A 92-year-old retired teacher who was the victim of a bureaucratic screwup should not be required to repay the full amount demanded by state officials for miscalculating his nursing home Medicaid assistance, the Third District Court of Appeal decided.
Sergio Garcia moved to the nursing home in Miami-Dade County in June 2010 and was told by the state Department of Children and Families he was eligible for $42,717 in assistance for the first year.
The following May he was told his monthly income from his pension and Social Security was above the $2,022 limit, and he would have to create a qualified income trust and pay part of his nursing home bill to qualify for partial Medicaid coverage.
He did so, but complained when, several months later, DCF told him he would have to repay the entire $42,717 because he did not have a trust the first year.
The Third District relied on a Fourth District opinion in Forman v. DCF that concluded the department has a legal obligation to timely inform applicants and thus cannot seek full repayment.
"DCF is only entitled to recover $11,561, the amount Garcia was not eligible to receive, and would not have received, had DCF correctly taken into account his teacher pension," Judge Ivan Fernandez wrote in Wednesday’s opinion.