Florida health agency sued over alleged illegal Medicaid terminations

Two Florida families have filed a class-action lawsuit against a state health agency, alleging that low-income individuals are losing Medicaid coverage and don’t know how to challenge the decisions.

In three months, more than 182,000 Florida residents have been issued notices saying they are no longer eligible for coverage, with hundreds of thousands of cases to still be reviewed, according to a press release. The class-action suit said that residents kicked off Medicaid never received “adequate individualized written notice” of the reason.

The lawsuit (PDF), filed in the U.S. District Court in Jacksonville by the Florida Health Justice Project and the National Health Law Program on behalf of three plaintiffs, alleges that Florida began redetermining eligibility for Medicaid members on March 1, almost a full month before federal legislation said they were allowed.

Unwinding is expected to be complete by May 2024.

“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, a senior attorney at the National Health Law Program. “Nevertheless, the state continues to use them. The people receiving these notices do not understand the action the state has taken or what to do next. This leaves many of them without coverage for critical care including prescriptions, vaccinations, and postpartum care.”

Medicaid members are sent standardized “reason codes” with vague descriptions for termination. A case study from 2018 from the State Health Access Data Assistance Center showed that the agency is aware these notices are confusing for members. ­

When Chianne D., a plaintiff of the case, received her notice in the mail, she said she called an agent with the health agency. The agent told her, “I’m not going to sit here and answer your questions,” she alleges.

Chianne said that if she was able to understand her two-year-old’s child coverage, she would have submitted an appeal on the child’s behalf. In the following weeks without Medicaid coverage, the family missed prescription drugs, did not attend daycare and had to cancel a doctor’s appointment. The child needed to go to the emergency room because her primary care provider would not see them without insurance. This caused excess financial burden, the family said.

"As long-time advocates, we know that low-income individuals and families in Florida struggle against sometimes insurmountable barriers to healthcare," said Miriam Harmatz, director of advocacy and founder of the Florida Health Justice Project, in a statement. "It is critical that people who have had Medicaid throughout the COVID-19 pandemic understand why DCF thinks they are no longer eligible and how to challenge their termination if it's incorrect. The current notices are incomprehensible to most recipients, and we hope that this lawsuit brings immediate relief to those who have been deprived of their due process rights."

Nearly 4 million people have been cut from Medicaid since states began to reviewing enrolled members following the end of pandemic-era protections. Attorneys for the case said they believe it is the first lawsuit of its kind.