Court Backs DCF In Nursing Home Expenses Case

Apr 6, 2016

An appeals court Monday sided with the Florida Department of Children and Families in a dispute about expenses for a woman who went into a Tallahassee nursing home after suffering a spinal-cord injury in an accident.

The 1st District Court of Appeal issued a pair of opinions that upheld a department decision in an administrative case and rejected patient Gabrielle Goodwin's attempt to be a plaintiff in a class-action lawsuit. The dispute centered on Goodwin applying for help with nursing-home costs through what is known as the Institutional Care Program in Medicaid, according to the opinion in the administrative case.

Beneficiaries in the program are required to cover co-payments based on their income levels. Goodwin became eligible for the program effective in December 2011, and the Department of Children and Families said her co-payment was roughly $1,000 a month. But Goodwin contended the amount should be lower because it did not take into consideration about $70,000 in nursing-care expenses before she was determined eligible for the program.

She appealed administratively and later filed a class-action lawsuit based on the same issues in the administrative case. A circuit court denied Goodwin's attempt to move forward with a class-action lawsuit, and both cases were then considered by the 1st District Court of Appeal.

In a 12-page ruling in the administrative case, the appeals court said it needed to defer to the Department of Children and Families on the issue.

"Here, we defer to DCF's reasonable interpretation and enforcement practice because it is the enforcing agency,'' said the ruling, written by Judge Timothy Osterhaus and joined by judges Brad Thomas and Ross Bilbrey. "Its interpretation of Medicaid law prevails, irrespective of which interpretation we might prefer, because it is reasonable, and not clearly erroneous or contrary to law."