Improving Access to Medicaid in Florida
Nearly two million children living in poverty in Florida face serious obstacles getting basic medical and dental care, even though federal Medicaid law requires states to provide prompt and effective treatment services. For more than a decade, we have litigated to increase access to services for these kids.
We all need access to dental and medical care in order to live healthy, productive lives that will allow us to reach our potential. That is why federal law requires states with Medicaid programs to provide prompt medical and dental service to low income children. However, too often, we know that this doesn’t happen. State Medicaid programs often fail to pay the doctors and dentists who see low income children enough to make it economically feasible for them to participate. The need is so great that those physicians who do accept Medicaid patients cannot meet all of the demand. As a result, children born into low-income families often have to wait weeks or months to access care (longer if they require a specialist), or are unable to receive care at all. With these delays and barriers to care, minor ailments can grow into serious health concerns with lifelong consequences.
In Florida, the problem is particularly severe, so in 2005, the Law Center filed a class action lawsuit on behalf of the Florida Pediatric Society and all children — currently numbering 1.9 million — enrolled in, or eligible for, Medicaid in the state. The law firm of Boies, Schiller and Flexner LLP is co-counsel on the case.
The case was tried before Judge Adalberto Jordan in the U.S. District Court for the Southern District of Florida over the course of two years and closing arguments were held in April 2012. In December 2014, Judge Jordan issued findings in our favor, ruling that the state is not meeting federal requirements in providing preventative medical care. The court and legal teams are now exploring both remedy and settlement options for this case.
- Order Approving Settlement (June 2016)
- Order Granting Motion for Preliminary Approval (April 2016)
- Plaintiffs’ Motion for Preliminary Approval of Settlement Agreement (April 2016)
- Settlement Agreement (April 2016)
- Plaintiffs’ Reply in Support of Their Motion for Leave to Take Limited Discovery Regarding Injunctive Relief (August 2015)
- Defendants’ Response in Opposition to Plaintiff’s Motion for Leave to Take Limited Discovery in Support of Request for Injunctive Relief (July 2015)
- Plaintiffs’ Motion for Leave to Take Limited Discovery in Support of Request for Injunctive Relief (July 2015)
- Plaintiffs’ Reply in Support of Proposed Declaratory Judgment (June 2015)
- Defendants’ Response to Plaintiffs’ Proposed Declaratory Judgment (May 2015)
- Order Dismissing Count II (May 2015)
- Notice of Filing [Proposed] Declaratory Judgment (May 2015)
- Defendant’s Offer of Proof (April 2015)
- Plaintiffs’ Memorandum of Law Addressing the Impact of Armstrong v. Exceptional Child Care Center, Inc. (April 2015)
- Defendants’ Memorandum of Law Addressing the Impact of Armstrong v. Exceptional Child Care Center, Inc. (April 2015)
- Plaintiff’s Offer of Proof in Support of Declaratory and Injunctive Relief (April 2015)
- Defendants’ Reply to Plaintiffs’ Opposition to Defendants’ Motion to Amend or Correct (February 2015)
- Plaintiffs’ Opposition to Defendants’ Motion to Amend or Correct (February 2015)
- Defendants’ Motion to Amend or Correct (January 2015)
- Findings of Fact and Conclusions of Law (December 2014)
- Order Denying Defendants’ Suggestion of Mootness and Motion to Reopen (November 2014)
- Defendants’ Reply in Support of Suggestion of Mootness and Motion to Reopen
- Plaintiffs’ Opposition to Defendants’ Motion to Reopen Trial Record (October 2014)
- Motion to Reopen Trial Record (October 2014)
- DCF’s Suggestion of Mootness (October 2014)
- Order Denying Suggestion of Mootness (July 2014)
- Plaintiff’s Memorandum of Law in response to status report (July 2013)
- Defendant’s Status Report (June 2013)
- Order Denying Motion to Dismiss (March 2013)
- Plaintiff’s Memorandum of Law in response to mootness issue (March 2013)
- Defendants’ Memorandum of Law in response to mootness issue (March 2013)
- Plaintiff’s Proposed Findings of Fact and Conclusions of Law (March 2012)
- Defendant’s Proposed Findings of Fact and Conclusions of Law (March 2012)
- Motion for Preliminary Injunction (March 2011)
- Orders denying the defendants’ motions for summary judgment and granting the plaintiffs’ motion for class certification (September 2009)
- Order Correcting Clerical Error In Report (July 2009)
- Report & Recommendation on Plaintiff’s Motion for Class Certification (June 2009)
- Amended Complaint (June 2007)
- Court Order Denying Defendants Motion for Reconsideration & Clarification (April 2007)
- Court Order Denying Defendants Motion to Dismiss (January 2007)
Settlement on Behalf of 2 Million Kids in Florida Approved
Judge Adelberto Jordan approved the settlement agreement in this case on June 28. The agreement provides for state agencies to make substantial improvements so that children enrolled in Medicaid can access medical and dental care throughout the state.
Settlement Agreement Reached in Florida Medicaid Case to Improve Medical and Dental Care for Florida Children
The Florida Chapter of the American Academy of Pediatrics (“FCAAP”), the Florida Academy of Pediatric Dentistry (“FAPD”), Boies Schiller & Flexner LLP and the Public Interest Law Center announce that a settlement has been reached in a 10-year-old class action suit brought on behalf of the more than two million Florida children who depend on the state’s Medicaid program for their health care.
The settlement agreement provides for the Agency for Health Care Administration (“AHCA”) and other state agencies to make substantial improvements in the access of children on Medicaid to medical and dental care throughout the state, and is designed to raise Florida to at least national norms over several years.
Key aspects of the settlement include:
- Beginning with contracts effective October 1, 2016, managed care plans will be required to offer board-certified pediatricians a reasonable opportunity to earn Medicare-equivalent reimbursement rates, which are significantly higher than Medicaid reimbursement rates, for pediatricians that meet objective measures of access and treatment for children.
- The incentive plans are designed to expand in successive years to provide opportunities to earn Medicare-equivalent rates for other providers of medical care for Medicaid children.
- AHCA commits to meet national norms by 2019 for the percentage of children on Medicaid receiving preventive care, and meeting other metrics, and AHCA commits to take additional steps to expand access to care if required.
- AHCA also agrees to a series of steps that will bring Florida’s Medicaid program up to national norms in preventive dental care and dental treatment by not later than 2021.
- The settlement provides for enhanced outreach for children eligible for but not enrolled in Medicaid and to promote use of preventive care.
- AHCA and the Department of Children and Families are required to continue to reduce administrative obstacles to receiving care.
- FCAAP and FAPD will work collaboratively and on an ongoing basis with state agencies under the settlement.
“This settlement is a significant step forward in improving access to medical care for the two million Florida children on Medicaid,” said Dr. Tommy Schechtman, president of FCAAP. “We look forward to this new collaborative relationship with Florida’s state agencies to ensure all Florida children obtain the quality health care they need and deserve.”
Dr. Louis St. Petery, past executive vice president and long-term member of FCAAP, said: “I am hopeful that today’s announcement will represent real change and will improve the health care and dental access issues that Medicaid children have been struggling with for many years.”
The FAPD’s president, Dr. Eric Berry, said: “The Academy is pleased that the mediated settlement of the lawsuit will create an opportunity for improved access for the children at highest risk for dental disease and that the hope for these improvements will not be delayed any further.”
The class action lawsuit was brought in 2005 by FCAAP, FAPD, and the parents of children on Medicaid to secure rights to medical and dental treatment under federal law. Following a 90-day trial, federal Judge Adalberto Jordan found extensive violations of federal law, including that Florida’s children on Medicaid did not receive care with reasonable promptness.
Even before Judge Jordan’s ruling on December 31, 2014, Florida had begun addressing a number of the issues identified in the lawsuit and had moved to a managed care system for Medicaid statewide. The proposed settlement is based upon utilizing efficiencies in the managed care system to generate financial savings which will be directed into further improvements in children’s medical care.
“After 10 years of litigation, we are pleased that we have been able to reach a comprehensive settlement that will substantially improve health care access and outcomes for the millions of Florida children who depend on Medicaid,” said Stuart Singer, the head of Boies, Schiller & Flexner’s Fort Lauderdale office and the lead counsel for the plaintiffs.
Ben Geffen of the Public Interest Law Center added, “Children who get high-quality health care will be healthier as adults. So today’s settlement is great news for Florida’s children and great news for keeping lifelong health care costs under control.”
A motion for court approval of the settlement will be filed shortly.
Florida Medicaid Program Not Providing Children with Federally Guaranteed Rights to Medical and Dental Care, Federal Court Finds
Federal judge found that Florida’s Medicaid program is not providing children with federally guaranteed rights to medical and dental care.
On December 31, 2014, Judge Adalberto Jordan found that Florida’s 1.9 million children who depend on the Florida Medicaid program for their medical and dental care are not receiving the care required by federal law.
In his 153-page findings of fact and conclusions of law, Judge Jordan documented the extreme failures in that state’s Medicaid system, leading to life-threatening delays or failures to provide medical and dental care, insurmountable bureaucratic hurdles faced by low income children and an enrollment system that failed to capture a quarter of a million additional eligible children
Together with Boies, Schiller & Flexner, we brought this case back in 2005 on behalf of children who depend on the Medicaid program, and by the Florida Chapter of the American Academy of Pediatrics, and the Florida Academy of Pediatric Dentistry.
Following more than 90 days of trial, the Court found that hundreds of thousands of children did not receive even one of the check-ups they need in a year, even newborns; only 60,000 of the 250,000 1- and 2-year-olds who should have received lead screenings received one, even though Florida has the 8th largest number of children with elevated blood lead levels; the state faces a “crisis” in the availability of specialists to treat children enrolled in Medicaid; and only a small fraction of the children received any dental care at all.
The Court documented the bureaucratic hurdles contributing to this systematic failure: the state unlawfully terminated tens of thousands of newborns and young children from Medicaid; it switched children to different doctors without informing their parents, or their doctors, causing delays in needed treatments and tests; and it eliminated a budget for outreach and enrollment, replacing it with an incomprehensible, 50-screen online application process.
Finally, the Court documented the extremely low—and sometimes below cost– reimbursement rates established by Florida state officials without reference to whether those rates are sufficient to secure enough doctors or dentists to serve the children enrolled in Medicaid. Relying on state Medicaid officials’ own published statements as well as expert testimony and reports, the Court found that these low rates are a significant cause of the state’s systemic failure to provide for the required medical and dental services; and that when rates are increased, the number of children who receive services also increase.
Judge Again Denies Defendants’ Motion to Dismiss for Mootness
The defendants in this case, the Secretary of the Department of Children and Families (DCF) as well as the Secretary of the Agency for Health Care Administration, have moved respectively to dismiss the claims in this lawsuit as moot and to reopen the record for liability. On November 25, 2014, District Judge Adalberto Jordan again denied these motions. While the defendants have repeatedly tried to argue that their recent modifications to the Florida Medicaid program would make it “impossible to award any meaningful relief to the plaintiffs”, Judge Jordan maintained his stance that without an inquiry and study into these new changes, there is no way yet of knowing whether they can remedy the issues brought by the plaintiffs.
Judge Finds No Aspect of Class Action Lawsuit Moot
On July 10, 2014, District Judge Adalberto Jordan from the Southern District of Florida ruled that no aspect of the Florida Pediatric Society’s case against the Secretary of the Florida Agency for Health Administration was moot.
The Law Center originally filed the class lawsuit on behalf of the Florida Pediatric Society in 2005. The lawsuit alleges that the Florida’s Medicaid program violates federal Medicaid requirements since it does offer sufficient health and dental care to children.
Judge Jordan’s most recent decision comes in response to the defendant’s assertion that the lawsuit is moot because reimbursements and the new privatized manage care system that starts in August will allow those in the program achieve relief.
However, Judge Jordan did not rule against the defendants since he found that the amendments to the Medicaid system cannot guarantee a solution to all its deficiencies. He wrote in his order that “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. 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 Law Center is still waiting for a final ruling which is expected by October of 2014.
Federal Judge Declines to Dismiss Lawsuit
Judge Adalberto Jordan declined to dismiss the lawsuit against the State of Florida that argues its Medicaid program has failed to provide adequate health and dental care to children and in doing so is in violation of federal Medicaid requirements. The court previously requested briefs from both sides in 2013.
The Law Center originally filed the class action lawsuit on behalf of the Florida Pediatric Society and all children — currently numbering about 2 million — enrolled in or eligible for Medicaid in the state back in 2005. According to the Associated Press, the Judge plans on making a final ruling in October 2014.
The state contends that the privatization of the Medicaid program will increase access and amend the other numerous barriers to healthcare, such as reimbursement rates. However, Judge Jordan decided that these potential improvements and the uncertainties still surrounding how privatization will work do not provide a sufficient cause to dismiss the case.
Court Requests Briefs and Denies Partial Motion to Dismiss (2013)
The court recently requested briefs from both sides examining the issue of mootness of the case. This request was based on mandates under the Affordable Care Act (ACA) that require Florida to raise reimbursement rates to certain primary care physicians in 2013 and 2014. The Defendants argued that these mandates moot the case, while the Law Center’s brief argued that this temporary increase in reimbursement rates does not guarantee rates will remain at an appropriate level in 2015 or beyond, nor do these increases apply to all providers. Following the submission of the briefs, Judge Jordan denied the Defendants’ partial motion to dismiss, which was submitted with their brief. The Law Center now awaits final judgment from the court.
Press Coverage of the Court Order
After 100 Days over 3 Years, Trial Comes to a Close
Testimony began in our Florida Medicaid litigation on December 7, 2009, and following an extremely complex and intensive trial, the parties in our Florida Medicaid case have rested and now await a ruling from Judge Jordan.
The plaintiffs and defendants submitted their Proposed Findings of Fact and Conclusions of Law in March, 2012, and closing arguments were held in April. (Read coverage of the closing arguments here.)
The Law Center is awaiting the decision.
Plaintiffs File for Preliminary Injunction
In March of 2011, the Law Center filed a motion for preliminary injunction on behalf of the plaintiffs, asking the court to compel Florida’s Medicaid program to raise its reimbursement rates to a level that would ensure Florida children enrolled in Medicaid can access care through the rest of the trial.
The motion followed testimony from senior Medicaid officials confirming that reimbursement rates paid to dentists have only been increased 13% in the last 24 years, though dentists’ costs have increased by over 50%. The motion points out clear evidence that the low fees paid to physicians and dentists have left hundreds of thousands of children without adequate or timely care, causing irreparable harm to the children.
Class Certified, Motion for Summary Judgment Denied
In September of 2009, Judge Jordan awarded class status to children who are enrolled in Medicaid along with those who are eligible but not yet enrolled. In doing so, he also denied the defendants’ motion for summary judgment, moving the lawsuit a step closer to trial.
The judge held that the law in the Eleventh Circuit requires states that receive Medicaid funding not simply to reimburse doctors and dentists, but to set rates high enough to ensure that medical and dental care are actually promptly provided to children – at that time a contentious point in Medicaid law.
Court Recommends Class Certification (June 2009)
In June 2009, a Magistrate Judge recommended that the suit be allowed to proceed as a class action, on behalf of not only the Law Center’s clients but also all children either enrolled in Medicaid or eligible for Medicaid. As of 2011, the class includes nearly two million children.
Florida state officials argued that the proposed class was too broad and faced different types of problems, and that a lawsuit on behalf of the class therefore could not successfully address the violations alleged in the complaint. The Court disagreed, finding that the breadth of the harms alleged in the lawsuit would require relief for all.
Court Rejects Motion to Dismiss (2007)
In January of 2007, the district court denied the defendants’ motions to dismiss, holding that the Law Center’s clients have the right to sue under Medicaid law. The defendants argued that the language of the statute did not grant private parties the right to enforce its provisions but failed to persuade the judge. On April 24, 2007, the court denied Defendants’ Motion for Reconsideration and to Certify Issues for Immediately Appeal on the same grounds.
Lawsuit is Filed on Behalf of Children Reliant on Medicaid for Care (November 2005)
The lawsuit was filed in November, 2005, on behalf of the Florida Pediatric Society and twelve children, representing a class of low-income children and families who have faced gross inadequacies in access to healthcare as a result of low fees paid to doctors and dentists who participate in Florida’s Medicaid program.
In the year prior to filing, 44% of eligible children received no health care check-ups and 75% received no dental examinations. More than 500,000 enrolled Florida children received no preventive health care services at all.