A lawsuit against the state alleges that its processes for conducting Medicaid eligibility reviews are potentially harming people who are eligible but lose coverage.
Three Floridians sued the Florida Agency for Health Care Administration and the Florida Department of Children and Families with the assistance of the Florida Health Justice Project in federal court alleging their Medicaid coverage was improperly terminated.
“Without Medicaid coverage, Plaintiffs are unable to obtain care they need, including prescription drugs, children’s vaccinations, and post-partum care,” the complaint states. “Absent this court’s intervention, improper terminations will continue for the foreseeable future.”
Plaintiffs seek preliminary and permanent declaratory and injunctive relief to ensure that Floridians enrolled in Medicaid are provided with a pre-termination hearing and adequate notice.
Counts in the complaint, filed in the Middle District of Florida on Aug. 22, include violations of due process under the U.S. Constitution and of the Medicaid Act.
"The danger is that the state system is not going to be able to effectively prevent eligible people from losing coverage because mistakes are going to be made," said Sarah Grusin, National Health Law Program senior attorney. "People who should remain eligible won't understand the reason for termination and won't be able to challenge it and will just lose coverage."
The National Health Law Program is listed as an attorney on the complaint.
Under the first count, the plaintiffs accuse the state of violating their due process rights by depriving them of their property, including Medicaid benefits.
“The U.S. Constitution says individuals who are losing critical benefits like Medicaid have a right to a hearing before they lose their coverage to present any objection and what we're saying is the notices don't enable people to understand whether the state is even terminating their coverage,” Grusin told the Florida Record. “Some of the reasons that the state gives sound like you still have coverage and even if they can understand they're losing coverage, they don't know why.”
The second count states that the Medicaid Act requires state programs to provide for fair hearings in advance of denial and with reasonable promptness.
“The law and the facts are clear that notices must be provided of adequate explanation for the reason the state finds the person ineligible, and Florida's are clearly not,” said Florida Health Justice Project attorney Miriam Harmatz. “People are clearly being hurt. In addition to the plaintiffs who we described in the complaint there, there are other stories.”
The state has yet to respond to the suit.