Lawsuit: Florida is illegally kicking Medicaid-eligible people off health insurance

Clayton Harrell, an 18-year-old adopted out of the state's foster-care system, has pituitary dwarfism, pseudotumor cerebri, fetal alcohol syndrome and an anxiety disorder. For years, the state has ensured he could see specialists and take the medication he needs.

But on Aug. 1, the state ended his Medicaid without informing him or his mother, according to a federal lawsuit filed Wednesday that argues Harrell, along with dozens of other clients, have been illegally removed from the state's Medicaid coverage.

The class-action lawsuit filed in Jacksonville highlights specific cases like Harrell's where Medicaid recipients were kicked off the coverage even when they shouldn't have been. In Harrell's case, he aged out of one category of Medicaid eligibility, but the state should have known he was still eligible under other categories. His lawsuit seeks to force the state to reinstate Medicaid coverage to everyone whose coverage ended illegally.

Attorney Katy Debriere of Jacksonville Area Legal Aid said the number of people who have been kicked off Medicaid inappropriately could reach into the thousands. When she started her current job in 2015, she almost immediately faced clients like Harrell, she said. Over the last four years, she's represented 10 different people who were improperly removed from Medicaid.

The Department of Children and Families said it received notice of the lawsuit Thursday afternoon and it was reviewing it before offering any comment.

The lawsuit was filed against the Department of Children and Families and the Agency for Health Care Administration on behalf of all Florida residents whose Medicaid coverage ended without the state department first determining if the residents were still eligible, without giving residents' notice or without giving them an opportunity to appeal the decision. The residents must have been eligible for Medicaid under either the Adoption Assistance Agreement or through federal disability benefits.

Harrell and his mother didn't realize his Medicaid ended until they walked into the office of his primary-care doctor, the lawsuit said, and the doctor said he no longer had health insurance.

"Had DCF conducted an ex parte review," the lawsuit said, "it would have discovered that, due to age, household income, and disability, Clayton continues to be eligible for Medicaid under other Medicaid categories, including SSI and Family Related Medicaid; DCF would have assigned Clayton to the appropriate Medicaid category or requested additional information to complete a redetermination of his Medicaid eligibility."

The lawsuit said children with disabilities who were adopted through the state's foster care system would have Medicaid until they became an adult, when they should have continued having Medicaid due to their qualification for federal disability benefits. Similarly, those who received federal disability benefits but then had those benefits cut off shouldn't have had their Medicaid cut off until the state's Department of Children and Families reviewed their eligibility under other categories of Medicaid.

The lawyers who filed the lawsuit, from Disability Rights Florida, Jacksonville Area Legal Aid and the National Center for Law and Economic Justice, said they've had "at least 30 individuals" contact them about having their Medicaid cut off without a review of their eligibility. "However, the legal services organizations of undersigned counsel rely on individuals contacting them and it is unknown how many individuals are not aware of their services but may nonetheless be impacted by Defendants' failures," the lawsuit says.

While those law firms have filed suit reacting to people who they learned were removed from Medicaid, the class-action suit seeks to be a pro-active way of ensuring others, even those who didn't realize they were removed improperly, can get their Medicaid coverage back.

According to the law, the state's Department of Children and Families, which is tasked with determining Medicaid eligibility, is only supposed to kick someone off Medicaid after the agency determines if that person is ineligible under all eligibility categories. The department hasn't been doing that, according to the lawsuit.

The lawsuit also cited a 2018 state Auditor General report citing a lack of staffing needed to process data used to determine Medicaid eligibility. The report warned that DCF ran the "risk that eligible individuals may not timely receive benefits." The department told the auditor that the backlog was due to the amount of work being larger than the staff could handle.

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