrera v. State of Florida , Agency for

Health Care Administration , 2021 WL 115232 8 ( Mar . 2 6 , 2021 ) . Under very

similar facts involving a tragic accident where the victim d ied before the

underlying wrongful death case was settled, the court announced several

controlling principles that drive the outcome of this case as well.

37. First, the court determined:

While nothing in section 409.910(17)(b) expressly

prohibits a deceas ed Medicaid recipient or her

personal representative from challenging the

amount payable to the Agency, the statute

unambiguously states that a recipient may

challenge the amount payable Ñ[i]f federal law

limits the agency to reimbursement from the

recover ed medical expense damages.Ò Federal law

did not limit the Agency to reimbursement in the

present case.

38. The court added:

Medicaid is a joint federal - state cooperative

program, and participating states must comply

with certain statutory requir ements. Eady, 279 So.

3d at 1254 Ï 55 (citing Giraldo v. Agency for Health

Care Admin. , 248 So. 3d 53 (Fla. 2018)). Among

those requirements are the anti - lien provision (42

U.S.C. § 1396p(a)), the anti - recovery provision (42

U.S.C. § 1396p(b)), and the force d - assignment

provisions (42 U.S.C. § 1396k) of the Federal

Medicaid Act. As detailed below, none of these

limits the Agency's reimbursement for purposes of

section 409.910(17)(b) when a Medicaid recipient is

deceased.

(emphasis added) .

39. Of particular importance to this case, the court unequivocally stated:

The federal anti - lien provision states, Ñ[n]o lien

may be imposed against the property of any

individual prior to his death on account of medical

assistance paid or to be paid on his behalf under

t he State plan ....Ò 42 U.S.C. £ 1396(p)(a)(1) (2017).

Thus, by its express terms, the Medicaid Act's anti -

lien provision applies only to living Medicaid

recipients . Estate of Hernandez v. Agency for

Health Care Admin ., 190 So. 3d 139, 143 Ï 46 (Fla.

3d DCA 2 016) (citing Austin v. Capital City Bank ,

353 P.3d 469 (Kan. Ct. App. 2015)).

(emphasis added) .

40. After analyzing both the federal anti - lien and forced - assignment

provisions, and concluding that neither applied, the Cabrera court affirmed

the administ rative law judgeÔs dismissal of the petition challenging A HC AÔs

Medicaid lien and concluded:

Nothing in the federal anti - lien, anti - recovery, or

forced - assignment provisions apply to limit the

Agency's reimbursement or allow Appellant to

challenge the amo unt of medical expenses

allocated under the formula in the present case. To

hold otherwise would contradict statutory

provisions and clear legislative intent: Ñit is the

intent of the Legislature that Medicaid be repaid in

full and prior to any other perso n, program, or

entity. Medicaid is to be repaid in full from, and to

the extent of, any third - party benefits, regardless

of whether a recipient is made whole or other

creditors paid.Ò

§ 409.910(1), Fla. Stat. (2017).

41. As outlined above, because this case involves the recover y and

settlement of third - party benefits after the death of the Medicaid recipient,

Mr. Sharpe, section 409.910(17)(b) does not afford Petitioner the right to

challenge Respondent's recovery pursuant to the formula AHCA utilized

f ound in section 409.910(11)(f) . Cabrera , 2021 WL 1152328 (Mar. 26, 2021) .

42. The parties stipulated that Petitioner was entitled to contest the

amount payable to A HC A under the formula found in section 409.910(11)(f).

JPHS, p . 7.

43. However, under the c ircumstances of this case and due to Mr.

SharpeÔs death prior to the settlement, his challenge, regrettably, fails since

his challenge ultimately relies on the Medicaid ActÔs anti - lien provisions,

which only apply to living Medicaid recipients. Cabrera , 20 21 WL 1152328

(Mar. 26, 2021) .

44. To the extent the partiesÔ stipulations seek to circumvent or ignore

the application of Cabrera , their agreement must be rejected .

45. There is no question in the mind of the undersigned that Mr. SharpeÔs

family ha s suff ered, and continue s to suffer, a tragic loss .

46. T he outcome of this Final Order may seem unfair . However , the

Florida Legislature has clearly stated that equity cannot serve as the basis

for reducing a Medicaid lien. § 409.910(6)(a) and (b)2., Fla. Stat.

47. As compelling as the circumstances of this proceeding may be, the

undersigned is constrained and obliged t o follow the law. Here, the

applicable law, discussed in detail above, dictates that pursuant to

section 409.910(11)(f), Respondent is entitled to recover $ 29,353.30 in third -

party benefits paid to Petitioner through settlement of his action in tort.

O RDER

Based on the foregoing Findings of Fact and Conclusions of Law, it is

O RDERED A ND A DJUDGED that t he Petition to Determine Medicaid Lien filed

by Angela Sharpe , as Personal Representative of the Estate of Thomas

Kenneth Sharpe , deceased, is dismissed with prejudice , and Respondent is

entitled to recover $29,353.30 under the formula outlined in section

409.910(11)(f) .

D ONE A ND O RDERED this 30th d ay of April , 2021 , in Tallahassee, Leon

County, Florida.

S

R OBERT L. K ILBRIDE

Administrative Law Judge

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 30th day of April , 2021 .

C OPIES F URNISHED :

Alexander R. Boler, Esquire Shena L. Grantham, Esquire

Suite 300 Agency for Health C are Administration

2073 Summit Lake Drive Mail Stop 3

Tallahassee, Florida 32317 2727 Mahan Drive

Tallahassee, Florida 32308

Darryn L. Silverstein, Esquire

Silverstein, Silverstein James D. Varnado, General Counsel

and Silverstein, P.A. Agency for Health C are Administration

Suite 504 2727 Mahan Drive, Mail Stop 3

20801 Biscayne Boulevard Tallahassee, Florida 32308

Aventura, Florida 33180

Simone Marstiller, Secretary

Richard J. Shoop, Agency Clerk Agency for Health C are Administration

Agency for Health C are Administration 2727 Mahan Drive, Mail Stop 1

2727 Mahan Drive, Mail Stop 3 Tallahassee, Florida 32308

Tallahassee, Florida 32308

Thomas M. Hoeler, Esquire

Agency for Health C are Administrati on

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

N OTICE O F R IGHT T O J UDICIAL R EVIEW

A party who is adversely affected b y this Final Order is entitled to judicial

review pursuant to section 120.68, Florida Statutes. Review proceedings are

governed by the Florida Rules of Appellate Procedure. Such proceedings are

commenced by filing the original notice of administrative appe al with the

agency clerk of the Division of Administrative Hearings within 30 days of

rendition of the order to be reviewed, and a copy of the notice, accompanied

by any filing fees prescribed by law, with the clerk of the d istrict c ourt of

a ppeal in the a ppellate district where the agency maintains its headquarters

or where a party resides or as otherwise provided by law.