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Florida Tries Again to End Decade-Old Lawsuit Calling State’s Children’s Health Care Inadequate

| October 27, 2014

Florida wants to put a happy face on its Medicaid coverage of children's health.

Florida wants to put a happy face on its Medicaid coverage of children’s health.

Pointing to a new managed-care system and changes stemming from the Affordable Care Act, attorneys for the state are asking a federal judge to dig back into whether Florida properly provides care to children in the Medicaid program.


The Agency for Health Care Administration, the Department of Health and the Department of Children and Families last week filed court documents asking federal judge Adalberto Jordan to consider new evidence in a nearly decade-old case that centers on the adequacy of care provided to low-income children through Medicaid.

Jordan has not ruled in the case, which was filed in 2005 and has been spearheaded by the Florida Pediatric Society. But the court documents filed last week indicate that Jordan could issue his findings soon.

In two motions filed Thursday, the state agencies contend that the Medicaid program has undergone significant changes since evidence was presented in 2012. In part, that is because the state this year finished putting in place a new system that requires almost all Medicaid beneficiaries to enroll in HMOs or other types of managed-care plans.

In one of the motions, the Agency for Health Care Administration and the Department of Health argued that managed-care plans are required to have adequate networks of physicians and other types of service providers.

In the past, a longstanding complaint about the Medicaid program was that beneficiaries often had problems finding health-care providers, such as specialists, who would treat them. A key issue in the lawsuit is whether care has been hampered by low Medicaid payment rates to physicians.

“Since the trial there have been a multitude of significant changes to the Florida Medicaid service delivery system that affect the issues in this case, and that render the existing record on liability stale,” attorneys for the two agencies wrote in the motion.

But in July, Jordan rejected a request by the state to declare the case moot — a request that focused, in part, on the shift to statewide managed care. At the time, Jordan wrote that the managed-care system would not be in “full swing” until Oct. 1.

“At this time nobody knows whether or not the new managed care system will alleviate or solve the issues that the plaintiffs have been complaining about for years,” Jordan wrote. “Without a developed factual record on how the managed care system is working (or not working), it is impossible to declare any part of this case moot.”

The new motion by AHCA and the Department of Health asked that the case be reopened to provide more evidence, not that the case be determined moot.

But the Department of Children and Families raised the possibility that part of the lawsuit could be declared moot. That part deals with the department’s determination of Medicaid eligibility for children.

The department cited a new computer system and other changes that were an outgrowth of the federal Affordable Care Act, better known as Obamacare. While Gov. Rick Scott and the Republican-controlled Legislature opposed the controversial health law, the department said in last week’s motion that the state has made important changes in how Medicaid eligibility determinations are performed and that the changes were “driven largely” by the federal measure.

–Jim Saunders, News Service of Florida

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