Dive Brief:
- Florida officials are being sued in the first legal challenge against a state for how it’s conducting Medicaid eligibility checks after a pandemic-era pause.
- Three Floridians, including two children, filed a lawsuit against the state on Tuesday alleging it illegally cut their Medicaid coverage without proper notice or a pre-termination hearing.
- The plaintiffs, which are being represented by two consumer advocacy groups, are asking the court to restore Medicaid coverage to those who lost benefits due to deficient termination notices, and to forbid the state from continuing redeterminations until it fixes the current notification process.
Dive Insight:
Florida has pursued one of the more aggressive redetermination plans compared with other states, removing more than 408,000 people from its Medicaid rolls to date, according to a KFF tracker. More than half of those who lost coverage in the state were removed from the safety-net program for procedural reasons such as paperwork errors, instead of actual ineligibility.
The Florida Health Justice Project and the National Health Law Program filed the suit on behalf of three Floridians in the U.S. District Court for the Middle District of Florida.
The suit, which seeks class action status, was filed against the state’s Agency for Health Care Administration and the Department of Children and Families.
It argues that Florida violated federal law by failing to sufficiently inform enrollees that their coverage was in danger of ending and not giving them information on how to appeal. The faulty notices resulted in beneficiaries losing coverage “without meaningful and adequate” notification, the lawsuit says.
“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, in a Tuesday statement. “Nevertheless, the State continues to use them.”
State officials disputed the allegations, with the Florida Department of Children and Families calling the lawsuit “baseless” in a statement provided to Healthcare Dive.
“While the State cannot comment on pending litigation, we offer the following indisputable facts: Our letters to recipients are legally sufficient," the statement says. "In fact, CMS 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.”
States could resume enrollment checks for Medicaid as early as April after a three-year pause during the COVID-19 pandemic.
Regulators, Democrat lawmakers and patient advocates have expressed alarm over the high level of procedural terminations, which account for roughly three-fourths of all terminations nationwide, according to KFF.
The HHS has intervened to try and prevent procedural cuts, pausing Medicaid checks in states that don’t comply with renewal requirements and releasing policy flexibilities earlier this year that include allowing managed care plans to help beneficiaries complete renewal forms.
Florida is the only state that has not taken advantage of those flexibilities, according to the CMS.
