Consumer / Employer, Payers, Legal

Floridians Sue Florida Over Medicaid Redeterminations Process

Two Florida families allege that tens of thousands of Floridians are being terminated from Medicaid coverage without sufficient information as to why. This comes as the U.S. continues the unwinding of the Medicaid continuous enrollment requirement, which stopped states from disenrolling Medicaid enrollees during the Covid-19 public health emergency.

Two families in Florida filed a class-action lawsuit against officials at the Florida Agency for Health Care Administration (AHCA) and the Florida Department of Children and Families (DCF), alleging that “tens of thousands of Floridians” are being terminated from Medicaid coverage without receiving “adequate individualized written notice.”

During the Covid-19 public health emergency, the continuous enrollment provision was in place, barring states from disenrolling Medicaid enrollees in exchange for enhanced federal funding. This provision ended March 31, and now states are resuming the redetermination process, in which they determine if enrollees are still eligible for Medicaid coverage.

The lawsuit was filed Tuesday in the U.S. District Court of Jacksonville against Jason Weida, secretary of the AHCA, and Shevaun Harris, secretary of DCF. It was filed by the Florida Health Justice Project and the National Health Law Program on behalf of three plaintiffs: Chianne D., a 25-year-old resident of Jacksonville, Florida; C.D., a two-year-old who has cystic fibrosis and is the daughter of Chianne D.; and A.V., a one-year-old resident of Miami Dade County. The full names were not disclosed in the lawsuit.

The lawsuit alleges that notices sent to Medicaid members informing them that their coverage is being terminated “routinely fail to include … the legal or factual basis for the agency’s decision. Instead, the notices use a set of standardized ‘reason codes’ many of which provide little or no explanation of the actual reason for the agency’s decision.”

Both Chianne D. and C.D. were previously enrolled in Medicaid, and the family received a 12-page notice from DCF in April stating that their coverage would be terminated May 31. The reason given was that they are “receiving the same type of assistance from another program.”

“Plaintiff Chianne D. was utterly confused by the notice,” the lawsuit states. “She did not understand what action DCF was taking or why. As a result, Chianne was unable to prepare a response to the proposed termination of coverage.”

Chianne D. contacted DCF about the notice, in which case a representative told her “I’m not going to sit here and answer your questions” and “I have a rule that says I cannot talk to you for over 20 minutes.” The plaintiffs’ coverage ultimately ended May 31, and C.D. had to go without necessary medical care, including weeks of prescription medications. Since then, Chianne D’s daughter was enrolled in CHIP, but Chianne D. herself is still lacking coverage.

Plaintiff A.V. and her mother had a similar experience. A.V. was scheduled for a vaccination on June 6, but according to the lawsuit, her mother received a call from A.V.’s pediatrician beforehand stating that she was no longer insured. A.V.’s mother then read an 8-page notice from DCF dated May 16, which stated that A.V.’s coverage was ending on May 31. It gave the reasoning of “you or a member(s) of your household remain eligible for Medicaid under a different Medicaid coverage group,” but the mother did not understand what this meant.

“She thought that A.V. should still be on Medicaid because the notice stated that she was in a ‘different Medicaid coverage group,’ and she believed that A.V. was still eligible for Medicaid because she is only one-year old,” the lawsuit said. “Also, based on her prior experience with Medicaid, she thought that it could mean that her daughter was being transferred to a new Medicaid managed care plan.”

A.V. is still without coverage, according to the lawsuit.

Bailey Smith, communications director of AHCA, called the lawsuit “baseless” in an email to MedCity News. Smith said that the organization cannot comment on the pending litigation, but added that its “letters to recipients are legally sufficient. 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.”

So far, more than 5.2 million people have been disenrolled from Medicaid coverage, according to KFF. In Florida, 408,000 people have been disenrolled.

Photo: AndreyPopov, Getty Images