Saturday, December 5, 2015

Guardian May Not Deduct Fee From Medicaid Recipient's Income

A Florida appeals court rules that the guardian of a Medicaid recipient may not deduct a guardianship fee from the recipient's income because the fee is not medically necessary. Lutheran Services Florida, Inc. v. Department of Children and Families (Fl. Ct. App., 2nd Dist., No. 2D13-5840, Nov. 25, 2015).

Lutheran Services Florida (LSF) is the court-appointed guardian of nursing home resident Larry Peron. LSF's duties include reviewing Mr. Peron's medical treatment and giving consent for medical procedures. When Mr. Peron qualified for Medicaid, he paid the majority of his income to the nursing home as the patient responsibility amount.

LSF obtained a court order authorizing that a monthly $200 guardianship fee be deducted from Mr. Peron's income and petitioned the Department of Children and Families to deduct the guardianship fee from Mr. Peron's patient responsibility amount. The Department denied the petition, determining that the fee cannot be deducted from a Medicaid recipient's income because it is not "medically necessary" under state law.  A hearing officer upheld the determination, noting that state law defines medically necessary as services provided in accordance with generally accepted standards of medical practice and reviewed by a physician. LSF appealed.

The Florida Court of Appeals affirms, holding that the guardianship fee is not medically necessary. According to the court, state law allows only deductions from a Medicaid recipient's income for "medical or remedial care services rendered by a medical professional directly to the Medicaid recipient." The court acknowledges that this result leaves a gap "wherein a guardian of an incapacitated ward who provides the necessary consent for medically necessary treatment cannot be compensated for its services under the state's Medicaid program," and suggests that the legislature look into changing the law.

For the full text of this decision, go to:,%202015/2D13-5840.pdf
Full Article & Source:
Guardian May Not Deduct Fee From Medicaid Recipient's Income


Betty said...

I am very glad to see this decision, especially because so many people are forced into guardianship. They should not be forced to pay for being the subject of a hostile take-over.

honeybear said...

This article will help many families going through this.

Mike Centurian, NV said...

I agree with the decision and I don't mean to sound like I don't. But if you take the abuse out of guardianship, wouldn't guardianship be medically necessary if someone can't make decisions about his or her health?

Anonymous said...

Mike, I think you're making a high leap. Medically necessary? No. Not in the truest sense of the words.

Rachel said...

This should be a common sense issue. And guardians are getting caught dipping into essential funds.