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Health News Florida

Advocates Sue AHCA Over Medicaid Records

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Advocates say redaction fees make it difficult for Medicaid recipients to access records that could help them with benefits appeals.

Attorneys are suing Florida's Agency for Health Care Administration to make it easier to access records about Medicaid hearings.

When Medicaid benefits are denied, terminated or reduced, those affected can appeal in what's known as a Fair Hearing. This lawsuit asks the state to publish final decisions from those hearings online.

Right now plaintiff Nancy Wright, who advocates for Medicaid recipients, said people have to request the records and pay redaction fees. The attorney said seeing the earlier decisions helps people figure out how AHCA decides to approve or reject appeals.

“If you look at a final order and the hearing officer says, ‘It’s important to have a letter from your doctor,’ you're going to get a letter from your doctor,” Wright explained. “It's making things more transparent for a program that's very complicated and hard to understand.”

Katy DeBriere with the Florida Health Justice Project, which filed the suit on Wright's behalf, said the current fees also make it difficult for many of the low-income people who need Medicaid to obtain this information.

She said publicizing the records could also help the community ensure whether the agency is applying the rules fairly.

“Having access to these decisions is one way in which those who are Medicaid-enrolled and Medicaid practitioners can ensure they understand how the agency applies the policy and exactly what the rules of the game are,” she said.

The complaint asks AHCA to publish Fair Hearing decisions on the Florida Division of Administrative Hearings website for free.

The state requires many similar records to be published on that site, but DeBriere said AHCA has argued in the past that these Medicaid records are exempt.

After requesting an extension ahead of the holidays, the agency now has until January 14 to respond.

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