Trial begins in case to force Florida to reinstate Medicaid patients who lost coverage

A trial with sweeping implications for Florida’s government healthcare system is set to begin Thursday in a federal, class-action lawsuit filed by Medicaid patients who say they were illegally cut off from their healthcare by the state.

At issue is whether the state has been violating patients’ constitutional rights to due process and to a fair hearing under the federal Medicaid Act when notifying them that they are no longer eligible for the government-subsidized health insurance program. Florida has purged more than 1.8 million patients from its Medicaid rolls since April of last year, though the case centers on only those who lost coverage because they were determined to be ineligible due to their incomes exceeding Florida’s strict limits.

The case is being brought by three children and two adults who say the standardized notices they received from the state failed to adequately explain why they were being cut from Medicaid and didn’t offer them a fair chance to prove they were still eligible before their coverage was terminated. They are asking a judge to automatically reinstate all Medicaid patients who improperly lost their coverage since the federal government lifted a pandemic-related hold last April that blocked states from kicking patients off Medicaid — a process known as the “unwind” — and force the state to reissue their determinations in a way that would pass muster.

“We know that people who receive Medicaid in Florida have historically struggled with bureaucratic issues when it comes to renewing their coverage. Unfortunately, many of these issues were exacerbated during the Medicaid Unwind process,” Erica Li, a health policy analyst with the Florida Policy Institute, said in a statement.

Li said Medicaid notices “are difficult to understand, don’t always reach the recipient on time, and then individuals struggle to receive the proper help.”

“This lawsuit reflects the stories of Floridians who have lost coverage because of this,” said Li. “And it is a big deal due to its ability to potentially hold the state agencies accountable in the wake of massive coverage loss over the last year.”

The Agency for Health Care Administration administers the Medicaid program in Florida, and the Department of Children and Families has been reviewing patients’ eligibility. The secretaries for this state agency and state department are being sued in their official capacities.

Attorneys for the plaintiffs declined to comment. The deputy chief of staff for the Florida Department of Children and Families said the department “does not discuss pending litigation or disclose details of any specific individual’s case.”

In its answer to the plaintiffs’ complaint, the state acknowledged it uses “uniform language” in issuing coverage termination notices to Medicaid enrollees but otherwise denied the allegations.

The outcome of the case has implications for hundreds of thousands of patients booted from Medicaid by the state over the last year. If the judge rules in favor of the plaintiffs, patients who have been deemed ineligible for exceeding Florida’s strict income requirements since federal COVID-related protections ended last spring could be reinstated, at least temporarily.

Because Florida is one of just 10 states that have declined to expand Medicaid to its working poor, the program mostly serves pregnant women, children and the medically complex or disabled.

Still, the COVID-related protections allowed the program to swell during the pandemic, in part by allowing potentially ineligible patients to remain on the rolls due to the federal COVID-protections.

Between March 2020 and November 2022, Florida’s Medicaid program increased from 3.8 million enrollees to 5.5 million, according to the judge’s order establishing the lawsuit’s classes.

Last April, the state began terminating Medicaid coverage for patients through the “unwind.” Florida cut more than 1.8 million people during that process as of March, according to the nonprofit, nonpartisan health policy group, KFF.

The majority of these patients were dropped for procedural or red-tape reasons, and may still be eligible for Medicaid. But more than 650,000 of these patients lost their coverage because they were determined to be ineligible, per KFF. A subset of these patients is at the center of the lawsuit.

This is the only lawsuit in the nation to date related to the Medicaid unwind, the National Health Law Program told the Herald/Times back in May when the case was previously scheduled to go to trial.

Joan Alker, the executive director for the Georgetown Center for Children and Families, said that if the judge orders Florida to fix its Medicaid termination notices, it will “help families trying to retain their coverage in the future.”

“The case is a very important one because it exposes deficiencies in the state’s process that predated unwinding,” said Alker.

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