Florida Medicaid ‘rewind’ lawsuit alleges state’s conduct was inappropriate : Shots

Jason Wajda is the director of the Florida Department of Health Administration named in the lawsuit.

Phil Sears/Associated Press

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Phil Sears/Associated Press

Jason Wajda is the director of the Florida Department of Health Administration named in the lawsuit.

Phil Sears/Associated Press

A toddler with cystic fibrosis in Jacksonville, Fla., forgot to take his medicine for several weeks after he and his mother were cut off from Medicaid.

In Miami-Dade County, a 1-year-old child did not receive routine immunizations. Her mother was called the day before the appointment to inform her that her checkup had been canceled because the child did not have insurance.

The two children and their parents are suing the state of Florida for terminating Medicaid coverage without proper notice or an opportunity to challenge the state agency’s decision.

The lawsuit was filed Tuesday in federal district court in Jacksonville by the Florida Health Justice Project and the National Health Law Program, and the complaint was shared exclusively with NPR.

Lawyers for the plaintiffs believe it’s the first lawsuit of its kind since the Medicaid “rollback” began in April. The complaint alleges plaintiffs’ due process rights were violated and directs state Medicaid agencies to suspend deenrollment of Florida residents “until timely and legally appropriate notice of termination is provided to Florida residents.” I am asking the court to

Millions paid out of Medicaid, mostly for paperwork reasons

During the three years of the COVID-19 pandemic, no one needed any renewals to stay on Medicaid. Now that protection has ended and states are evaluating the eligibility of everyone on the roster.

So far, more than 5.2 million people have lost Medicaid nationwide, according to reports from 45 states and the District of Columbia analyzed by health research firm KFF. And, according to the KFF, on average he loses insurance 74% of the time, not because he’s actually ineligible, but because of paperwork.

KFF’s Jennifer Tolbert said more than 400,000 Floridians have lost coverage so far, partly reflecting the size of the program in the country’s third most populous state. pointed out. “Interestingly, however, Florida’s eviction rate is 31%, which is below the overall average of 38%,” says Tolbert.

She added that many of Florida’s Medicaid recipients are children and low-income parents because Florida is one of the few remaining states that has not expanded Medicaid.

The Florida Department of Children and Families sent a leaflet to NPR advertising that the state “continues to lead the redetermination.” So far, 1.9 million beneficiaries have been re-determined, with 89% having responded to the forms sent by the agency.

At the time of publication, the agency did not immediately respond to the lawsuit.

The Florida lawsuit explains how both families suing the state received highly misleading notices from Florida’s Medicaid agency. The notice is page after page with conflicting information in different sections and does not explain why the coverage was terminated or what steps families can take to challenge the decision. It wasn’t explained clearly.

For the Jacksonville family, 25-year-old Kianne DeBarry had a baby in February and was supposed to be covered for 12 months postpartum until February 2024. Her 2-year-old daughter Charlotte has cystic fibrosis. , she is “medically in need” and is therefore eligible for her insurance coverage. The Doveries recently shared their story on the Orlando Sentinel.

Vulnerable Children on Medicaid

Nearly 14 million children nationwide had special medical needs in 2019, according to KFF analysis. “It’s a category of eligibility where the state allows families to have their medical bills calculated according to their income. So even if your income is too high to qualify for Medicaid, your ongoing health care needs are covered. So on a month-to-month basis, individuals can qualify,” explains Tolbert. Florida had nearly 800,000 children with special medical needs in 2019, more than half of whom were on Medicaid.

The complaint states that when Kianne contacted state officials for clarification after receiving her Medicaid notice, she was told by a representative, “I’m not going to sit here answering questions,” and that there was a rule that said you weren’t allowed to speak. There is a record of how he was told. to you over 20 minutes. Kianne and her infant Medicaid coverage ended on May 31.

Charlotte “had lost her appetite and was constantly tired and grumpy after missing her prescription for several weeks,” the lawsuit alleges.

She also developed a persistent cough that her doctor could not see without insurance, so her parents took her to the hospital’s emergency department for treatment. According to her complaint, her $2,800 bill for her hospital visit was sent for collection.

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