Legal aid groups are suing the Florida Agency for Health Care Administration (AHCA), accusing the agency of failing to manage critical home-care services for plaintiffs suffering from conditions such as quadriplegia and Alzheimer’s disease.
The Gainesville-based Southern Legal Counsel, Legal Services of Greater Miami and pro bono attorney Nancy Wright filed the federal lawsuit on Sept. 23 in the Northern District of Florida. The complaint was filed on behalf of five plaintiffs, aged 22 to 84, alleging that the AHCA violated the plaintiffs’ constitutional rights, the Medicaid Act, Americans With Disabilities Act and a section of the Rehabilitation Act of 1973.
The plaintiffs and their home-based caregivers have experienced systemic reductions or denials of critical care services, as well as misleading notices, inaccurate health assessments and tactics that keep them in the dark about service changes, according to the lawsuit.
The focus of the litigation is the AHCA’s management of what’s called the Medicaid Long-Term Care (LTC) Waiver Program. The Florida agency contracts with managed care plans to provide community- and home-based health care services to those with disabilities. The plans have unilaterally acted in ways that shift more of the care-giving burden for disabled patients to family members without providing families meaningful ways to appeal these decisions, according to the lawsuit.
“Plaintiffs have been harmed by AHCA’s failure to require that plans provide them with adequate and timely written notice of denial, reduction or termination of services and other information needed to meaningfully challenge plan decisions,” the complaint states. “... Whether by AHCA’s lack of oversight or, in certain instances, approval of plan practices that ignore the actual care needs of plaintiffs, plans are allowed to make arbitrary decisions to deny or reduce critical services needed to safely maintain plaintiffs in their homes.”
None of the managed care plans is a defendant in the litigation. Only Jason Weida, in his position as AHCA secretary, is listed as a defendant. The plaintiffs’ legal team decided that the AHCA would be the defendant because it is the state agency with the ultimate control over operation of the LTC Waiver, according to attorney Wright.
“While the managed care plans act as gatekeepers for services under the LTC Waiver, it is accomplished through detailed contracts with AHCA,” she told the Florida Record in an email. “AHCA is required to oversee the plans and monitor their performance and compliance with federal and state laws. In this case, we believe that AHCA has not only failed its responsibility in oversight of the plans but is also approving plan actions that violate state and federal authority.”
The AHCA did not respond to a request for comment on the lawsuit.
The administration of the waiver was beset by a “lack of information, misinformation and slight of hand,” according to Wright.
One plaintiff has a rare genetic disorder and other complications, and his personal care services were reduced from 84 hours per week to 48 hours, even though he is facing increasing care needs. The plaintiff’s health assessments were eventually found to be inaccurate, according to the lawsuit.
The plaintiffs are requesting that the federal court declare the AHCA’s practices in violation of constitutional due-process provisions – that the agency’s actions place the plaintiffs at risk of unnecessary institutionalization and fail to comply with fair hearing requirements under federal law. The plaintiffs are also asking the court to require the defendant to prohibit managed care plans from placing illegal limits on services and put in place a process of fair hearings for the disabled.