Sunday, August 20, 2017

State Rebuffed in Children’s Medicaid Fight

News-Service-Florida-Logo-68x25BY | JIM SAUNDERS

THE CAPITAL, TALLAHASSEE, May 4, 2015………. A federal judge last week rejected the state’s latest attempt to end a decade-long lawsuit that contends Florida has not properly provided care to children in the Medicaid program.

Attorneys for the state pointed to a recent U.S. Supreme Court decision in an Idaho case to argue that Judge Adalberto Jordan should dismiss claims that Florida has failed to adequately provide care such as check-ups and screenings to low-income children.

But Jordan, in a brief order issued Thursday, dismissed only one of three counts in the case, which has been spearheaded by the Florida Chapter of the American Academy of Pediatrics. The dismissed count dealt with arguments that Florida has not paid adequate reimbursement rates to doctors and dentists and, as a result, has limited the amount of care available in the Medicaid program.

In a court document filed last month, plaintiffs in the case acknowledged that the Supreme Court ruling in the Idaho case required that the reimbursement-related count be dismissed. But Jordan agreed with the plaintiffs that two other counts — which include allegations such as care not being available with “reasonable promptness” and outreach to Medicaid-eligible children being inadequate — should continue forward.

Jordan, who began hearing the case as a U.S. district judge but is now an appeals-court judge, held a trial in the case in 2012 and issued a 153-page decision in December that found widespread problems in the way the Medicaid program has provided care to children. The ruling included findings about the effects of low reimbursement rates but also dealt with other issues.

The December decision set the stage for another phase in the case to determine remedies. But in the meantime, the Supreme Court ruled March 31 in the Idaho case, which involved Medicaid providers arguing that reimbursement rates were too low and seeking to force higher payments. A divided Supreme Court rejected the providers’ arguments.

In a document filed last month in the Florida case, attorneys representing the state Agency for Health Care Administration argued that the Supreme Court opinion prevents “private enforcement” of legal disputes about whether Medicaid is properly providing care. It said the U.S. Department of Health and Human Services has enforcement powers.

“The majority opinion … reflects the court’s concern that statutory provisions which require enforcement of ‘judgment-laden’ standards be appropriately enforced by the secretary of the U.S. Department of Health and Human Services (HHS) as Congress intended and not through private actions,” the state attorneys argued. “This would ensure that HHS’ ‘expertise, uniformity, widespread consultation, and resulting administrative guidance could be brought to bear on these issues.’ It would likewise avoid inconsistent interpretations of statute and avoid unintended consequences which may result.”

But attorneys for the plaintiffs wrote in a document that Jordan should move forward with the case, even though the Supreme Court decision required dismissal of the reimbursement-related count.

“This court should strongly reject defendants’ contention that (the Idaho ruling) totally upends the well-established authority authorizing judicial enforcement of beneficiaries’ rights under the Medicaid Act,” the plaintiffs’ attorneys wrote.


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