PHE- Florida Medicaid eligibility: Lawsuit seeks to halt state from terminating some residents’ benefits

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.


[MM Curator Summary]: And so it begins.



Clipped from:

CNN  — 

Two consumer advocacy groups filed a lawsuit in a Florida federal court Tuesday seeking to halt the state’s termination of residents’ Medicaid benefits.

The suit is the first in the nation to challenge states’ resumption of reviewing Medicaid enrollees’ eligibility and dropping those deemed no longer qualified. The process, which Congress had suspended for three years during the Covid-19 pandemic, restarted as early as April, depending on the state.

The Florida Health Justice Project and the National Health Law Program filed the lawsuit on behalf of three Floridians in US District Court in Jacksonville against the state’s Agency for Health Care Administration and the Department of Children and Families. The residents are a 25-year-old woman and her 2-year-old daughter, who has cystic fibrosis, as well as a 1-year-old girl.

Ad Feedback

The plaintiffs argue that the notices the agencies are sending to inform enrollees that they are no longer eligible are confusing and don’t provide sufficient explanation as to why they are losing coverage.

“As a result, Plaintiffs and 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,” the complaint reads. “Without Medicaid coverage, Plaintiffs are unable to obtain care they need, including prescription drugs, children’s vaccinations, and post-partum care.”

The advocates are asking the court to require the state to stop terminating enrollees until the agencies provide adequate notice and an opportunity for a pre-termination fair hearing.

Mallory McManus, deputy chief of staff for the Department of Children and Families, called the lawsuit “baseless.” While she said the state cannot comment on pending litigation, she said the letters to recipients are “legally sufficient.”

The federal Centers for Medicare and Medicaid Services “approved the Department’s redetermination plan based on their regulations. There are multiple steps in the eligibility determination process and the final letter is just one of multiple communications from the Department,” said McManus, adding that the agency “continues to lead on Medicaid determinations and being fiscally responsible.”

The Agency for Health Care Administration did not immediately return a request for comment.

Nearly 183,000 Floridians have been issued notices saying they no longer qualify for Medicaid, according to the lawsuit. Hundreds of thousands more will have their coverage reviewed in the coming year.

In addition to those determined ineligible, nearly 226,000 were dropped for so-called procedural reasons, typically because enrollees did not complete the renewal application, according to KFF, formerly the Kaiser Family Foundation. This often happens because it may have been sent to an old address, it was difficult to understand or it wasn’t returned by the deadline.

Nearly 898,000 Florida residents have had their coverage renewed, according to KFF.

Nationwide, more than 5.2 million people have been disenrolled since the so-called Medicaid unwinding began in the spring, according to KFF. Nearly three-quarters of those who have lost coverage were dropped for procedural reasons.