Florida Settles Long-Running Case Over Children's Medicaid

A decade-old class-action lawsuit brought on behalf of 2 million children who depend on Florida’s Medicaid system for care has been settled, with an agreement that agencies responsible for running the system continue to improve medical and dental care—including raising reimbursement rates to Medicare equivalents.

The settlement to the suit, brought by the Florida chapters of the American Academy of Pediatrics and the Academy of Dentistry, the Public Interest Law Center and the powerful law firm Boies Schiller & Flexner LLP, calls for raising the state’s healthcare standards for its poorest citizens over several years. An agreement was announced Tuesday and must be approved by the federal court where the suit was filed.

First brought in 2005, the suit charged that Florida Medicaid reimbursements were so low they fell short of federal standards and discouraged doctors from seeing patients, leaving children in harm’s way. In 2014, after a 90-day trial, a federal judge ordered the state to settle with the plaintiffs after finding it failed to create an adequate health system for children on Medicaid.

The incidents presented at trial were horrific: children who went years without seeing a doctor; 80% of the children in Medicaid had never seen a dentist; a child referred to a pulmonologist who waited more than 3 months for an appointment. One child who needed lead testing was told to go to a laboratory that was a 3-hour bus ride from home. Attorneys for the state argued at trial that Medicaid had made improvements in the years since the case was field, but the judge was unmoved.

The settlement also requires the state to pay $12 million in legal fees to the firms and parents of the families that brought the suit.

According to a statement from the plaintiffs, the settlement provides for the following:

• Board-certified physicians must have a chance to earn Medicaid-equivalent reimbursements starting October 1, 2016. This will result in an immediate boost in pay for those accept Medicaid clients and should attract more physicians to the system.
• Pay incentives will increase over time for specialists.
• The Florida Agency for Healthcare Administration, which administers Medicaid, must meet national averages for children receiving preventive care by 2019.
• AHCA must take steps to put get Florida Medicaid to national norms for preventive dental care by 2021.
• Florida must reach out and find children eligible for preventive care through Medicaid who are not receiving it and enroll them in programs. The state must get rid of administrative barriers to children and families seeking care.

“This settlement is a significant step forward in improving access to medical care for the two million Florida children on Medicaid,” said Tommy Schechtman, MD, president of the Florida chapter of the American Academy of Pediatrics. “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.”

Eric Berry, DDS, president of the Florida chapter of the American Academy of Dentistry, 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.”

In their statement, the plaintiffs acknowledged that Florida had begun making improvements which they hope will continue. “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,” the statement from the Public Interest Law Center said.