State fights medicaid eligibility allegations

Gov. Ron DeSantis’ administration is trying to fend off a potential class-action lawsuit that alleges the state has not provided adequate information to Medicaid beneficiaries before dropping them from the health-care program.

Attorneys for the state Agency for Health Care Administration and the Department of Children and Families on Friday filed court documents arguing that a federal judge should reject requests to issue a preliminary injunction and to make the lawsuit a class action.

The lawsuit, filed in August in Jacksonville, stems from a process that the state started this spring to determine whether more than 5 million people enrolled in Medicaid remained eligible for benefits. The process was a result of the end of a federal COVID-19 public-health emergency.

One of the documents filed Friday said the state since April has conducted about 2.5 million “redeterminations,” with more than 1.7 million people found eligible and nearly 830,000 found ineligible. The redetermination process is expected to continue for months.

The plaintiffs’ lawyers argue that the state has violated due-process rights and a federal Medicaid law because it has not provided adequate notice about reasons for terminating people’s benefits and about opportunities for hearings before termination. They are seeking an injunction that would require reinstating coverage to people and ending additional terminations until adequate information is provided.

“Medicaid enrollees must be given timely and adequate notice detailing the reasons for a proposed termination and how they can challenge the action, and they must be given an opportunity to make their case before an impartial decision-maker prior to termination of their Medicaid coverage,” the lawsuit said.

But attorneys for the Agency for Health Care Administration and Department of Children and Families on Friday disputed that the state had violated beneficiaries’ rights and said U.S. District Judge Marcia Morales Howard should deny the requests for a class action and an injunction.

“Plaintiffs’ requested injunction upsets the apple cart with respect to millions of people: those who were found ineligible for full Medicaid whom plaintiffs demand be reinstated, and those for whom eligibility re-determinations would be halted during the pendency of this litigation,” one of the documents said. “DCF’s (the Department of Children and Families’) administration of a multibillion-dollar program cannot simply pivot overnight to accommodate chaos of that magnitude.”

The judge has scheduled a hearing Oct. 30 on the issues. The Senate Health and Human Services Appropriations Committee also is slated Wednesday to receive presentations about the redetermination process.

The process has drawn close scrutiny — and criticism from Democrat lawmakers and groups advocating for beneficiaries — for months.

The federal government declared the public-health emergency in 2020 as the COVID-19 pandemic began. Medicaid is jointly funded by the federal and state governments. As part of the emergency, Washington agreed to pick up more of the tab for the program.

But there was a catch: In exchange for the extra money, states had to agree that they wouldn’t drop people from the Medicaid rolls during the emergency. Florida’s program grew from about 3.8 million beneficiaries in January 2020 to nearly 5.8 million in April of this year, at least in part because people who might not otherwise be eligible for coverage could not be dropped.

With the end of the emergency, the state began redetermination, and the Medicaid rolls had dropped to about 5.25 million in August, according to data on the Agency for Health Care Administration website.

The Agency for Health Care Administration runs most of the Medicaid program, though the Department of Children and Families is heading the redetermination process.

The plaintiffs in the lawsuit are a mother and daughter from Jacksonville and a mother and daughter from Miami-Dade County. Both of the children and one of the mothers lost Medicaid coverage. Their full names are not included in the lawsuit.

The lawsuit alleges that the plaintiffs and potential class members “are losing Medicaid coverage without meaningful and adequate notice, leaving them unable to understand the agency’s decision, properly decide whether and how to contest their loss of Medicaid coverage or plan for a smooth transition of coverage that minimizes disruptions in necessary care. Without Medicaid coverage, plaintiffs are unable to obtain care they need, including prescription drugs, children’s vaccinations and postpartum care.”

But in the filings Friday, the state’s lawyers disputed the allegations.

“Even if technical violations exist on a case-by-case basis, plaintiffs cannot demonstrate that these technical violations cause a classwide risk harm justifying a preliminary injunction against the state,” one of the documents said. “DCF sends multiple communications and notices to recipients regarding eligibility redeterminations and the termination of benefits. Those communications contain a host of information, from the reason for termination, to phone numbers and websites to access for more information, to apprising the recipient of hearing rights, to advising recipients where they can receive free legal advice, to identifying additional programs and services and more. DCF maintains a robust website with information about benefits eligibility, fair hearing processes, and other available resources and programs.”

Jim Saunders - News Service of Florida

State fights medicaid eligibility allegations

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State fights medicaid eligibility allegations

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