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Legal Aid Groups File Lawsuit Against Florida Medicaid

Aug 20, 2019

Several civil legal aid organizations in Florida have filed a federal class action lawsuit against the agencies that operate the state's Medicaid system.

Jacksonville Area Legal Aid, Disability Rights Florida, the Florida Health Justice Project and the National Center for Law and Economic Justice filed the suit, which accuses the state Agency for Health Care Administration and Department of Children and Families of “improperly terminating coverage of those whose eligibility originally stemmed from their qualification for federal disability benefits or their adoption through the state’s dependency system.”

Read the complaint here.

The organizations say the lawsuit is an effort to force AHCA and DCF to stop wrongfully denying Medicaid coverage to class members until their eligibility has been properly determined under all eligibility categories and until they have been properly notified.

From the complaint:

“Federal law requires state Medicaid agencies to continue to provide coverage until a beneficiary has been determined to be ineligible under all eligibility categories. Additionally, the Florida Department of Children and Families has to provide an opportunity for a fair hearing to anyone whose claim is denied. Furthermore, the agency must provide written notice of the right to a hearing at least 10 days before Medicaid is terminated.”

"That ex parte process does not happen. And the individual's then terminated from Medicaid and often they lose their Medicaid services,” said Amanda Heystek, director of systems reform for Disability Rights Florida.

“Medicaid services, especially home and community-based services, are a critical factor in keeping individuals with disabilities healthy and safe in their own homes,” Heystek said. “Ensuring the continued eligibility for these services is vital to their well-being.”

One of two named plaintiffs, Lakeland resident Austin Trueblood, 31, has Down syndrome. His benefits were cut when the Social Security Administration approved his application for Disabled Adult Child (DAC) benefits, which made him ineligible for the Supplemental Security Income that had originally qualified him for Florida Medicaid.

The suit claims if DCF conducted a federally mandated review prior to cutting his Medicaid benefits, the agency would have discovered that Trueblood remained eligible for Medicaid based on his DAC benefits.

A 2018 State of Florida Auditor General report showed that as of November 2017, DCF had not conducted a timely review of 650,131 data exchanges and that “the risk that eligible individuals may not timely receive benefits and ineligible individuals may receive benefits is increased when data exchange responses are deleted or are not timely reviewed and processed.”

This was not the first time DCF had been warned about reviewing this information.  

"So whether it's a lack of caring, whether it's a shortage of staff, whether it's a technological issue, whether it's an effort issue, whether ever the barrier is it still exists, and it's not being done, and it needs to be done. And it's required to be done by federal law,” Heystek said.

Heysteck added it’s difficult to know at this how many individuals are affected, but they intend to find out through the discovery process.

An Agency for Health Care Administration official said they don't comment on pending litigation. The Department of Children and Families has not responded to requests for comment.