Florida health agency sued over Medicaid terminations
The lawsuit alleges that the Medicaid redeterminations began a month before they were allowed under federal legislation.
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A pair of Florida families have filed a class-action lawsuit against the Florida Agency for Health Care Administration and the Florida Department of Children and Families that claims that low-income patients in the state are losing Medicaid coverage and lack clarity on how to challenge the state's decisions.
Filed in U.S. District Court in Jacksonville, the lawsuit alleges that Florida's Medicaid redeterminations, in which the state updates the list of those eligible for the federal program, began on March 1, a month before they were allowed under federal legislation. Medicaid redeterminations began on April 1.
At issue in the suit are the notices these agencies are using to alert people that their Medicaid coverage is ending. It alleges that in three months, more than 182,000 Floridians have been issued notices saying they are no longer eligible for coverage, and hundreds of thousands more will have their coverage reviewed in the coming year.
As alleged in the complaint, low-income individuals who are losing Medicaid coverage have no idea whether the state is making the right decision, and whether – or how – to challenge their loss of coverage.
"The Florida Agency for Health Care Administration and Department of Children and Families have known since 2018 that their notices are confusing, difficult to read, and fail to adequately explain the reasons someone is losing Medicaid," said Sarah Grusin, senior attorney at the National Health Law Program, which filed the complaint on behalf of the plaintiffs, along with the Florida Health Justice Project. "Nevertheless, the state continues to use them. The people receiving these notices do not understand the action the state has taken or what to do next. This leaves many of them without coverage for critical care including prescriptions, vaccinations, and postpartum care.
"Fundamental due process requires the state to ensure that people receive adequate, meaningful notice of the state's decision and the opportunity to challenge it before coverage is terminated," she said by released statement. "This is not happening."
WHAT'S THE IMPACT?
Nationwide, nearly four million people have been cut from Medicaid since states started reviewing their rolls following the end of pandemic-era protections this spring, according to data from the Commonwealth Fund.
In Florida, Medicaid beneficiaries are sent reason codes with descriptions for their coverage termination that can be vague, the suit alleges. It cited case studies from the State Health Access Data Assistance Center suggesting that the agency is aware of the confusion these notices are causing for members.
"As long-time advocates, we know that low-income individuals and families in Florida struggle against sometimes insurmountable barriers to healthcare," said Miriam Harmatz, director of advocacy and founder of the Florida Health Justice Project, in a released statement. "It is critical that people who have had Medicaid throughout the COVID-19 pandemic understand why DCF thinks they are no longer eligible and how to challenge their termination if it's incorrect. The current notices are incomprehensible to most recipients, and we hope that this lawsuit brings immediate relief to those who have been deprived of their due process rights."
Amanda Avery, senior attorney at the National Health Law Program, called the scope of Medicaid terminations in the state "egregious" and said similar patterns are occurring in states across the country.
"For months, advocates have been warning state and federal agencies that the end of the COVID-19 public health emergency and the Medicaid unwinding process would lead to massive coverage losses for people who are still eligible for Medicaid," said Avery in a statement released. "We are seeing that play out in real time. The National Health Law Program and our partners in states across the country, including Health Law Partnerships, will continue to fight for the due process rights of Medicaid enrollees and ensure that eligible people maintain and regain their coverage."
THE LARGER TREND
In May, before Medicaid redeterminations began, data released by KFF showed that most Medicaid enrollees were unaware of the process.
About two-thirds (65%) of all Medicaid enrollees said they were "not sure" if states are now allowed to remove people from Medicaid if they no longer meet the eligibility requirements or don't complete the renewal process, with an additional 7% incorrectly saying states will not be allowed to do this.
Three in four adults 65 and older said they're unsure if states are allowed to remove people from Medicaid, and Black adults are more likely than white adults to incorrectly say that states are not allowed to do this. Just under three in ten (28%) overall are aware states are now allowed to remove people from Medicaid.
Part of the confusion may stem from the fact that almost half of enrollees said they've never been through the Medicaid renewal process before. That includes two-thirds (68%) of Medicaid enrollees who are 65 and older and more than half of Medicaid enrollees who are between the ages of 18 and 29 (53%).
Up to 18 million people are projected to lose Medicaid coverage as the continuous enrollment requirement put in place under the public health emergency ends. The Families First Coronavirus Response Act prevented state Medicaid agencies from disenrolling people during the PHE.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
