Document ID: ./input/supremecourt_opinions/opinions/21pdf/20-1263diff_868c.pdf
Page Number: 8

Cite as:  596 U. S. ____ (2022) 

3 

Opinion of the Court 

the  anti-lien  provision  prohibits  reimbursement.  Id.,  at 
285. 

B 

To  satisfy  its  Medicaid  obligations,  Florida  has  enacted 
its  Medicaid  Third-Party  Liability  Act,  which  directs  the
State’s  Medicaid  agency  to  “seek  reimbursement  from
third-party benefits to the limit of legal liability and for the 
full amount of third-party benefits, but not in excess of the
amount of medical assistance paid by Medicaid.”  Fla. Stat. 
§409.910(4) (2017).1  To this end, the statute provides that 
when  a  beneficiary  “accept[s]  medical  assistance”  from 
Medicaid,  the  beneficiary  “automatically  assigns  to  the 
[state] agency any right” to third-party payments for medi-
cal care.  §409.910(6)(b).  A lien “for the full amount of med-
ical  assistance  provided”  then  “attaches  automatically”  to
any settlements related to an injury “that necessitated that
Medicaid  provide  medical  assistance.”    §§409.910(6)(c), 
(6)(c)(1), 409.901(7)(a).

Rather  than  permit  the  State  to  recover  from  a  benefi-
ciary’s entire settlement, the statute entitles Florida to half 
a beneficiary’s total recovery, after deducting 25% for attor-
ney’s  fees  and  costs  (i.e.,  37.5%  of  the  total). 
See 
§409.910(11)(f )(1).  This amount presumptively represents
the portion of the tort recovery that is for “past and future
medical expenses.”  §409.910(17)(b).  Beneficiaries can re-
but that presumption by proving with clear and convincing
evidence  “that  the  portion  of  the  total  recovery  which
should be allocated as past and future medical expenses is 
less  than  the  amount  calculated  by  [Florida’s]  formula.” 
Ibid. 

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1 For the sake of simplicity, we refer to the State, its Medicaid agency,

or simply Medicaid interchangeably.